Periodontitis and Systemic Disease 2 Flashcards
What is desquamative gingivitis? What is its clinical appearance?
- A CLINICAL DESCRIPTION - gingivae are red, glazed with ulceration and desquamation of the attached gingivae.
- NOT plaque induced.
- NOT a diagnosis.
What causes pemphigoid and pemphigus? What is their clinical appearance?
- Associated with problems in the CELL to CELL attachment in the epithelium.
- VESICULAR BULLOUS CONDITION.
Name 5 diseases thst can present as desquamative gingivitis?
- Lichen planus.
- Benign mucous membrane pemphigoid.
- Pemphigus vulgaris.
- Plasma cell gingivitis.
- Erythema multiforme.
What is lichen planus? what is a common oral clinical presentation?
- Inflammatory condition.
- Buccal mucosa (white striae).
How is a diagnosis of desquamative gingivitis made?
- History, examination and BIOPSY (to identify underlying cause).
How are the diseases that cause desquamative gingivitis classified in the 2017 classification?
Gingival diseases: Non dental biofilm induced - section 3 inflammatory conditions and lesions.
What is the role of the biofilm in desquamative periodontitis?
- NOT plaque induced.
- Poor OH will EXACERBATE/ WORSEN it, thus patients receive perio treatment as part of management.
What does DIGE stand for?
Drug influenced gingival enlargements.
What causes DIGE?
Aberrant (abnormal) effects not expected from the known pharmacological actions of the drug when given in normal therapeutic doses.
How is DIGE classified in the 2017 classification?
Gingivitis: Dental Biofilm induced - C. drug influenced gingival enlargements.
3 disadvantages of DIGE?
- Difficult to maintain OH (increases perio risk).
- Aesthetic problems.
- Functional problems (patient occluding into excessive gingival tissues).
What does hyperplasia mean?
Increase in the number of cells.
Name the 3 main groups of drugs associated with gingival enlargements?
- Anti epilectic drugs.
- Calcium channel blockers.
- Immune regulators.
2 anti epileptic drugs associated with DIGE?
- PHENYTOIN.
- Sodium valproate.
5 Calcium channel blockers associated with DIGE?
- Nifedipine.
- Amlodipine.
- Verapamil.
- Diltiazem.
- Felodipine.
What are calcium channel blockers used for?
Hypertension
1 immune regulator associated with DIGE? Who is it used by?
Cyclosporine.
- Used for immunosuppression in transplant patients.
What causes DIGE?
- Lack of understanding of underlying mechanisms.
- PLAQUE BIOFILM is required alongside the drug (plaque-induced inflammation needed).
What is a known cellular/ molecular mechanism of DIGE?
- Target cells affected are GINGIVAL FIBROBLASTS.
- Increased production of EXTRACELLULAR MATRIX PROTEINS.
- REDUCED COLLAGENASE production leading to REDUCED TISSUE TURNOVER.
What age group is usually affected by DIGE? What part of the mouth? How long after starting medication? What is its effect on LoA?
- Higher prevalence in YOUNGER AGE GROUP.
- Tends to affect ANTERIOR REGION, PAPILLA FIRST.
- Within 3 MONTHS of starting medication.
- No associated LoA.
What is the difference between Phenytoin vs Cyclosporine vs Calcium Channel Blockers in terms of oral clinical presentation?
- Phenytoin: FIBROTIC enlargements.
- Cyclosporine: high INFLAMMATION (vascular, bleeding) with LITTLE FIBROSIS.
- CCB: Both FIBROSIS and INFLAMMATION.
Approximate incidence of DIGE for all 3 drugs?
- Phenytoin: 50%.
- Cyclosporine: 30%.
- CCB: 15%.
Which patients are at increased risk of developing DIGE?
KIDNEY TRANSPLANT
- Cyclosporine for transplant.
- CCB for renal problems.
INCREASES CHANCE OF GETTING GINGIVAL ENLARGEMENT.
How can DIGE be prevented (3)?
- Good plaque control will NOT PREVENT overgrowth but may REDUCE SEVERITY.
- FOLIC ACID SUPPLEMENTATION may be effective for Phenytoin related gingival enlargement where plasma and RBC levels of folate were low.
- Contact Dr to change medication!!!!!
