Gingival Overgrowth - DTH23 PDF

Gingival Overgrowth Julie Watson  GDC learning Outcomes 1.1 1.1.1 1.9.1 1.1.2 1.10.2. 1.1.3 1.10.3 1.1.4 1.10.4 1.1.11 1.10.5 1.2.2 3.1 1.2.3 3.2 1.2.4 5.2 1.5.3 6.1 1....

Gingival Overgrowth Julie Watson  GDC learning Outcomes 1.1 1.1.1 1.9.1 1.1.2 1.10.2. 1.1.3 1.10.3 1.1.4 1.10.4 1.1.11 1.10.5 1.2.2 3.1 1.2.3 3.2 1.2.4 5.2 1.5.3 6.1 1.7.1 6.2 1.7.3 6.3 2 Formative Assessment. Please complete the following 2 pieces of work. Compile a mind map titled; “The management of the patient presenting with drug induced gingival overgrowth” Complete the Gingival Overgrowth Workbook *Work to be returned to Mrs Watson 3 Aim The aim for todays lecture on Gingival Overgrowth is to bring awareness of this condition to you. To cover the causes, implications to us as clinicians. How we can assist our patients with this condition. 4 Learning outcomes List the Classification of Gingival Identify the clinical Overgrowth and state the areas in the features associated mouth where this may with gingival present overgrowth Evaluate the impact Categorize the of gingival overgrowth potential causative to the health of the factors of gingival oral cavity and well- overgrowth being of the patient Select appropriate Recommend the assessment measures potential of patients presenting management of with gingival patients with this  The overgrowth is chronic Gingival Overgrowth and slowly increases in size. Gingival enlargement or overgrowth is the Is pain free. proliferation and intensification of the If removed surgically, it gingiva. tends to reoccur. It is a common place clinical problem, usually associated with specific Spontaneous conditions. disappearance happens Typically, it occurs in within a few months after areas where teeth are discontinuation of the present, not in drug. edentulous spaces, and 6 the overgrowth Overgrowth/Enlargement V Hyperplasia What is the difference? The terms hyperplasia and hypertrophy have been used in the past to describe this condition. However, these are not precise descriptions of gingival enlargement because these terms require an histological analysis of a tissue sample. Hyperplasia Images, Stock Photos & Vec tors | Shutterstock 7  3.Cellular Hyperplasia 2. Fibrosis – – an increase an in the number of individual accumulation of 02 cells. collagenous connective tissue Enlargement 01 03 4.Oedema – A 1. Cellular collection of an Hypertrophy – abnormally large an increase in amount of fluid in 04 the size of the the intercellular individual cell. spaces.  INFLAMMAT ORY ENLARGEME NTS – CHRONIC & FALSE ACUTE ENLARGEMEN T- NOT TRUE ENLARGEMEN T BUT APPEAR AS AN DRUG INCREASE IN INDUCED SIZE DUE TO UNDERLYING CLASSIFICA ENLARGEME NT OSSEOUS OR DENTAL TION OF TISSUES. – TORI/GRNAUL GINGIVAL OMA OVERGROW TH ENLARGEME NTS NEOPLASTIC ASSOCIATED ENLARGEME WITH NT – SYSTEMIC GINGIVAL DISEASES TUMOURS AND CONDITIONS 9 Gingival Enlargement can be further classified by; Location or Distribution 10 Localised Limited to the gingiva adjacent to a single tooth or group of teeth. 11 Intechopen.com Generaliz ed Involving the gingiva throughout the mouth. 12 gskhealthpartner.com Marginal Confined to the gingival margins. 13 Image from Google March 21 Papillary Confined to the interdental papilla. 14 Image from Google March 21 Discrete An isolated enlargement, such as an abscess. 15 En.wikipedia.org Diffuse Involving the gingival margins, attached gingivae and interdental papillae. 16 Image from Google March 21 There is a scoring guide for gingival enlargement. This is something which could be incorporated into the body of contemporaneous note keeping. It would allow a record of progression or reduction of this condition. 17  No signs of gingival 0 enlargement. Enlargement confined to 1 the interdental papillae. Enlargement involves papilla 2 and gingival margins. 3 Covers more than ¾ of the tooth  19 Semanticscholar.org  INFLAMMAT ORY ENLARGEME NTS – FALSE CHRONIC & ENLARGEME ACUTE NT- NOT TRUE ENLARGEME NT BUT APPEAR AS DRUG AN INCREASE INDUCED IN SIZE DUE TO CLASSIFICA ENLARGEME NT UNDERLYING OSSEOUS OR TION OF DENTAL TISSUES. – GINGIVAL TORI/GRNAU LOMA OVERGROW TH ENLARGEME NTS NEOPLASTIC ASSOCIATED ENLARGEME WITH NT – SYSTEMIC GINGIVAL DISEASES TUMOURS AND CONDITIONS 20  What we are going to concentrate on today is Drug Induced Gingival Overgrowth D I G O 21  DIGO Manifests as abnormal growth of the gingiva due to an adverse drug reaction, it occurs as a side effect following the administration of systemic drug use. It is exacerbated by patients with a genetic predisposition, the presence of plaque or gingival inflammation. 22 Image from Google March 21  Drug Groups Associated with DIGO The groups of drugs that mainly cause DIGO are: Anti Convulsants Immunosuppressants Calcium Channel Blockers 23 Image from Google March 21 ANTI CONVULSANTS These are a group of drugs used for the treatment of epileptic patients. The first anti-epileptic drug was introduced in 1938. Within a year of its introduction for clinical use DIGO was reported. It is suspected that up to 50% of patients who are taking Anti Convulsant medication will present with DIGO. Younger patients appear more susceptible. DIGO becomes clinically noticeable within 2 to 3 months after initial administration, and reaches its 24 maximum severity at 12 to 18 months. Image from Google March 21  ANTI CONVULSANTS DRUGS MEDICAL CONDITIONS Phenytoin Ethatoin Downs Syndrome Sodium Valproate Parkinson’s Disease Phenobarbitone Epilepsy Vigabatrin Essential Tremor Primidone Mephenytoin Ethosuximide Methosuxinimide * Not an exhaustive list 25 Anti Convulsant DIGO Phenytoin drug induced Gingival overgrowth 26 Casereports.bmj.com  No signs of gingival 0 enlargement. Enlargement confined to 1 the interdental papillae. Enlargement involves papilla 2 and gingival margins. 3 Covers more than ¾ of the tooth IMMUNOSUPPRESSANTS These are a group of drugs which are widely used for the prevention of transplant rejection as well as for management of a number of auto immune conditions. The gingiva appears more vascularised than with anti Convulsants. Ciclosporin, Tacrolimus and Sirolimus are some of the immunosuppressant’s that cause DIGO. The most common being Ciclosporin. One study found the incidence of gingival 28 overgrowth to be nearly 53% in patients Dir.indiamart.com Tacrolimus another immunosuppressant sometimes used in place of Ciclosporin causes less hepatoxicity and renal toxicity and although DIGO is still evident, appears less severe. Ciclosporin induced gingival overgrowth appears to be more prominent on the labial surface. It is hyperemic, soft and has a higher bleeding tendency and gingival overgrowth is considerably higher should a patient be taking a combination astellas.com 29  IMMUNOSUPPRESSANTS DRUGS MEDICAL CONDITIONS Ciclosporin organ transplant Tacrolimus inflammatory bowel disease Sirolimus crohns disease ulcerative colitis rheumatoid arthritis ankylosing spondylitis * Not an exhaustive list 30 Immunosuppressant DIGO Ciclosporin drug induced Gingival overgrowth 31 Clinmedjournals.org ALCIUM CHANNEL BLOCKERS This group of drugs is widely used and is common place. They are used in the management and treatment of; Hypertension, Angina Pectoris, Peripheral Vascular Disease, Cardiac Arrhythmia and Coronary Artery Spasm to name a few. Calcium channel blocker induced gingival overgrowth appears to be more prominent in the papillary region resulting in a nodular/lobular morphology extending to the attached and marginal gingiva. These will be encountered regularly when taking a medical history. 32 Ukmeds.co.uk  CALCIUM CHANNEL BLOCKERS DRUGS MEDICAL CONDITIONS Amlodipine hypertension Felodipine gastro oesophageal reflux disease Nicardipine Hydrochloride arrhythmias Nifedipine angina Verapamil Hydrochloride peripheral vascular disease Diltiazem Hydrochloride coronary artery spasm Cardizem Dilacort 33 Calcium Channel Blocker DIGO Amlodipine drug induced Gingival overgrowth 34 Jcrsmed.org Complications Due To DIGO Thinking hats on! 35 Proofthatblog.com Exacerbating factors 36 Image from Google March 21 THANK YOU! 37 Further Reading https://www.ncbi.nlm.nih.gov/books/NBK538518/#:~: text=Drug%2Dinduced%20gingival%20overgrowth%20( DIGO,not%20the%20intended%20target%20organ. https://pubmed.ncbi.nlm.nih.gov/8724703/ https:// www.researchgate.net/publication/295402193_Drug_ind uced_gingival_enlargement https ://www.slideshare.net/dimpunani/drug-induced-gingival- enlargement https:// 38 eaom.eu/wp-content/uploads/2020/03/DRUG_INDUCED_  https://www.nature.com/articles/sj.bdj.2017.71/tables/1