Drug induced gingival enlargement

Question 1

What is gingival enlargement?

Answer 1

Increase in the size of the gingiva.

Question 2

Give 7 different types of gingival enlargement.

Answer 2

1. Drug induced gingival enlargement.
2. Gingival lesions of genetic origin.
3. Inflammatory Enlargement - Chronic or acute
4. Idiopathic Gingival Enlargement
5. Enlargements associated with systemic or local risk factors
6. Neoplastic Enlargements
7. False Enlargements

Question 3

What is type of gingival enlargement is Hereditary Gingival Fibromatosis?

Answer 3

Gingival lesion of genetic origin.

Question 4

How is Hereditary Gingival Fibromatosis inherited?

Answer 4

1. Mainly autosomal dominant
2. Rarely autosomal recessive modes of inheritance - 1:350,000

Question 5

• hat dentition does Hereditary Gingival Fibromatosis affect?

Answer 5

Permanent

Question 6

Does Hereditary Gingival Fibromatosis act locally or generally?

Answer 6

Both

Question 7

What is the mechanism of Hereditary Gingival Fibromatosis?

Answer 7

1. Excessive production of collagen.
2. Associated with activated fibroblasts, higher rate of proliferation.

Question 8

Give 8 problems associated with Hereditary Gingival Fibromatosis.

Answer 8

1. Plaque control - due to soft tissue morphology is harder.
2. True pockets - seen also in periodontitis as a result of apical migration of junctional epithelium.
3. Pseudo pockets - may occur as a result of improper brushing or flossing, which can cause the gum tissue to become inflamed and pull away from the tooth. Not related to gum disease.
4. Mastication - soft tissue, hard for muscles to go into spaces effectively.
5. Delayed tooth eruption - where gingivae can cover teeth.
6. Speech - due to soft tissue inflammation in mouth.
7. Aesthetics
8. Risk of recurrence

Question 9

Give 5 clinical appearance features of Hereditary Gingival Fibromatosis.

Answer 9

1. Generalised papillary swellings - inbetween teeth, enlarged fibrous appearance. These can present as pedunculated (have a base) regions of swelling.
2. Can be either a true or pseudo pocket.
3. Firm and fibrous gums.
4. Not present in edentulous areas.
5. Can be localised or generalised.

Question 10

Do all patients taking these drugs develop gingival enlargement/overgrowth?

Answer 10

No

Question 11

Give 3 drugs that cause drug induced gingival enlargement and what they manage.

Answer 11

1. Calcium Channel Blockers - Management of hypertension
2. Phenytoin - Management of epilepsy
3. Cyclosporin - Given following a transplant

Question 12

Give 2 features on how drug induced gingival enlargement grows.

Answer 12

1. Growth starts as a painless, beadlike enlargement of the interdental papilla.
2. Extends to the facial and lingual gingival margin which then unite.

Question 13

Give a potential mechanism for drug induced gingival enlargement.

Answer 13

1. Imbalance between collagen degradation and production.
2. As a result of inactive collagenase by gingival fibroblasts.
3. Cause an altered host response to bacteria.

Question 14

If plaque is not associated with gingival enlargement how do the lesions in the mouth present?

Answer 14

1. Lesions are mulberry shaped, firm, pale, pink with a lobulated surface that does not bleed.
2. After OHI and plaque removal the enlargement will remain.

Question 15

If plaque IS associated with gingival enlargement how do the lesions in the mouth present?

Answer 15

A secondary inflammatory reaction can ensue.

For example red and blueish demarkation w increase in bleeding tendency as a result can occur:

Question 16

What cardiovascular conditions do calcium channel blockers treat?

Answer 16

1. Hypertension
2. Angina
3. Cardiac arrythmias.

Question 17

What is the mechanism for calcium channel blockers?

Answer 17

1. Inhibition of calcium ion influx across the cell membrane.
2. The heart blocks movement of calcium ions in cells.
3. Coronary artery dilates.
4. Leading to an increase in oxygen and decrease in hypertension.

Question 18

Give 6 examples of calcium channel blockers.

Answer 18

1. Amlodipine
2. Felodipine
3. Nifedipine
4. Nitrendipine
5. Verapamil
6. Diltiazem

Question 19

What is the mechanism for immunosuppressants like cyclosporin?

Answer 19

1. Prevents organ transplant rejection and treats diseases of autoimmune origin.
2. Not known exactly but selectively and reversibly inhibits T helper cells and these play a role in cellular and immune responses.

Question 20

What amount of cyclosporin A is said to be proven to cause gingival overgrowth?

Answer 20

Over 500mg a day.

Question 21

If a patient is taking both calcium channel blockers and cyclosporin what is the effect?

Answer 21

Greater gingival overgrowth.

Question 22

What percent of patients on this drug experience gingival enlargements?

Answer 22

50%

Question 23

What is the mechanism for an anticonvulsant like phenytoin?

Answer 23

1. Production of inactive collagenase.
2. Inflammation of gingiva can be worsened with presence of plaque bacteria.

Question 24

How is drug induced gingival enlargement managed?

Answer 24

1. Plaque control - as it could be a secondary factor to the inflammation.
   
   2. Surgery - gingivectomy, flap surgery.
   3. Possibility of changing medication - may not be possible for some hypertensive patients who respond poorly to alternatives.
   4. Few alternatives to cyclosporin.