Periodontal lesions

Question 1

Clinical Presentation: Bright red, velvety or papillary, carpet looking plaque right at GM
Facial gingiva; maxillary predilection (max anterior usually)

Typically solitary; occasionally multifocal, at gingival margin

not due to poor hygiene

Answer 1

Localized Juvenile Spongiotic Gingival Hyperplasia aka Spongiotic gingival hyperplasia

Initially described in 2007  Idiopathic gingival alteration; externalized junctional or sulcular epithelium  Vast majority under age 20 (median 12 yrs)

Question 2

tx for Localized Juvenile Spongiotic Gingival Hyperplasia aka Spongiotic gingival hyperplasia

response to oral hygiene? recurrence?

Answer 2

No response to improved oral hygiene

 Conservative surgical excision with up to 16% recurrence rate; possibility for spontaneous regression

Question 3

First described in the young men who fought in the trenches during WWI, thus the term “trench mouth”  Mixed bacterial infection; controversial viral component  Contributing factors: stress, poor oral hygiene, poor diet, immune suppression, smoking, etc.

Answer 3

Necrotizing Ulcerative Gingivitis (NUG)  Previously termed ANUG

Question 4

Usually affects young or middle-aged adults

Clinical Presentation: “Punched-out” interdental papillae  Localized or diffuse gingival involvement  Severe pain, oral malodor, spontaneous hemorrhage

Answer 4

Necrotizing Ulcerative Gingivitis

Question 5

Necrotizing Ulcerative Gingivitis
 Occasionally, the process spreads to adjacent soft tissues, called _

 If necrotizing infection extends through mucosa to cutaneous surface of face, termed _

Answer 5

necrotizing ulcerative mucositis, necrotizing stomatitis - soft tissues

noma (cancrum oris)
- worst case, seein in very immunocompromised patient,

Question 6

NUG - Treatment

Answer 6

Debridement (using topical or local anesthesia)

Mild salt water rinse or chlorhexidine

Improve oral hygiene and diet

Broad spectrum antibiotic may be helpful, particularly if systemic symptoms

Question 7

Clinical term used to describe sloughing of the gingival epithelium

Associated with several different immunemediated vesiculobullous diseases (ie - erosive lichen planus, mucous membrane pemphigoid, pemphigus vulgaris)

Clinical description, not a diagnosis

Answer 7

Desquamative Gingivitis

Patient management: Incisional biopsy is necessary for definitive diagnosis

Superficial slushing off/ peeling off of squamous epi cells
Not specific

Question 8

Abnormal growth of gingival tissues secondary to use of a systemic medication

Diffuse involvement

Degree of clinical enlargement related to patient’s susceptibility and level of oral hygiene

Answer 8

Drug-Related Gingival Hyperplasia

aka – drug-related gingival overgrowth, drug-related gingival enlargement

Question 9

_ was first drug to be associated with gingival enlargement

Answer 9

Phenytoin (Dilantin)

an anti-seizure medication. causes folate deficiency

Question 10

In the 1980’s, _ agents were determined to cause gingival enlargement

_ was added to the list, treat and prevent graft-versus-host disease in bone marrow transplantation and to prevent rejection of kidney, heart, and liver transplants.[14][15] It is also approved in the US for treating of rheumatoid arthritis and psoriasis, persistent nummular keratitis following adenoviral keratoconjunctivitis,[16][15] and as eye drops for treating dry eyes caused by Sjögren’s syndrome and meibomian gland dysfunctio

Answer 10

nifedipine - used to manage angina, high blood pressure, and the calcium channel-blocking

Cyclosporin - an immunosuppressant medication and natural produc

Question 11

tx for Drug-Related Gingival Hyperplasia

Answer 11

Removal of the offending medication may result in cessation and some regression of the gingival enlargement

Home plaque control regimens and surgical therapy (gingivectomy) as needed

Question 12

Slowly progressive collagenous overgrowth of the gingiva

Isolated or familial

May be generalized or localized

Gingiva is firm, normal color

Answer 12

Gingival Fibromatosis
aka- fibromatosis gingivae

Other findings sometimes observed: Hypertrichosis - hairy
Epilepsy
Intellectual disability

Question 13

Gingival Fibromatosis tx

what can we do to reduce incidence of recurrence

Answer 13

Oral hygiene instruction

Gingivectomy (ideally delayed until after complete eruption of permanent dentition); reduced tendency for recurrence

 Selective tooth extractions sometime necessary in severe cases - because teeth seem to play some role in the gingival fibromatosis