Exam 2 Gingival Enlargements Flashcards
What are the gingival enlargements classified as inflammatory?
1) Acute or chronic
2) Localized or Generalized
3) Slight Moderate or Severe
What are the gingival enlargements classified as Hormonal induced?
1) Pregnancy gingivitis
2) Pyogenic granuloma
3) Puberty
What are the gingival enlargements classified as drug induced?
1) Phenytoin sodium (Dilantin)
2) Cyclosporine (Sandimmune)
3) Nifedipine (Procardia)
What are the gingival enlargements classified as Leukemia related?
1) Acute lymphocytic
2) Acute myelocytic
What are the other 2 types gingival enlargements classified as?
- Familial
- Idiopathic
Regarding hormonal relationships, _______________ is an essential nutrient for P. intermedia
Menadione
Menadione =
Methyl-naphthalenedione
Progesterone=
Naphthoquinone
P. intermedia can substitute _____________ for Methyl-naphthalenedione
-naphthoquinone
Elevated progesterone levels will facilitate growth and colonization of ______________
P. intermedia
P. Intermedia is tissue invasive and associated with _____________ formation
-Pyogenic granuloma
Drug induced gingival enlargement, Phenytoin sodium (Dilantin) is prescribed for?
1) Epilepsy
2) Severe clinical depression
3) Trauma induced seizures
4) Severe cluster headaches
Drug induced gingival enlargement, Phenytoin sodium (Dilantin) is characterized by?
1) 50 % incidence
2) Generally begins at 1-3 months
3) Initial lesion involves gingival papillae
4) Positive correlation with inadequate oral hygiene
The incidence and severity of gingival enlarement has no correlation with ____________ , __________ , and __________
- Dosage
- Plasma levels
- Duration
Percent of patient with gingival overgrowth by drug regimen is GREATEST when_________ + __________ + ___________
(83%) Phenytonin sodium + carbamazepine + phenobarbital
0% patient with gingival overgrowth by caused by what drug regimen
Carbamazepine
52% patient with gingival overgrowth by caused by what drug regimen
Phenytonin sodium
56% patient with gingival overgrowth by caused by what drug regimen
Phenytonin sodium +Sodium Valporate
71% patient with gingival overgrowth by caused by what drug regimen
Phenytonin sodium + carbamazepine
What is the mechanism of action of Dilantin induced gingival enlargement ?
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)
What is the clinical occurrence of Phenytoin Sodium (Dilantin)
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
What is the Dilantin hyperplasia histology?
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
What are the drug induced Ca++ channel blockers that case gingival enlargements?
1) Procardia
2) Cardizem
3) Aldalat
4) Cardene
5) Isoptin
Nifedipine (Procardia) Ca+ Channel Blocker is prescribed for?
1) Agina pectoris
2) Post-myocardial syndrome
- (Hypertension patients)
What does the Nifedipine (Procardia) Ca+ Channel Blocker do?
- It blocks influx of Ca++ into myocardial muscle cells leading to reduced oxygen demands
- Can present localized in a few spots
What is the pathogenesis of Nifedipine (Procardia) Ca+ Channel Blocker?
1) Genetic predisposition manifested by “responder” fibroblast phenotype producing more collagen & matrix
2) Collagenolytic activity of fibroblasts is Ca++ dependent event
What is the Cyclosporine (Sandimmune) prescribed for?
1) Immune suppression after major organ transplantation
2) Suppresses to some degree B-lymphocytes, but more specifically, CD 8 lymphocytes
The World Health Organization (WHO) claims that over 1 billion people world-wide will be using Cyclosporine for what 5 things?
1) Rheumatoid arthritis
2) Sarcoidosis
3) Malaria
4) Psoriasis
5) Multiple Sclerosis
Even though extensive studies have failed to elucidate the pathogenesis of cyclosporine induced gingival enlargement. Theories include what?
1) Genetic predisposition manifested through specific phenotypes of fibroblasts
2) Increased production of PDGF (platelet derived growth factor) that in turn facilitates fibroblast proliferation
What is the histology of Nifedipine/Cyclosporine Hyperplasia?
1) Elongated epithelial rete ridges
2) Normal collagen composition
3) INCREASED production of matrix macromolecules by fibroblasts
Hereditary gingival fibrzomatosis is associated with which chromosome and gene ?
chromosome 2p21
gene SOS1 gene mutation
What does the activation of the SOS1 gene result in?
Overproduction of its protein which, in turn, complexes with other cellular molecules to activate the ras single pathway (popular in cancer research)
The ras signal pathway once activated, can prompt what?
Cells to grow, differentiate, or even commit apoptosis, all tasks that are essential to life.
