Gingival Enlargement

Question 1

Hypertrophy is an increase in number of cells. Hypertrophy and hyperplasia usually occur simultaneously.
a. both statements are true
b. both statements are false
c. first statement true. second statement false
d. first statement false. second statement true

Answer 1

d. first statement false. second statement true

hyperplasia is an increase in number of cells while hypertrophy refers to increased cell size.
they usually both occur at the same time

Question 2

What did gingival enlargement used to be termed?

Answer 2

hypertrophic gingivitis or gingival hyperplasia

Question 3

Why do false enlargements usually occur?

Answer 3

increase in size (hypertrophy) of underlying osseous/dental tissues

Question 4

Which grade has gingival enlargement confined to interdental papilla?

Answer 4

Grade I

Grade 0= no signs
Grade I= enlargement confined to interdental papilla
Grade II= enlargement involves papilla and marginal gingiva
Grade III= enlargement covers 3/4 or more of crown

Question 5

T/F: inflammatory enlargement only occurs in chronic gingivitis.

Answer 5

False.

can also happen in acute

Question 6

T/F: Gingival Overgrowth associated with systemic condition and system diseases are the same thing.

Answer 6

False.

they are separate things

Question 7

What is the first indicator to differentiate between acute and chronic inflammatory enlargement?

Answer 7

In acute, it is painful and tender while chronic is coming & going pain because they’re used to it

Question 8

Where is the location of both acute and chronic inflammatory enlargement?

Answer 8

acute= generally limited to marginal gingiva and interdental papilla
chronic= increase until it covers part of the crowns

Question 9

What is the usual cause of acute inflammatory enlargement?

Answer 9

trauma

Question 10

Which can be generalized and which is rapidly expanding: acute and chronic inflammatory enlargement?

Answer 10

chronic inflammatory enlargement is generalized and progresses slowly and painlessly

acute chronic inflammatory is rapidly expanding and painful

Question 11

What type of cells are seen in histopath of inflammatory enlargement?

Answer 11

inflammatory cells with lots of capillaries

Question 12

T/F: Lesions that are pink and firm will have lots of fibroblasts and collagen fibers but less capillaries.

Answer 12

True

Question 13

What are the drugs that can induce gingival enlargement?

Answer 13

Anticonvulsants
Immunosuppressants
Calcium Channel Blockers

Question 14

Which drug is associated with anticonvulsants and what is the prevelance of gingival overgrowth?

Answer 14

Phenytoin
50%

phenobarbital and valproic acid are seen less often than phenytoin

Question 15

What is the clinical onset of anticonvulsant and when does the severity show?

Answer 15

clinical onset= 1 month
increasing severity= 12-18 months

Question 16

Where is the frequent site of lesion from anticonvulsants?

Answer 16

anterior buccal maxilla and mandible gingiva

Question 17

Where/which class does the enlargement from anticonvulsants arise from?

Answer 17

Class I- interdental papilla

Question 18

What is the prevalence of calcium channel blocker for gingival overgrowth?

Answer 18

6-83%
HIGHLY variable

Question 19

Which drug is involved in gingival overgrowth from immunosuppressants?

Answer 19

Cyclosporin A
(used to prevent rejection in transplants and autoimmune conditions)

Question 20

What is the prevalence of immunosuppressants for gingival overgrowth?

Answer 20

30% but much higher in pediatric population

Question 21

What is key in being able to tell immunosuppressant causes of GO rather than calcium channel blockers or anticonvulsants?

Answer 21

Immunosuppressants have MANY inflammatory cells and very red and bleeds regularly (increased vascularization)

Question 22

Which is involved in fibrosis and has stratified squamous epithelium with long, thin rate pegs extending deep into connective tissue?
a. phenytoin-induced GO
b. calcium channel blocker induced GO
c. cyclosporin A induced GO

Answer 22

a. phenytoin-induced GO

calcium channel blockers are also similar in having stratified squamous epithelium with long, thin rate pegs extending deep into connective tissue

Question 23

What is the mechanism of action for phenytoin-induced GO?

Answer 23

elevated levels of collagen synthesis

Question 24

What is the mechanism of action for calcium channel blocker induced GO?

Answer 24

decreased calcium levels in fibroblasts and T cells.
nifedipine- induced GO have defective collagen production due to decreased levels of collagenase activity

Question 25

What is the mechanism of action cyclosporin A induced GO?

Answer 25

cyclosporin A directly impairs collagen synthesis of fibroblasts which increase levels of type I collagen. It also decreases expression of matrix metalloproteinase (MMPs) which degrades extracellular matrix

Question 26

T/F: drug induced gingival overgrowth cannot be prevented

Answer 26

True. but it can be reduced by eliminating local factors, plaque control, and regular periodontal maintenance

Question 27

What are some ways to treat drug induced gingival overgrowth?

Answer 27

eliminate local factors, plaque control, regular periodontal maintenance, surgical elimination via gingivectomy or gingivoplasty the most effective treatment is withdrawn or substitution of the medication

Question 28

T/F: Recurrence rate is high for treating drug induced gingival overgrowth.

Answer 28

True

Question 29

What are the three types of conditioned gingival enlargements?

Answer 29

Hormonal, Nutritional, and Allergic

Question 30

Plaque is necessary for initiation of conditioned enlargements. It is the sole determinant of the clinical feature. a. both statements are true b. both statements are false c. first statement true. second statement false d. first statement false. second statement true

Answer 30

c. first statement true. second statement false

Question 31

What are other gingival overgrowths seen often in clinic?

Answer 31

pregnancy, puberty, and vitamin c deficiency

Question 32

What is the most helpful way to manage gingival overgrowth?

Answer 32

reducing plaque

Question 33

Where does Wegener Granulomatosis usually stem from?

Answer 33

respiratory tract

Question 34

Which systemic GO usually begins with eruption of primary/secondary dentition and can sometimes regress after extraction?

Answer 34

Idiopathic gingival enlargement Cause is unknown but thought that teeth were the initiating factor

Question 35

What is the most common neoplastic enlargement?

Answer 35

Fibroma

Question 36

Where do fibromas arise from?

Answer 36

gingival c.t. or PDL

Question 37

What does a Fibroma/neoplastic enlargement look like?

Answer 37

same color as gingiva and can be painful or painless or firm or soft

Question 38

What neoplastic enlargement is associated with human papilloma virus?

Answer 38

Papilloma Appear as solitary, cauliflower/wart like protuberances HPV 6 and 11 are isolated

Question 39

Which human papilloma virus is usually associated?

Answer 39

HPV 6 and 11

Question 40

Which side does Peripheral giant cell granuloma arise from?

Answer 40

labial/buccal

Question 41

In Peripheral giant cell granuloma, if it has a stock is it: a. sessile b. pedunculated

Answer 41

b. pedunculated if it has no stock= sessile

Question 42

Where can malignant tumors of gingiva arise from? a. carcinoma b. sarcoma c. malignant melanoma d. metastasis e. all of the above

Answer 42

e. all of the above

Question 43

Are false enlargements soft or hard?

Answer 43

Hard because it's overgrown bone underneath gingiva