Generalized Gingival Flashcards
Generalized Gingival Enlargement
Hyperplastic Gingivitis
◦ (Pregnancy, Puberty, Diabetes)
Drug-Related Gingival Hyperplasia
Gingival Fibromatosis
Mouth Breathing
Leukemic Infiltrates
Acute Gingivitis
Plaque-induced inflammatory response of the gingiva
Can be localized or generalized in nature
Lesion will typically blanch with pressure due to vascular dilation
Nontender, red, swollen gingival lesion that bleed with probing
or toothbrushing
Tx: Improve OH
◦ If does not resolve, consider other lesions or systemic condition
Gingivitis DDx
Chronic Hyperplastic Gingivitis
Mouth-breathing Gingivitis
Hormonal-induced/Puberty Gingivitis
Drug Induced Gingival Hyperplasia
◦ Phenytoin (50%)
◦ Cyclosporin (25%)
◦ Calcium Channel Blockers (25%)
Linear gingival erythema
Plasma cell gingivitis
Gingival Fibromatosis
Leukemic Infiltrates (AML/CML)
Systemic Factors
Granulomatous Gingivitis
Crohn Disease
Orofacial Granulomatosis
Sarcoidosis
Wegener’s Granulomatosis
Systemic Factors Associated with Gingivitis
Hormonal changes (Puberty/Pregnancy)
Diabetes mellitus
SLE (Systemic lupus erythematous)
Autoimmune diseases/disorders
Vitamin C Deficiency (Scurvy)
Down Syndrome
Immune dysfunction
Heavy metal poisoning (Systemic)
Chronic Hyperplastic Gingivitis
Classic plaque induced gingivitis that leads to a systemic response
and red, inflamed and edematous gingival tissue
Bleeds very easily and can be reversed with improved oral hygiene
Gingival tissue will swelling and become inflamed in the papillary
area
Mouth Breathing Gingivitis
Due to lip incompetence and/or open mouth breathing
Teeth may appear to be decalcified and maxillary incisors
have arch form that follows lip
Can be due to lower muscle tone, jaw discrepancy (Class
II), tongue thrust or open bit resulting from prolonged
habit
Typically will NOT bleed upon probing or touch
Hormonal-Induced Gingivitis
Changes in the gingival tissue can occur related to sex hormones
Typically occurs with puberty from age 11-13, depending on sex
and maturity
Not always correlated to plaque control
Increased hygiene may help improve the clinical presentation,
but ginigival inflammation may persist
Females on birth control and during pregnancy may see a change
or increase in related gingivitis due to increased and changing
hormone levels
Drug Induced Gingival Hyperplasia
◦ Phenytoin (50%)(anti-epileptic), cyclosporine (30%)(immunosuppressant),
calcium channel blockers (diltiazem, nifedipine, amlodipine) (15%) (antihypertensive).
◦ Depakote (valporic acid) will cause increased gingiva bleeding and possible
hyperplasia.
◦ Typical effects anterior gingiva and interdental papillae
◦ Absent with edentulous areas
◦ Higher prevalence in children, cause fibroblast line to proliferate
◦ Fibro-epithelial growth
◦ Onset within 3 months of starting drug
◦ Amount of plaque will effect degree of inflammation DRASTICALLY
◦ Direct relationship related to plaque control levels
◦ Consider adding chlorhexidine to daily routine
◦ Normal gingiva color and smooth/stippled surface
◦ F = M
◦ Cyclosporine = Transplant patient
◦ Treatment: Change drug if possible, but unlikely. Great OH and routine
Prophy. Gingivoectomy/plasty as needed.
Linear Gingival Erythema
Likely associated with candida infection
◦ Increased risk with HIV-related or immunosuppressed
child
◦ Minimal edema
Linear band or fiery red and edematous attached
gingiva that can extend to mucogingival junction or
beyond
Will NOT improve with increased OH or plaque
control methods
Diff DX: Cyclic neutropenia
TX: Prophylaxis, 0.12% chlorhexidine rinse and
possible antifungal agent
Plasma Cell Gingivitis
Allergic reaction to multiple allergens (Allergic Gingivitis)
Commonly caused by toothpaste, mouthwash, candy, gum
Diffuse enlargement of the attached gingiva of sudden onset
◦ May involve palate, lip and tongue
Bright red and swollen tissue with loss or lack of stippling
Burning sensation
Dx: Incisional biopsy with dietary history during onset.
Allergy testing if recurrent/persistent
TX: Remove causative agent and topical steriods
Gingival Fibromatosis
Familial (Autosomal Dominant) or idiopathic in nature
Diffuse, multinodular overgrowth of fibrous tissue of the
gingiva
◦ Clinically resembles phenytoin-induced gingival hyperplasia
Can be localized, especially in tuberosity-palatal area
R/O syndrome; Many syndromes have gingival
fibromatosis
Delay in tooth eruption can occur and lead to
malocclusion
TX: Routine OH/prophylaxis with mild cases; More
severe/diffuse cases can require surgical
excision/recontouring. Recurrence is fairly common
Leukemic Infiltrates
Typically a sign of AML or CML (Chronic Myeloid Leukemia)
Gingiva is boggy, NON tender swelling and possibly ulcerated
◦ Enlargement is due to leukemic infiltrates
Typically accompanied by other symptoms
◦ Malaise, anorexia, irritability, fatigue, bleeding, fevers, etc.
AML is most common in children
CML is typically found in 20-40 yo population
Immediate referral to primary and/or Hem/ONC
◦ Chemotherapy and must clean up oral cavity after clearance
◦ Ideal hygiene is needed through long chemotherapy treatment
Leukemic Infiltrates cont’d
Hematologic: Neutropenia, Leukemia
◦ AML : Leads to thinning of lamina dura, destruction of PDL, tooth migration, gingival enlargement and
ulceration
◦ Chemotherapy can lead to gingival changes
◦ Look for petechiae and mucosal ulcerations as well
Neutropenia followed by gingivitis
Radiographic multifocal alveolar bone loss and thinning/loss of lamina dura
Ewing’s Sarcoma
Possibly from neuroectodermal origin
3rd most common primary bone neoplasm
1-2% have jaw involvement
Mandible (ramus/angle)
Swelling, paresthesia, loosen of teeth
Ill defined radiolucency in jaw
Prepubertal Periodontitis
Leukocyte QUANTITY issues
◦ Agranulocytosis
◦ Cyclic Neutropenia
Leukocyte QUALITY/FUNCTION issues
◦ Lazy leukocyte syndrome (Chemotaxis)
◦ Job’s syndrome (Phagocytosis)
◦ Chediak-Higashi Syndrome (Chemotaxis/Degranulation)
◦ Chronic granulomatous disease (Oxidative Burst)
◦ Myeloperoxidase deficiency (Hypochlorous acid production)
◦ Leukocyte adhesion deficiency (Phagocytosis)
