Exam 2 - Gingival Enlargement Flashcards
Gingival enlargement is a well-known consequence of the administration of what 3 drug classes?
Anticonvulsants
Immunosuppressants
Ca channel blockers
Phenytoin sodium (Dilantin) is prescribed for what 4 things?
Epilepsy
Severe clinical depression
Trauma induced seizures
Severe cluster headaches
What is the incidence of gingival enlargement in patients taking Dilantin?
50% incidence
Although some authors have reported incidences from 3% to 84.5%
At what time period does gingival enlargement begin in patients taking Dilantin?
Generally begins at 1-3 months
The initial lesion of GE caused by Dilantin is found in what portion of the gingiva?
Initial lesion involves gingival papillae
How does oral hygiene correlate with GE caused by Dilantin
There is a positive correlation with inadequate oral hygiene
The incidence and severity of gingival enlargement in patients taking Dilantin has no correlation with what 3 things?
- Dosage
- Plasma levels: of dilantin
- Duration: how long patient is taking medication
Percent of patients with Gingival overgrowth by taking Phenytoin Sodium?
52%
Percent of patients with Gingival overgrowth by taking Phenytoin Sodium + Carbamazepine?
71%
Percent of patients with Gingival overgrowth by taking Carbamazepine?
0%
Percent of patients with Gingival overgrowth by taking Phenytoin Sodium + Carbamazepine + Phenobarbital?
83%
Percent of patients with gingival overgrowth by taking Phenytoin Sodium + Sodium Valporate?
56%
The mechanism of action of Dilantin induced gingival enlargement involves the suppression of what 3 targets?
Suppresses the expression of:
- MMP-1
- TIMP-1
- Lysosomal cystein proteinase (cathepsin B&L)
The mechanism of action of Dilantin induced gingival enlargement involves the increased synthesis or expression of what 2 things?
Increased synthesis of glycosaminoglycan
Increased expression of PDGF-beta
Dilantin induced gingival enlargement interfere with what action of metabolism?
Interferes with folic acid absorption and metabolism
affecting tissue with high turnover rates, e.g., epithelium
In what 3 clinical scenarios does Dilantin induced gingival enlargement occur?
- Susceptibility generally involves the presence of teeth and poor oral hygiene
- Although rare, Dilantin gingival enlargement may occur in edentulous mouths and under pontics or partial dentures
- Will occur around implant fixtures
Describe the histology of Dilantin induced gingival enlargement
- Epithelial rete ridge elongation
2. Heavy accumulation of collagen
Describe the characteristics of the collagen that accumulates during Dilantin induced gingival enlargement
- Twice the amount of Type III and less Type I than normal
2. Greater volume and density of non-collagen protein matrix
Name the 5 Brand names of Ca Channel Blockers that may cause gingival enlargement
- Nifedipine (Procardia)
- Cardizem
- Aldalat
- Cardene
- Isoptin
What is Nifedipine (Procardia) prescribed for?
Angina pectoris
Post-myocardial syndrome
The is the mechanism of action for Nifedipine (Procardia)
Blocks influx of Ca++ into myocardial muscle cells leading to reduced oxygen demands
(Also causes dilation of arteries and arterioles which improves the oxygen supply to heart muscle)
The pathogenies of nifedipine induced gingival enlargement includes:
- Genetic predisposition manifested by “responder” fibroblast phenotype producing more collagen and matrix
- Collagenolytic activity of fibroblasts is a Ca++ dependent event.
Cyclosporine (Sandimmune) is prescribed for what 2 things?
- Prescribed for immune suppression after major organ transplantation
- Suppresses to some degree B-lymphocytes, but more specifically, CD8 lymphocytes
The WHO claims that over 1 billion people world-wide will be using cyclosporine for what 5 things?
- Rheumatoid Arthritis
- Sarcoidosis
- Malaria
- Psoriasis
- Multiple Sclerosis
Theories of the pathogenies of cyclosporine induced gingival enlargement
- Genetic predisposition manifested through specific phenotypes of fibroblasts
- Increased production of PDGF (platelet derived growth factor) that in turn facilitates fibroblast proliferation
Nifedipine/Cyclosporine hyperplasia has what 2 histologic characteristics
- Elongated epithelial rete ridges
- Normal collagen composition
- Increased production of matrix macromolecules by fibroblasts
Hereditary Gingival Fibromatosis is associated with what chromosome?
2p21
What type of mutation is involved in Hereditary Gingival Fibromatosis?
SOS1 gene mutation
Mechanism of action in activation of the mutation that is associated with Hereditary Gingival Fibromatosis ?
- Activation of the SOS1 gene results in overproduction of its protein which, in turn, complexes with other cellular molecules to activate the ras signal pathway
- The raw signal pathway, once activated, can prompt cells to grow, differentiate, or even commit apoptosis, all tasks that are essential to life.
