Podcast
Questions and Answers
What is typically the characteristic of gingival overgrowth?
What is typically the characteristic of gingival overgrowth?
Which classification category does gingival overgrowth NOT fall into?
Which classification category does gingival overgrowth NOT fall into?
What is the expected outcome of discontinuing the drug associated with gingival overgrowth?
What is the expected outcome of discontinuing the drug associated with gingival overgrowth?
Where does gingival overgrowth most commonly occur?
Where does gingival overgrowth most commonly occur?
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What term should always be used instead of hyperplasia when discussing gingival overgrowth?
What term should always be used instead of hyperplasia when discussing gingival overgrowth?
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What is the nature of pain associated with gingival overgrowth?
What is the nature of pain associated with gingival overgrowth?
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What might happen after surgical removal of gingival overgrowth?
What might happen after surgical removal of gingival overgrowth?
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Which is a key consideration in managing patients with gingival overgrowth?
Which is a key consideration in managing patients with gingival overgrowth?
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Which drug is most commonly associated with drug-induced gingival overgrowth?
Which drug is most commonly associated with drug-induced gingival overgrowth?
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In patients taking Phenytoin, where is gingival enlargement typically observed?
In patients taking Phenytoin, where is gingival enlargement typically observed?
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What is a primary reason for prescribing immunosuppressants?
What is a primary reason for prescribing immunosuppressants?
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What percentage of renal transplant patients on Ciclosporin may experience gingival overgrowth?
What percentage of renal transplant patients on Ciclosporin may experience gingival overgrowth?
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What should dental therapists do if a patient is experiencing gingival overgrowth while on anticonvulsants?
What should dental therapists do if a patient is experiencing gingival overgrowth while on anticonvulsants?
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Which of the following is NOT a condition associated with the use of anticonvulsants?
Which of the following is NOT a condition associated with the use of anticonvulsants?
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What characteristic does the gingiva exhibit in patients on immunosuppressants compared to those on anticonvulsants?
What characteristic does the gingiva exhibit in patients on immunosuppressants compared to those on anticonvulsants?
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Which term refers specifically to an increase in the size of individual cells?
Which term refers specifically to an increase in the size of individual cells?
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What is the primary distinction between hyperplasia and hypertrophy?
What is the primary distinction between hyperplasia and hypertrophy?
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Which pathological process involves an accumulation of connective tissue?
Which pathological process involves an accumulation of connective tissue?
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What condition is described as a collection of an abnormally large amount of fluid in intercellular spaces?
What condition is described as a collection of an abnormally large amount of fluid in intercellular spaces?
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Why are hyperplasia and hypertrophy not precise descriptions of gingival enlargement?
Why are hyperplasia and hypertrophy not precise descriptions of gingival enlargement?
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In which condition would you primarily observe an increase in the number of individual cells?
In which condition would you primarily observe an increase in the number of individual cells?
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Which of the following processes would you associate with tissue thickening due to excessive collagen production?
Which of the following processes would you associate with tissue thickening due to excessive collagen production?
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What does Drug Induced Gingival Overgrowth (DIGO) primarily result from?
What does Drug Induced Gingival Overgrowth (DIGO) primarily result from?
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What pathological process is involved in gingival enlargement due to dehydration of tissue cells?
What pathological process is involved in gingival enlargement due to dehydration of tissue cells?
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Which of the following drug groups is NOT associated with Drug Induced Gingival Overgrowth?
Which of the following drug groups is NOT associated with Drug Induced Gingival Overgrowth?
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Which of the following is NOT a pathological process associated with gingival enlargement?
Which of the following is NOT a pathological process associated with gingival enlargement?
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How long after starting anti-convulsant medication does DIGO usually become clinically noticeable?
How long after starting anti-convulsant medication does DIGO usually become clinically noticeable?
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Gingival enlargement can be caused by multiple factors, which of the following is a feature of hypertrophy specifically?
Gingival enlargement can be caused by multiple factors, which of the following is a feature of hypertrophy specifically?
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What percentage of patients taking anti-convulsant medication may experience DIGO?
What percentage of patients taking anti-convulsant medication may experience DIGO?
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Which of the following factors can exacerbate the severity of DIGO?
Which of the following factors can exacerbate the severity of DIGO?
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What role does plaque presence have in DIGO?
What role does plaque presence have in DIGO?
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When does DIGO typically reach its maximum severity after starting drug treatment?
When does DIGO typically reach its maximum severity after starting drug treatment?
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Which condition is specifically NOT linked to the use of anti-convulsants related to DIGO?
Which condition is specifically NOT linked to the use of anti-convulsants related to DIGO?
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What type of drug is most commonly introduced for treating epilepsy and linked to DIGO?
What type of drug is most commonly introduced for treating epilepsy and linked to DIGO?
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In which patient demographic is DIGO more noticeable?
In which patient demographic is DIGO more noticeable?
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What is the most likely appearance of gingiva in a patient with oral conditions?
What is the most likely appearance of gingiva in a patient with oral conditions?
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What is a significant benefit of maintaining good oral hygiene in the context of gingival enlargement?
What is a significant benefit of maintaining good oral hygiene in the context of gingival enlargement?
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Which scoring level indicates no signs of gingival enlargement?
Which scoring level indicates no signs of gingival enlargement?
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Which category of enlargement is characterized by diseased tissue rather than true enlargement?
Which category of enlargement is characterized by diseased tissue rather than true enlargement?
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What type of papillae involvement is categorized under scoring level 1?
What type of papillae involvement is categorized under scoring level 1?
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In case of an abscess, which treatment may be required?
In case of an abscess, which treatment may be required?
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What does scoring level 3 indicate regarding gingival enlargement?
What does scoring level 3 indicate regarding gingival enlargement?
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Which of the following is NOT associated with inflammatory enlargements?
Which of the following is NOT associated with inflammatory enlargements?
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What is the primary reason for developing a scoring guide for gingival enlargement?
What is the primary reason for developing a scoring guide for gingival enlargement?
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In gingival enlargement, what is the role of underlying osseous tissue?
In gingival enlargement, what is the role of underlying osseous tissue?
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Study Notes
Gingival Overgrowth
- Gingival overgrowth is the proliferation and intensification of gingival tissue.
- It's a common clinical problem often linked to specific conditions.
- Typically, overgrowth occurs in areas with teeth and disappears if a tooth needs extraction.
- The overgrowth is chronic and gradually increases in size.
- It is pain-free.
- If surgically removed, the overgrowth often recurs.
- Overgrowth usually disappears within a few months after discontinuing the problematic drug.
GDC Learning Outcomes
- The presentation includes a list of GDC learning outcomes
- The outcomes are referenced with numbers and letters
Formative Assessment
- Students need to create a mind map titled "The management of a patient presenting with drug-induced gingival overgrowth."
- Students should complete the Gingival Overgrowth Workbook.
- The completed work should be returned to Mrs. Watson.
Aim
- The aim of the lecture is to raise awareness of gingival overgrowth.
- The lecture aims to cover the causes, implications for clinicians, and how to assist patients.
Learning Outcomes (Specific)
- Identify clinical features associated with gingival overgrowth.
- Categorize potential causes of gingival overgrowth.
- Select appropriate assessment measures for patients with gingival overgrowth.
- Outline the classification of gingival overgrowth and its locations in the mouth.
- Evaluate the impact of overgrowth on oral health and patient well-being.
- Recommend potential management strategies.
Overgrowth/Enlargement vs. Hyperplasia
- The terms "hyperplasia" and "hypertrophy" have been used to describe gingival overgrowth in the past.
- However, these terms are not precise descriptions, as they require microscopic (histological) analysis of a sample.
Pathological Processes 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: A collection of an abnormally large amount of fluid in the intercellular spaces.
Classification of Gingival Overgrowth
- Includes Inflammatory enlargements (chronic or acute), Drug-induced enlargements, Neoplastic enlargements (gingival tumors), Enlargements associated with systemic diseases.
Types of Gingival Overgrowth (by Location/Distribution)
- Localized: Limited to the gingiva adjacent to a single tooth or a group of teeth.
- Generalized: Involves the gingiva throughout the mouth.
- Marginal: Confined to the gingival margins.
- Papillary: Confined to the interdental papilla.
- Discrete: An isolated enlargement such as an abscess.
- Diffuse: Involves the gingival margins, attached gingivae, and interdental papillae.
Scoring Guide for Gingival Enlargement
- A scoring guide for gingival enlargement exists, allowing for tracking progression or reduction of the condition in patient records.
- A scoring guide with levels 0 to 3 helps in grading the severity.
- 0: No signs of enlargement.
- 1: Enlargement confined to the interdental papilla.
- 2: Enlargement involves papilla and gingival margins.
- 3: Covers more than 1/3 of the tooth surface.
Drug-Induced Gingival Overgrowth (DIGO)
- DIGO manifests as abnormal gingival growth resulting from an adverse drug reaction.
- It's a side effect of systemic drug use.
- Exacerbated by genetic predisposition, plaque, or gingival inflammation.
- Key drug groups associated with DIGO are anticonvulsants, immunosuppressants, and calcium channel blockers..
Anticonvulsants
- Anticonvulsants are used to treat epilepsy.
- The first anticonvulsant drug introduced in 1938 was often linked to DIGO incidence.
- Up to 50% of anticonvulsant users may experience DIGO.
- DIGO onset usually in 2–3 months after drug introduction.
- The severity peaks at 12–18 months.
Anticonvulsant Drugs (Examples)
- Phenytoin
- Ethosuximide
- Sodium Valproate
- Phenobarbital
- Vigabatrin
Immunosuppressants
- Immunosuppressants are used to prevent transplant rejection and manage autoimmune conditions.
- The gingiva exhibits a greater vascularized appearance with immunosuppressants than anticonvulsants.
- Ciclosporin, tacrolimus, and sirolimus can cause DIGO.
- Ciclosporin is the most common culprit.
Calcium Channel Blockers
- Calcium channel blockers are frequently used to treat hypertension, angina pectoris, and other conditions.
- DIGO associated with these drugs is often more notable in the papillary region.
- It can manifest as nodular or lobular gingival enlargement extending to the attached and marginal gingiva.
- Amlodipine is a common culprit for this specific type of DIGO.
Complications of DIGO
- DIGO can present with aesthetic, functional, pain, and oral hygiene difficulties.
- The overgrowth can hinder normal bite force.
- Plaque and oral hygiene issues are common complications to consider
Exacerbating factors
- Most exacerbating factor is the presence of plaque.
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Description
Test your knowledge on gingival overgrowth, its characteristics, associated drugs, and management strategies. This quiz will cover critical aspects of this dental condition, including expected outcomes and key considerations for treatment. Ideal for dental students and professionals seeking to deepen their understanding of gingival overgrowth.
