Exam 2 - Gingival Enlargement

Question 1

Gingival enlargement is a well-known consequence of the administration of what 3 drug classes?

Answer 1

Anticonvulsants
Immunosuppressants
Ca channel blockers

Question 2

Phenytoin sodium (Dilantin) is prescribed for what 4 things?

Answer 2

Epilepsy
Severe clinical depression
Trauma induced seizures
Severe cluster headaches

Question 3

What is the incidence of gingival enlargement in patients taking Dilantin?

Answer 3

50% incidence

Although some authors have reported incidences from 3% to 84.5%

Question 4

At what time period does gingival enlargement begin in patients taking Dilantin?

Answer 4

Generally begins at 1-3 months

Question 5

The initial lesion of GE caused by Dilantin is found in what portion of the gingiva?

Answer 5

Initial lesion involves gingival papillae

Question 6

How does oral hygiene correlate with GE caused by Dilantin

Answer 6

There is a positive correlation with inadequate oral hygiene

Question 7

The incidence and severity of gingival enlargement in patients taking Dilantin has no correlation with what 3 things?

Answer 7

1. Dosage
2. Plasma levels: of dilantin
3. Duration: how long patient is taking medication

Question 8

Percent of patients with Gingival overgrowth by taking Phenytoin Sodium?

Answer 8

52%

Question 9

Percent of patients with Gingival overgrowth by taking Phenytoin Sodium + Carbamazepine?

Answer 9

71%

Question 10

Percent of patients with Gingival overgrowth by taking Carbamazepine?

Answer 10

0%

Question 11

Percent of patients with Gingival overgrowth by taking Phenytoin Sodium + Carbamazepine + Phenobarbital?

Answer 11

83%

Question 12

Percent of patients with gingival overgrowth by taking Phenytoin Sodium + Sodium Valporate?

Answer 12

56%

Question 13

The mechanism of action of Dilantin induced gingival enlargement involves the suppression of what 3 targets?

Answer 13

Suppresses the expression of:

1. MMP-1
2. TIMP-1
3. Lysosomal cystein proteinase (cathepsin B&L)

Question 14

The mechanism of action of Dilantin induced gingival enlargement involves the increased synthesis or expression of what 2 things?

Answer 14

Increased synthesis of glycosaminoglycan

Increased expression of PDGF-beta

Question 15

Dilantin induced gingival enlargement interfere with what action of metabolism?

Answer 15

Interferes with folic acid absorption and metabolism

affecting tissue with high turnover rates, e.g., epithelium

Question 16

In what 3 clinical scenarios does Dilantin induced gingival enlargement occur?

Answer 16

1. Susceptibility generally involves the presence of teeth and poor oral hygiene
2. Although rare, Dilantin gingival enlargement may occur in edentulous mouths and under pontics or partial dentures
3. Will occur around implant fixtures

Question 17

Describe the histology of Dilantin induced gingival enlargement

Answer 17

1. Epithelial rete ridge elongation

2. Heavy accumulation of collagen

Question 18

Describe the characteristics of the collagen that accumulates during Dilantin induced gingival enlargement

Answer 18

1. Twice the amount of Type III and less Type I than normal

2. Greater volume and density of non-collagen protein matrix

Question 19

Name the 5 Brand names of Ca Channel Blockers that may cause gingival enlargement

Answer 19

1. Nifedipine (Procardia)
2. Cardizem
3. Aldalat
4. Cardene
5. Isoptin

Question 20

What is Nifedipine (Procardia) prescribed for?

Answer 20

Angina pectoris

Post-myocardial syndrome

Question 21

The is the mechanism of action for Nifedipine (Procardia)

Answer 21

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)

Question 22

The pathogenies of nifedipine induced gingival enlargement includes:

Answer 22

1. Genetic predisposition manifested by “responder” fibroblast phenotype producing more collagen and matrix
2. Collagenolytic activity of fibroblasts is a Ca++ dependent event.

Question 23

Cyclosporine (Sandimmune) is prescribed for what 2 things?

Answer 23

1. Prescribed for immune suppression after major organ transplantation
2. Suppresses to some degree B-lymphocytes, but more specifically, CD8 lymphocytes

Question 24

The WHO claims that over 1 billion people world-wide will be using cyclosporine for what 5 things?

Answer 24

1. Rheumatoid Arthritis
2. Sarcoidosis
3. Malaria
4. Psoriasis
5. Multiple Sclerosis

Question 25

Theories of the pathogenies of cyclosporine induced gingival enlargement

Answer 25

1. Genetic predisposition manifested through specific phenotypes of fibroblasts
2. Increased production of PDGF (platelet derived growth factor) that in turn facilitates fibroblast proliferation

Question 26

Nifedipine/Cyclosporine hyperplasia has what 2 histologic characteristics

Answer 26

1. Elongated epithelial rete ridges
2. Normal collagen composition
   
   • Increased production of matrix macromolecules by fibroblasts

Question 27

Hereditary Gingival Fibromatosis is associated with what chromosome?

Answer 27

2p21

Question 28

What type of mutation is involved in Hereditary Gingival Fibromatosis?

Answer 28

SOS1 gene mutation

Question 29

Mechanism of action in activation of the mutation that is associated with Hereditary Gingival Fibromatosis ?

Answer 29

• 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.