Exam 2 Gingival Enlargements

Question 1

What are the gingival enlargements classified as inflammatory?

Answer 1

1) Acute or chronic
2) Localized or Generalized
3) Slight Moderate or Severe

Question 2

What are the gingival enlargements classified as Hormonal induced?

Answer 2

1) Pregnancy gingivitis
2) Pyogenic granuloma
3) Puberty

Question 3

What are the gingival enlargements classified as drug induced?

Answer 3

1) Phenytoin sodium (Dilantin)
2) Cyclosporine (Sandimmune)
3) Nifedipine (Procardia)

Question 4

What are the gingival enlargements classified as Leukemia related?

Answer 4

1) Acute lymphocytic

2) Acute myelocytic

Question 5

What are the other 2 types gingival enlargements classified as?

Answer 5

• Familial

- Idiopathic

Question 6

Regarding hormonal relationships, _______________ is an essential nutrient for P. intermedia

Answer 6

Menadione

Question 7

Menadione =

Answer 7

Methyl-naphthalenedione

Question 8

Progesterone=

Answer 8

Naphthoquinone

Question 9

P. intermedia can substitute _____________ for Methyl-naphthalenedione

Answer 9

-naphthoquinone

Question 10

Elevated progesterone levels will facilitate growth and colonization of ______________

Answer 10

P. intermedia

Question 11

P. Intermedia is tissue invasive and associated with _____________ formation

Answer 11

-Pyogenic granuloma

Question 12

Drug induced gingival enlargement, Phenytoin sodium (Dilantin) is prescribed for?

Answer 12

1) Epilepsy
2) Severe clinical depression
3) Trauma induced seizures
4) Severe cluster headaches

Question 13

Drug induced gingival enlargement, Phenytoin sodium (Dilantin) is characterized by?

Answer 13

1) 50 % incidence
2) Generally begins at 1-3 months
3) Initial lesion involves gingival papillae
4) Positive correlation with inadequate oral hygiene

Question 14

The incidence and severity of gingival enlarement has no correlation with ____________ , __________ , and __________

Answer 14

• Dosage
• Plasma levels
• Duration

Question 15

Percent of patient with gingival overgrowth by drug regimen is GREATEST when_________ + __________ + ___________

Answer 15

(83%) Phenytonin sodium + carbamazepine + phenobarbital

Question 16

0% patient with gingival overgrowth by caused by what drug regimen

Answer 16

Carbamazepine

Question 17

52% patient with gingival overgrowth by caused by what drug regimen

Answer 17

Phenytonin sodium

Question 18

56% patient with gingival overgrowth by caused by what drug regimen

Answer 18

Phenytonin sodium +Sodium Valporate

Question 19

71% patient with gingival overgrowth by caused by what drug regimen

Answer 19

Phenytonin sodium + carbamazepine

Question 20

What is the mechanism of action of Dilantin induced gingival enlargement ?

Answer 20

1) Suppresses the expression of MMP-1
*** this increases synthesis &expression of Growth factors
2) Suppresses the expression of TIMP-1
3) Suppresses the expression of lysosomal cystein proteinase (cathepsin B& L )
4) INCREASED synthesis of glycosaminoglycan
5) INCREASED expression of PDGF-Beta
6) Interferes w/ folic acid absorption and metabolism
(affecting tissues w/ high turnover rates, e.g epithelium)

Question 21

What is the clinical occurrence of Phenytoin Sodium (Dilantin)

Answer 21

1) Susceptibility (50% incidence) generally involves the presence of teeth & poor hygiene
2) Although RARE, gingival enlargement may occur in edentulous moths and under points or partial dentures
3) Will occur around implant fixtures

Question 22

What is the Dilantin hyperplasia histology?

Answer 22

1) Epithelial rete ridge elongation
2) Heavy accumulation of collagen
3) 2X the amount of type III and less type I than normal
4) Greater volume & density of non-collagen protein matrix

Question 23

What are the drug induced Ca++ channel blockers that case gingival enlargements?

Answer 23

1) Procardia
2) Cardizem
3) Aldalat
4) Cardene
5) Isoptin

Question 24

Nifedipine (Procardia) Ca+ Channel Blocker is prescribed for?

Answer 24

1) Agina pectoris
2) Post-myocardial syndrome
- (Hypertension patients)

Question 25

What does the Nifedipine (Procardia) Ca+ Channel Blocker do?

Answer 25

• It blocks influx of Ca++ into myocardial muscle cells leading to reduced oxygen demands
• Can present localized in a few spots

Question 26

What is the pathogenesis of Nifedipine (Procardia) Ca+ Channel Blocker?

Answer 26

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

Question 27

What is the Cyclosporine (Sandimmune) prescribed for?

Answer 27

1) Immune suppression after major organ transplantation

2) Suppresses to some degree B-lymphocytes, but more specifically, CD 8 lymphocytes

Question 28

The World Health Organization (WHO) claims that over 1 billion people world-wide will be using Cyclosporine for what 5 things?

Answer 28

1) Rheumatoid arthritis
2) Sarcoidosis
3) Malaria
4) Psoriasis
5) Multiple Sclerosis

Question 29

Even though extensive studies have failed to elucidate the pathogenesis of cyclosporine induced gingival enlargement. Theories include what?

Answer 29

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 30

What is the histology of Nifedipine/Cyclosporine Hyperplasia?

Answer 30

1) Elongated epithelial rete ridges
2) Normal collagen composition
3) INCREASED production of matrix macromolecules by fibroblasts

Question 31

Hereditary gingival fibrzomatosis is associated with which chromosome and gene ?

Answer 31

chromosome 2p21

gene SOS1 gene mutation

Question 32

What does the activation of the SOS1 gene result in?

Answer 32

Overproduction of its protein which, in turn, complexes with other cellular molecules to activate the ras single pathway (popular in cancer research)

Question 33

The ras signal pathway once activated, can prompt what?

Answer 33

Cells to grow, differentiate, or even commit apoptosis, all tasks that are essential to life.