Immunosuppressant Cyclosporine
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Questions and Answers

Which term is used to describe an increase in size of the gingiva in a strictly clinical descriptive way?

  • Gingival hyperplasia
  • Gingival enlargement (correct)
  • Gingival overgrowth
  • Hypertrophic gingivitis
  • Which of the following is NOT a category of gingival enlargement according to the text?

  • Drug-induced enlargement
  • Enlargements associated with systemic diseases or conditions
  • Infectious enlargement (correct)
  • Neoplastic enlargement
  • Which is NOT listed as a cause of conditioned enlargement in the text?

  • Vitamin C deficiency
  • Calcium channel blockers (correct)
  • Pregnancy
  • Puberty
  • Which disease is mentioned as causing gingival enlargement?

    <p>All of the above</p> Signup and view all the answers

    Which type of enlargement is specifically associated with gingival tumors?

    <p>Neoplastic enlargement</p> Signup and view all the answers

    Which category of drug is NOT mentioned as causing drug-induced gingival enlargement?

    <p>Antibiotics</p> Signup and view all the answers

    Which term is used to describe nonspecific conditioned enlargement in the text?

    <p>Pyogenic granuloma</p> Signup and view all the answers

    What is the reported incidence of pregnancy tumors?

    <p>1.8% to 5%</p> Signup and view all the answers

    What is the characteristic color of enlarged gingiva during pregnancy?

    <p>Bright red or magenta</p> Signup and view all the answers

    What distinguishes pubertal gingival enlargement from uncomplicated chronic inflammatory gingival enlargement?

    <p>Size of the enlargement and tendency to recur</p> Signup and view all the answers

    Which systemic disease may result in gingival enlargement characterized by a shiny surface and moderate firmness?

    <p>Leukemia</p> Signup and view all the answers

    What type of disease is sarcoidosis?

    <p>Granulomatous disease</p> Signup and view all the answers

    What characterizes plasma cell gingivitis?

    <p>Mild marginal gingival enlargement extending to the attached gingiva</p> Signup and view all the answers

    What distinguishes pyogenic granuloma from conditioned gingival enlargement seen during pregnancy?

    <p>The location of the lesion</p> Signup and view all the answers

    What type of tumors are most lesions referred to by the term 'epulis'?

    <p>Inflammatory rather than neoplastic</p> Signup and view all the answers

    What type of gingival enlargement is confined to the marginal gingiva?

    <p>Marginal</p> Signup and view all the answers

    Which grade of gingival enlargement involves papilla and marginal gingiva?

    <p>Grade II</p> Signup and view all the answers

    What is the common site of involvement for gingivitis and gingival enlargement in mouth breathers?

    <p>Maxillary anterior region</p> Signup and view all the answers

    Which drug is a hydantoin known to induce gingival enlargement?

    <p>Phenytoin (Dilantin)</p> Signup and view all the answers

    What is the typical appearance of a gingival abscess in its early stages?

    <p>Red swelling with a smooth, shiny surface</p> Signup and view all the answers

    What is the etiology of acute inflammatory gingival enlargement?

    <p>Bacteria forcefully embedded into the tissues</p> Signup and view all the answers

    What is the characteristic appearance of drug-induced gingival enlargement in its early stages?

    <p>Painless, beadlike enlargement</p> Signup and view all the answers

    What is the most common site of involvement for drug-induced gingival enlargement?

    <p>Maxillary anterior region</p> Signup and view all the answers

    Which drug class inhibits calcium ion influx across the cell membrane of heart and smooth muscle cells?

    <p>Calcium channel blockers</p> Signup and view all the answers

    What is the mechanism of action of Cyclosporine A?

    <p>Selective inhibition of helper T cells</p> Signup and view all the answers

    Which drug, often used in kidney transplant recipients, can induce gingival enlargement in 20% of patients?

    <p>Nifedipine</p> Signup and view all the answers

    Which condition is characterized by a rare gingival enlargement of undetermined cause?

    <p>Idiopathic gingival enlargement</p> Signup and view all the answers

    What type of enlargement occurs when the systemic condition exaggerates or distorts the usual gingival response to dental plaque?

    <p>Conditioned enlargement</p> Signup and view all the answers

    Which systemic diseases can develop oral manifestations that may include gingival enlargement?

    <p>Cardiovascular diseases, hormonal conditions, nutritional diseases, and neoplastic conditions</p> Signup and view all the answers

    What is the most common site affected by idiopathic gingival enlargement?

    <p>Gingival margin and interdental papillae</p> Signup and view all the answers

    What causes pregnancy gingival enlargement?

    <p>Increase in levels of progesterone and estrogen</p> Signup and view all the answers

    Which of the following is a benign proliferation of surface epithelium that may be associated with the human papillomavirus?

    <p>Papilloma</p> Signup and view all the answers

    What is the most common malignant tumor of the gingiva?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    Which condition is defined as a white patch or plaque that cannot be diagnosed as any other disease?

    <p>Leukoplakia</p> Signup and view all the answers

    What is the common association of leukoplakia?

    <p>Candida albicans</p> Signup and view all the answers

    Which of the following is not a true enlargement of the gingival tissues, but may appear as such due to underlying osseous or dental tissues?

    <p>False Enlargement</p> Signup and view all the answers

    Which condition is characterized by rapid growth and early metastasis and tends to occur in the hard palate and maxillary gingiva of older persons?

    <p>Malignant Melanoma</p> Signup and view all the answers

    Which condition accounts for less than 3% of all malignant tumors in the body, but is the sixth most common cancer in males and the twelfth most common in females?

    <p>Carcinoma</p> Signup and view all the answers

    What are the four main categories of gingival enlargement according to the text?

    <p>Inflammatory enlargement, Drug-induced enlargement, Enlargements associated with systemic diseases or conditions, Neoplastic enlargement</p> Signup and view all the answers

    What are the two subtypes of inflammatory enlargement listed in the text?

    <p>Chronic, Acute</p> Signup and view all the answers

    Which drug class is NOT mentioned as a cause of drug-induced gingival enlargement in the text?

    <p>Antibiotics</p> Signup and view all the answers

    What are the five systemic diseases or conditions that are listed as causing conditioned enlargement in the text?

    <p>Pregnancy, Puberty, Vitamin C deficiency, Plasma cell gingivitis, Nonspecific conditioned enlargement (pyogenic granuloma)</p> Signup and view all the answers

    Which systemic disease is mentioned as causing gingival enlargement characterized by a shiny surface and moderate firmness?

    <p>Leukemia</p> Signup and view all the answers

    What is the characteristic appearance of drug-induced gingival enlargement in its early stages?

    <p>Bilateral, painless, slowly progressive, and diffuse</p> Signup and view all the answers

    What is the common site of involvement for gingivitis and gingival enlargement in mouth breathers?

    <p>Labial gingiva of the maxillary anterior teeth</p> Signup and view all the answers

    What is the mechanism of action of Cyclosporine A, which can induce drug-induced gingival enlargement?

    <p>Inhibits T-lymphocyte function and interleukin production</p> Signup and view all the answers

    What are the criteria used to designate gingival enlargement based on location and distribution?

    <p>Localized and Generalized</p> Signup and view all the answers

    What is the scoring for Grade II gingival enlargement?

    <p>Enlargement involves papilla and marginal gingiva</p> Signup and view all the answers

    What causes chronic inflammatory gingival enlargement?

    <p>Prolonged exposure to dental plaque</p> Signup and view all the answers

    What are the clinical features of gingivitis and gingival enlargement in mouth breathers?

    <p>Red and edematous appearance with diffuse surface shininess</p> Signup and view all the answers

    What is the etiology of acute inflammatory gingival enlargement?

    <p>Bacteria carried deep into the tissues when a foreign substance is embedded into the gingiva</p> Signup and view all the answers

    What is the characteristic appearance of drug-induced gingival enlargement?

    <p>Painless, beadlike enlargement of the interdental papilla extending to the facial and lingual gingival margins</p> Signup and view all the answers

    What is the common site of involvement for drug-induced gingival enlargement?

    <p>Maxillary and mandibular anterior regions</p> Signup and view all the answers

    What are the drugs known to induce gingival enlargement?

    <p>Phenytoin, Ethotoin, Mephenytoin, Succinimides, Valproic acid</p> Signup and view all the answers

    What is the exact mechanism of action of Cyclosporine?

    <p>The exact mechanism of action of Cyclosporine is not well known.</p> Signup and view all the answers

    What is the reported incidence of Cyclosporine-induced gingival enlargement?

    <p>The reported incidence varies from 25% to 70%.</p> Signup and view all the answers

    Which drug can replace nifedipine in some cases and does not induce gingival overgrowth?

    <p>Isradipine</p> Signup and view all the answers

    What is the mode of inheritance for idiopathic gingival enlargement in some cases?

    <p>Autosomal recessive in some cases and autosomal dominant in others</p> Signup and view all the answers

    What type of systemic diseases can develop oral manifestations, including gingival enlargement?

    <p>Systemic diseases that cause gingival enlargement</p> Signup and view all the answers

    What are the three types of conditioned gingival enlargement?

    <p>Hormonal, nutritional, and allergic</p> Signup and view all the answers

    What specific hormonal changes lead to gingival edema and an increased inflammatory response during pregnancy?

    <p>Increase in levels of both progesterone and estrogen</p> Signup and view all the answers

    What are the two mechanisms by which systemic diseases can affect the periodontium?

    <p>Magnification of existing inflammation initiated by dental plaque and manifestation of the systemic disease independently of the inflammatory status of the gingiva</p> Signup and view all the answers

    What is the reported incidence of pregnancy tumors?

    <p>1.8% to 5%</p> Signup and view all the answers

    What distinguishes pubertal gingival enlargement from uncomplicated chronic inflammatory gingival enlargement?

    <p>The degree of enlargement and its tendency to recur in the presence of relatively scant plaque deposits</p> Signup and view all the answers

    What is the common site of involvement for drug-induced gingival enlargement?

    <p>Facial gingivae</p> Signup and view all the answers

    What type of enlargement occurs when the systemic condition exaggerates or distorts the usual gingival response to dental plaque?

    <p>Nonspecific Conditioned Enlargement (Pyogenic Granuloma)</p> Signup and view all the answers

    What causes pregnancy gingival enlargement?

    <p>Inflammatory response to bacterial plaque, modified by the patient’s condition</p> Signup and view all the answers

    What is the characteristic appearance of drug-induced gingival enlargement in its early stages?

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

    What is the characteristic color of enlarged gingiva during pregnancy?

    <p>Bright red or magenta</p> Signup and view all the answers

    What is the most common malignant tumor of the gingiva?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    What is the characteristic appearance of malignant melanoma in the gingiva?

    <p>darkly pigmented, flat or nodular, rapid growth, and early metastasis</p> Signup and view all the answers

    What is the most common malignant tumor of the gingiva?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    What are the probable factors associated with leukoplakia of the gingiva?

    <p>tobacco (smoke or smokeless), Candida albicans, HPV-16 and HPV-18, and trauma</p> Signup and view all the answers

    What is the characteristic appearance of gingival papillomas?

    <p>solitary wartlike or cauliflower-like protuberances</p> Signup and view all the answers

    What is the characteristic appearance of central giant cell granuloma?

    <p>produce central cavitation, occasionally creating a deformity of the jaw that makes the gingiva appear enlarged</p> Signup and view all the answers

    What is the characteristic appearance of false enlargements of the gingiva?

    <p>not true enlargements of the gingival tissues, but may appear as such due to increases in the size of the underlying osseous or dental tissues</p> Signup and view all the answers

    What is the characteristic appearance of peripheral giant cell granuloma?

    <p>smooth, regularly outlined masses to irregularly shaped, multilobulated protuberances with surface indentations</p> Signup and view all the answers

    What is the characteristic appearance of hard fibromas of the gingiva?

    <p>rare; most lesions diagnosed as 'fibromas' are inflammatory enlargements</p> Signup and view all the answers

    The reported incidence of pregnancy tumors is between ______% and ______%

    <p>5</p> Signup and view all the answers

    Gingival enlargement during puberty is characterized by prominent bulbous interproximal ______

    <p>papillae</p> Signup and view all the answers

    The extent of the inflammation is exaggerated in patients with scurvy due to the massive ______ enlargement

    <p>gingival</p> Signup and view all the answers

    Plasma cell gingivitis consists of a mild marginal gingival enlargement that extends to the attached ______

    <p>gingiva</p> Signup and view all the answers

    The differential diagnosis of pyogenic granuloma is based on the patient’s ______

    <p>history</p> Signup and view all the answers

    Leukemic gingival enlargement may appear as a diffuse enlargement of the gingival mucosa, an oversized extension of the marginal gingiva, or a discrete ______ interproximal mass

    <p>tumorlike</p> Signup and view all the answers

    Wegener’s granulomatosis is characterized by acute granulomatous necrotizing lesions of the respiratory tract, including nasal and oral ______

    <p>defects</p> Signup and view all the answers

    Fibromas of the gingiva arise from the gingival connective tissue or from the ______ ligament

    <p>periodontal</p> Signup and view all the answers

    Gingival papillomas appear as solitary ______ or cauliflower-like protuberances.

    <p>wartlike</p> Signup and view all the answers

    Squamous cell carcinoma is the most common malignant tumor of the ______.

    <p>gingiva</p> Signup and view all the answers

    Malignant melanoma tends to occur in the hard palate and maxillary gingiva of ______ persons.

    <p>older</p> Signup and view all the answers

    Enlargement of the bone subjacent to the gingival area occurs most often with ______ and exostoses.

    <p>tori</p> Signup and view all the answers

    Malignant melanoma is characterized by rapid growth and early ______.

    <p>metastasis</p> Signup and view all the answers

    Leukoplakia is a white patch or plaque that does not rub off and that cannot be diagnosed as any other ______.

    <p>disease</p> Signup and view all the answers

    Gingival cysts of microscopic proportions are common, but they seldom reach a clinically significant ______.

    <p>size</p> Signup and view all the answers

    Oral cancer accounts for less than 3% of all malignant tumors in the body, but it is the sixth most common cancer in males and the twelfth most common in ______.

    <p>females</p> Signup and view all the answers

    Cyclosporine selectively and reversibly inhibit helper T cells, which play a role in cellular and humoral immune responses. Cyclosporine A is administered intravenously or by mouth, and dosages of more than 500 mg/day have been reported to induce ______ overgrowth.

    <p>gingival</p> Signup and view all the answers

    Cyclosporine-induced gingival enlargement is more vascularized than phenytoin enlargement. Its occurrence varies, according to different studies, from 25% to ______ %.

    <p>70</p> Signup and view all the answers

    Nifedipine, which is one of the most often used, induces ______ enlargement in 20% of patients.

    <p>gingival</p> Signup and view all the answers

    Idiopathic gingival enlargement is a rare condition of undetermined cause. It has been designated by such terms as gingivostomatosis, elephantiasis, idiopathic fibromatosis, hereditary gingival hyperplasia, and congenital familial ______.

    <p>fibromatosis</p> Signup and view all the answers

    These drugs are the dihydropyridine derivatives (amlodipine, felodipine, nicardipine, nifedipine); the benzothiazine derivatives (diltiazem); and the phenylalkylamine derivatives (verapamil). Some of these drugs can induce ______ enlargement.

    <p>gingival</p> Signup and view all the answers

    Pregnancy gingival enlargement may be marginal and generalized, or it may occur as a single mass or multiple ______ masses.

    <p>tumorlike</p> Signup and view all the answers

    During pregnancy, there is an increase in levels of both progesterone and estrogen, which by the end of the third trimester reach levels 10 and 30 times the levels present during the menstrual cycle, respectively. These hormonal changes induce changes in vascular permeability, which leads to gingival edema and an increased inflammatory response to dental ______.

    <p>plaque</p> Signup and view all the answers

    The specific manner in which the clinical picture of conditioned gingival enlargement differs from that of chronic gingivitis depends on the nature of the modifying ______ influence.

    <p>systemic</p> Signup and view all the answers

    An increase in size of the gingiva is a common feature of gingival disease. The accepted current terms for this condition are gingival enlargement and gingival overgrowth. These are strictly clinical descriptive terms, and they avoid the erroneous pathologic connotations of terms used in the past, such as ______ and gingival hyperplasia.

    <p>hypertrophic gingivitis</p> Signup and view all the answers

    Drug-induced enlargement is associated with certain types of medications. These medications include anticonvulsants, immunosuppressants, and ______ channel blockers.

    <p>calcium</p> Signup and view all the answers

    Enlargements associated with systemic diseases or conditions can be conditioned, such as those occurring during pregnancy, puberty, Vitamin C deficiency, plasma cell gingivitis, and nonspecific conditioned enlargement (pyogenic granuloma), or they can be caused by systemic diseases such as leukemia, and granulomatous diseases like Wegener’s granulomatosis and ______.

    <p>sarcoidosis</p> Signup and view all the answers

    Neoplastic enlargement refers to gingival tumors, and these can be either benign or malignant. Examples of benign gingival tumors include ______.

    <p>pyogenic granuloma</p> Signup and view all the answers

    Pregnancy, puberty, Vitamin C deficiency, plasma cell gingivitis, and nonspecific conditioned enlargement (pyogenic granuloma) are examples of conditioned enlargements associated with systemic diseases or conditions. Additionally, systemic diseases like leukemia and granulomatous diseases can also cause this type of gingival enlargement. Another type of enlargement associated with systemic diseases is ______ enlargement.

    <p>neoplastic</p> Signup and view all the answers

    The enlargement of the gingiva due to systemic diseases can include conditioned enlargement associated with pregnancy, puberty, Vitamin C deficiency, and plasma cell gingivitis. Nonspecific conditioned enlargement, such as ______, is also possible.

    <p>pyogenic granuloma</p> Signup and view all the answers

    Drug-induced enlargement can be caused by medications like anticonvulsants, immunosuppressants, and calcium channel blockers. Another type of drug-induced enlargement is associated with the use of ______ A.

    <p>Cyclosporine</p> Signup and view all the answers

    Gingival enlargements can be classified into different categories, such as inflammatory enlargement and drug-induced enlargement. Inflammatory enlargement can be chronic or acute, while drug-induced enlargement can be induced by anticonvulsants, immunosuppressants, and ______ channel blockers.

    <p>calcium</p> Signup and view all the answers

    Gingival enlargement is designated as localized when it is limited to the gingiva adjacent to a single tooth or group of teeth, and generalized when it involves the gingiva throughout the mouth. It is also designated as marginal when confined to the marginal gingiva, and papillary when confined to the interdental papilla.

    <p>Localized, generalized, marginal, papillary</p> Signup and view all the answers

    The degree of gingival enlargement can be scored as follows: Grade 0 indicates no signs of gingival enlargement, Grade I indicates enlargement confined to interdental papilla, Grade II indicates enlargement involves papilla and marginal gingiva, and Grade III indicates enlargement covers three quarters or more of the crown.

    <p>Grade 0, Grade I, Grade II, Grade III</p> Signup and view all the answers

    Chronic inflammatory gingival enlargement is caused by prolonged exposure to dental plaque, poor oral hygiene, irritation by anatomic abnormalities, and improper restorative and orthodontic appliances. Gingival changes associated with mouth breathing are often seen in patients who are mouth breathers.

    <p>dental plaque, poor oral hygiene, irritation by anatomic abnormalities, improper restorative and orthodontic appliances, mouth breathing</p> Signup and view all the answers

    Acute inflammatory gingival enlargement results from bacteria carried deep into the tissues when a foreign substance (e.g., toothbrush bristle, piece of apple core, lobster shell fragment) is forcefully embedded into the gingiva. The lesion is confined to the gingiva and should not be confused with periodontal or lateral abscesses.

    <p>bacteria, toothbrush bristle, piece of apple core, lobster shell fragment, periodontal or lateral abscesses</p> Signup and view all the answers

    Gingival enlargement is a well-known consequence of the administration of some anticonvulsants, immunosuppressants, and calcium channel blockers. The first drug-induced gingival enlargements reported were those produced by phenytoin (Dilantin). Other anticonvulsants that have the same side effect are the succinimides (ethosuximide [Zarontin], methsuximide [Celontin]) and valproic acid (Depakene).

    <p>anticonvulsants, immunosuppressants, calcium channel blockers, phenytoin, succinimides, valproic acid</p> Signup and view all the answers

    Drug-induced enlargement may occur in mouths with little or no plaque, and it may be absent in mouths with abundant deposits. However, some investigators believe that inflammation is a prerequisite for development of the enlargement, which therefore could be prevented by plaque removal and fastidious oral hygiene.

    <p>little or no plaque, abundant deposits, inflammation, plaque removal, fastidious oral hygiene</p> Signup and view all the answers

    Dilantin is a hydantoin that was introduced for the treatment of all forms of epilepsy, except petit mal seizures. Its relationship with gingival enlargement was reported shortly thereafter. Gingival enlargement occurs in about 50% of patients receiving the drug, although different authors have reported incidences from 3% to 5%. It occurs more often in younger patients.

    <p>all forms of epilepsy, petit mal seizures, 50%, 3% to 5%, younger patients</p> Signup and view all the answers

    Gingival enlargement caused by anticonvulsants starts as a painless, beadlike enlargement of the interdental papilla that then extends to the facial and lingual gingival margins. As the condition progresses, the marginal and papillary enlargements unite, and they may develop into a massive tissue fold that covers a considerable portion of the crowns; this may interfere with occlusion.

    <p>interdental papilla, facial and lingual gingival margins, marginal and papillary enlargements, massive tissue fold, occlusion</p> Signup and view all the answers

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