Gingival Overgrowth
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Questions and Answers

What is the primary aim of the lecture on gingival overgrowth?

  • To explore surgical methods of treatment
  • To raise awareness of the condition and its management (correct)
  • To discuss the history of gingival diseases
  • To classify types of oral surgeries

Where does gingival overgrowth typically occur?

  • In edentulous spaces only
  • In areas where teeth are present (correct)
  • In areas without teeth
  • In the soft palate region

What is a characteristic feature of gingival overgrowth?

  • It is chronic and increases slowly (correct)
  • It occurs rapidly
  • It is often associated with acute pain
  • It is primarily observed in the palate

What happens to gingival overgrowth after discontinuation of the causative drug?

<p>It disappears spontaneously (D)</p> Signup and view all the answers

Which of the following is a management approach for patients with gingival overgrowth?

<p>Surgical removal of overgrowth (C)</p> Signup and view all the answers

What is a potential consequence of untreated gingival overgrowth?

<p>Impact on oral health and patient well-being (C)</p> Signup and view all the answers

Which aspect is crucial for managing patients with gingival overgrowth?

<p>Evaluating the potential causative factors (B)</p> Signup and view all the answers

What is the difference between overgrowth and hyperplasia in gingival conditions?

<p>They have different underlying causes and implications (C)</p> Signup and view all the answers

What is the term used to describe gingival enlargement that is restricted to the interdental papillae?

<p>Papillary enlargement (C)</p> Signup and view all the answers

Which score indicates that gingival enlargement covers more than three-quarters of the tooth?

<p>Score 3 (A)</p> Signup and view all the answers

What does the acronym DIGO stand for in relation to gingival condition?

<p>Drug Induced Gingival Overgrowth (B)</p> Signup and view all the answers

What factor exacerbates Drug Induced Gingival Overgrowth in patients?

<p>Genetic predisposition (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of the gingival enlargement classification?

<p>Papillary enlargement affects both the tooth surface and gingival margins (C)</p> Signup and view all the answers

In what context does Drug Induced Gingival Overgrowth manifest?

<p>As a side effect of systemic drug use (D)</p> Signup and view all the answers

Which of the following types of enlargement involves the gingival margins, attached gingivae, and interdental papillae?

<p>Diffuse enlargement (B)</p> Signup and view all the answers

The scoring guide for gingival enlargement allows for monitoring of what aspect of the condition?

<p>Progression or reduction of the condition (C)</p> Signup and view all the answers

What is the main distinction between hyperplasia and hypertrophy in terms of cellular changes?

<p>Hyperplasia involves an increase in the number of individual cells, whereas hypertrophy refers to an increase in cell size. (D)</p> Signup and view all the answers

Which of the following describes fibrotic changes in gingival tissue?

<p>An increase in the number of cells, specifically collagenous tissue. (D)</p> Signup and view all the answers

What defines oedema in the context of gingival enlargement?

<p>A collection of fluid in the intercellular spaces. (A)</p> Signup and view all the answers

How can gingival enlargement be classified based on location?

<p>Localized, generalized, and marginal. (C)</p> Signup and view all the answers

Which type of gingival enlargement is characterized by involvement of the gingiva throughout the mouth?

<p>Generalized enlargement. (D)</p> Signup and view all the answers

Which of the following accurately describes false enlargement in the gingiva?

<p>An appearance of enlargement without any tissue change. (B)</p> Signup and view all the answers

What is the relationship between systemic diseases and gingival enlargement?

<p>Certain systemic diseases can contribute to gingival enlargement. (A)</p> Signup and view all the answers

What histological analysis is required to accurately classify gingival enlargement?

<p>Examination of tissue samples to distinguish between hyperplasia and hypertrophy. (D)</p> Signup and view all the answers

Which drug group is primarily associated with drug-induced gingival overgrowth (DIGO)?

<p>Anti Convulsants (B)</p> Signup and view all the answers

What proportion of patients taking anti-convulsants may experience DIGO?

<p>50% (B)</p> Signup and view all the answers

Which of the following is NOT considered an anti-convulsant medication?

<p>Ciclosporin (B)</p> Signup and view all the answers

What is the common occurrence timeframe for DIGO to become clinically noticeable after starting anti-convulsant medication?

<p>2 to 3 months (B)</p> Signup and view all the answers

Which immunosuppressant is noted for having the most common association with DIGO?

<p>Ciclosporin (C)</p> Signup and view all the answers

Which statement regarding Tacrolimus is accurate?

<p>It tends to cause less severe DIGO compared to Ciclosporin. (C)</p> Signup and view all the answers

Which clinical features characterize gingival overgrowth caused by anti-convulsants?

<p>Involves interdental papillae (D)</p> Signup and view all the answers

When does DIGO typically reach its maximum severity in patients taking anti-convulsants?

<p>12 to 18 months (B)</p> Signup and view all the answers

What is a common consequence of using ciclosporin?

<p>Gingival overgrowth (B)</p> Signup and view all the answers

Which calcium channel blocker is noted for potentially leading to drug-induced gingival overgrowth?

<p>Amlodipine (C)</p> Signup and view all the answers

What is a characteristic of gingival overgrowth due to calcium channel blockers?

<p>Nodular/lobular morphology (C)</p> Signup and view all the answers

Which of the following medical conditions is NOT typically treated with ciclosporin?

<p>Cardiac Arrhythmia (C)</p> Signup and view all the answers

Which of the following statements is true regarding the use of calcium channel blockers?

<p>Gingival overgrowth can occur with their use. (A)</p> Signup and view all the answers

Why are immunosuppressants like ciclosporin prescribed?

<p>To prevent rejection after organ transplants. (C)</p> Signup and view all the answers

Which of the following calcium channel blockers is used to manage coronary artery spasm?

<p>Verapamil Hydrochloride (A)</p> Signup and view all the answers

In patients taking Amlodipine, where does drug-induced gingival overgrowth typically appear?

<p>In the papillary region of the gums (A)</p> Signup and view all the answers

Flashcards

What is gingival overgrowth?

Gingival overgrowth is the abnormal enlargement of the gums. It is a common condition, often related to certain medications.

What are the characteristics of gingival overgrowth?

Gingival overgrowth is usually painless and grows slowly over time.

What are the common causes of gingival overgrowth?

Gingival overgrowth is often associated with specific medications, particularly those used to prevent organ transplant rejection, control seizures, and treat high blood pressure.

How does gingival overgrowth affect oral health?

Gingival overgrowth can make it difficult to clean teeth properly, leading to plaque buildup, gingivitis, and ultimately, periodontal disease.

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What are the implications of gingival overgrowth for patients?

Gingival overgrowth can cause discomfort, difficulty chewing, and aesthetic concerns, affecting a patient's self-esteem and quality of life.

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What are the treatment options for gingival overgrowth?

The treatment for gingival overgrowth depends on the underlying cause. In many cases, discontinuing the medication or switching to a different medication can resolve the issue.

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How is gingival overgrowth managed through dental care?

If medication changes are not sufficient, oral hygiene improvements, scaling and root planing, and sometimes surgical intervention may be necessary to manage gingival overgrowth.

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How can gingival overgrowth be prevented?

Regular dental checkups and good oral hygiene are crucial for preventing and managing gingival overgrowth. Patients should inform their healthcare providers about any medications they are taking.

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Cellular Hyperplasia

An increase in the number of individual cells in a tissue.

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Cellular Hypertrophy

An increase in the size of individual cells in a tissue.

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Fibrosis

An accumulation of collagenous connective tissue.

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Oedema

An abnormally large amount of fluid in the intercellular spaces of a tissue.

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Localized Gingival Enlargement

Gingival enlargement limited to the gingiva adjacent to a single tooth or group of teeth.

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Generalized Gingival Enlargement

Gingival enlargement involving the gingiva throughout the mouth.

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Marginal Gingival Enlargement

Gingival enlargement confined to the gingival margins.

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Classifying Gingival Enlargement

Gingival enlargement that can be categorized by its location and distribution in the mouth.

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Papillary Gingival Enlargement

Gingival enlargement that is limited to the interdental papillae.

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Discrete Gingival Enlargement

Gingival enlargement that affects one isolated area, like an abscess.

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Diffuse Gingival Enlargement

Gingival enlargement that affects the entire gum, including the margins, attached gingivae and interdental papillae.

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Gingival Enlargement Scoring Guide

A scoring system used to document the severity of gingival enlargement.

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Drug-Induced Gingival Overgrowth (DIGO)

Gingival enlargement caused by drug reactions.

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What is Drug-Induced Gingival Overgrowth?

DIGO is a side effect of drug therapy, causing abnormal gum growth.

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Risk Factors for DIGO

Patients with a predisposition to certain genes, plaque, or gingivitis are more likely to develop DIGO.

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How does DIGO occur?

DIGO can occur as a side effect following the administration of systemic drugs.

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Immunosuppressant DIGO

A type of DIGO caused by immunosuppressant medications like cyclosporine, tacrolimus, and sirolimus.

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Calcium Channel Blocker DIGO

A type of DIGO caused by calcium channel blockers like amlodipine, felodipine, and nifedipine.

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Calcium Channel Blockers

A common group of medications prescribed for various cardiovascular conditions.

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Immunosuppressants

Medications that suppress the immune system to prevent organ rejection in transplant patients.

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Nodular/Lobular Morphology

A common side effect of DIGO, causing gums to become larger and bulbous, particularly near the teeth.

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Increased Bleeding Tendency

The condition of having a higher tendency to bleed than normal.

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Exacerbating Factors

Factors that exacerbate or worsen the effects of DIGO.

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Anti-Convulsants

A group of medications used to treat seizures, sometimes causing gingival overgrowth in up to 50% of patients.

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Phenytoin

A commonly used anti-convulsant medication known to cause gingival overgrowth.

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Ciclosporin

The most common immunosuppressant medication known to cause gingival overgrowth.

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Tacrolimus

Another immunosuppressant medication used in place of Ciclosporin, causing less severe gingival overgrowth.

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Labial surface

DIGO is most prominent on the front surface of the gums, often presenting as a distinct swelling.

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Gingival Overgrowth Progression

The progression of DIGO often starts with slight swelling between teeth and can eventually cover most of the tooth surface.

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Study Notes

Gingival Overgrowth

  • Gingival overgrowth is the proliferation and intensification of the gingiva.
  • It's a common clinical problem, often linked to specific medical conditions.
  • Typically, overgrowth occurs in areas with teeth, not in edentulous spaces.
  • The overgrowth is chronic and slowly increases in size.
  • It's typically pain-free.
  • Following surgical removal, it often recurs.
  • Spontaneous disappearance is possible within months after discontinuation of the causative drug.

GDC Learning Outcomes

  • The presentation includes a list of GDC learning outcomes, coded alphabetically (e.g. 1.1, 1.1.1, 1.1.2 etc).
  • Outcomes are related to gingival overgrowth.
  • No further details on specific outcomes are available.

Formative Assessment

  • Students must complete a mind map titled "The management of the patient presenting with drug-induced gingival overgrowth."
  • They must also complete a separate gingival overgrowth work assignment.
  • The completed assignments should be returned to Mrs. Watson

Aim

  • The goal of today's lecture is to raise awareness about gingival overgrowth.
  • The lecture will cover the causes and implications of this condition for clinicians.
  • It will also address how clinicians can assist patients with this issue.

Learning Outcomes

  • Identify the clinical features of gingival overgrowth.
  • Categorize the potential causes of gingival overgrowth.
  • Select appropriate assessment methods for patients with gingival overgrowth.
  • Detail the classification of gingival overgrowth and associated locations.
  • Evaluate the impact of gingival overgrowth on the oral cavity and well-being of patients.
  • Recommend potential management strategies for patients with gingival overgrowth.

Overgrowth/Enlargement V Hyperplasia

  • The terms hyperplasia and hypertrophy used in the past for gingival issues are imprecise.
  • Precise descriptions require histological (tissue) sample analysis.

Types of Enlargement

  • Fibrosis: Accumulation of collagenous connective tissue.
  • Cellular hypertrophy: Increase in the size of individual cells.
  • Cellular hyperplasia: Increase in the number of individual cells.
  • Oedema: Abnormal accumulation of fluid in intercellular spaces.

Classification of Gingival Overgrowth

  • The classification categorizes different types of gingival overgrowth.
  • Includes inflammatory, drug-induced, and neoplastic types.
  • Mentions chronic and acute conditions.

Location/Distribution of Gingival Enlargement

  • Gingival enlargement can be categorized by location or distribution in the mouth.
  • Localized: Limited to the gingiva adjacent to a tooth or group of teeth.
  • Generalized: Involves the gingiva throughout the mouth.
  • Marginal: Confined to the gingival margins.
  • Papillary: Confined to the interdental papillae.
  • Discrete: An isolated enlargement, such as an abscess.
  • Diffuse: Involves gingival margins, attached gingiva, and interdental papillae.

Scoring Guide for Gingival Enlargement

  • There exists a scoring guide for gingival enlargement.
  • This guide can be used for recording progression or reduction of the condition in patient notes.
  • The guide displays a pyramid with 0 (no enlargement), 1 (enlargement confined to interdental papilla), 2 (enlargement involving papilla and gingival margins), and 3 (enlargement covering more than ¾ of a tooth).

Drug Induced Gingival Overgrowth (DIGO)

  • DIGO is an abnormal gingival growth due to adverse drug reactions from systemic drugs.
  • It's exacerbated by genetic predispositions, plaque, and/or gingival inflammation in patients.

Drug Groups Associated with DIGO

  • Anticonvulsants, Immunosuppressants, and Calcium Channel Blockers.

Anticonvulsants and DIGO

  • Anticonvulsants are used in epilepsy treatment.
  • One year after their introduction, DIGO was documented.
  • A high percentage (up to 50%) of patients using anticonvulsants can exhibit DIGO.
  • DIGO symptoms manifest usually between 2-3 months after initiation and peak in severity around 12-18 months.
  • Specific anticonvulsant drugs associated with DIGO are Phenytoin, Ethosuximide, Sodium Valproate, Phenobarbitone, Primidone, Carbamazepine, and others.

Immunosuppressants and DIGO

  • Immunosuppressants are used for preventing transplant rejection and treating autoimmune diseases.
  • The gingival tissue appears inflamed and vasculature seems more visible.
  • Ciclosporin, Tacrolimus, and Sirolimus cause DIGO.
  • One study's results show that up to 53% of patients exhibit gingival overgrowth from ciclosporin.

Calcium Channel Blockers and DIGO

  • Calcium channel blockers treat blood pressure, angina and cardiac issues.
  • DIGO from Calcium Channel Blockers often is concentrated on the labial surface and is hyperemic, soft, with a higher bleeding tendency
  • This gingival overgrowth is typically more notable in the papillary region, extending to attached and marginal gingiva.
  • The overgrowth is commonly encountered when reviewing medical issues in patients using these drugs.
  • Relevant drug examples involve amlodipine, nifedipine, and verapamil.

Complications of DIGO

  • The presentation highlights a need for investigation into potential complications of DIGO.
  • No details on the potential complications are provided.

Exacerbating Factors for DIGO

  • Exacerbating factors that may worsen gingival overgrowth are mentioned (but the factors presented are not explained further).

Further Reading

  • A list of links to potential further information about this topic is provided.

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