Gingival Enlargements Short And Long Essay Question And Answers

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Gingival Enlargements

Gingival Enlargements Definitions

1. Periodontal abscess

  • The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Gingival Enlargements Important Notes

1. Gingival enlargement

  1. Based on etiology
    • Inflammation – Acute
    • Chronic
  2. Drug-induced
    • Phenytoin
    • Cyclosporins
  3. Systemic diseases
    • Conditioned enlargements
      • Puberty
      • Pregnancy
      • Non-specific
    • Systemic diseases
      • Leukemia
    • Neoplastic
      • Benign tumors
      • Malignant tumors
    • False enlargements
      • Idiopathic
  4. According to location
    • Localized-limited to one/more teeth
    • Generalized- involves the entire mouth
    • Papillary-confined to interdental papilla – Marginal- confined to marginal gingiva – Diffuse-involves entire gingiva
    • Discrete-isolated lesions
  5. According to the degree
    • Grade 0- Normal gingiva
    • Grade 1- Involves interdental gingiva
    • Grade 2- Involves marginal and interdental papilla
    • Grade 3- Covers 3/4th of the crown of teeth

2. Leukemic gingival enlargement

  • Occurs only in the acute type and not in the chronic type
  • Mostly occurs in acute monocytic leukemia
  • The gingival connective tissue is infiltrated with immature leukocytes

3. Gingival enlargements and their locations

Gingival Enlargements Gingival enlargement and their locations

4. Cyclosporine

  • It is a potent immunosuppressive drug used to prevent organ transplant rejection and treat several autoimmune diseases
  • Gingival enlargement, nephrotoxicity, hypertension, etc are its side effects
  • Another immunosuppressive tacrolimus exhibits less severe gingival inflammation
  • It is used as a substitute for cyclosporine

5. Phenytoin

  • It is used to treat all forms of epilepsy
  • Gingival enlargements occur in 50% of patients on this drug
  • It often occurs in young patients
  • Phenytoin stimulates the fibroblasts and reduces collagen degradation
  • Ethosuximide, valproic acid, and mephenytoin are other antiepileptic drugs causing gingival enlargements

6. Plasma cell gingivitis

  • Gingiva appears red, friable, granular
  • It bleeds easily
  • It may be associated with cheilitis and glossitis
  • It is allergic in origin possibly related to components of chewing gums, denitrifies, or diet.

7. Gingival abscess

  • It is a localized, painful rapidly expanding lesion of sudden onset
  • It is limited to marginal gingiva or interdental papilla
  • It is due to foreign substances carried deep into the tissues such as toothbrush bristle, a piece of apple core, or a lobster shell

Gingival Enlargements Long Essays

Question 1. Classify gingival enlargements. Discuss the history- theology and clinical features of drug-induced gingivitis.
Answer:

Gingival Enlargements Classification:

1. Based on etiology:

Inflammation:

  • Acute
  • Chronic

Drug-Induced:

  • Phenytoin
  • Cyclosporins

Gingival Enlargements Systemic diseases:

  • Conditioned enlargements:
    • Puberty
    • Pregnancy
    • Non-specific
  • Systemic diseases:
    • Leukemia
  • Neoplastic:
    • Benign tumors
    • Malignant tumors
    • False enlargements:
    • Idiopathic:

Read And Learn More: Periodontics Question and Answers

3. According to the degree:

  • Grade 0- Normal gingiva
  • Grade 1- Involves interdental gingiva
  • Grade 2- Involves marginal and interdental papilla
  • Grade 3- Covers 3/4th of the crown of teeth

Drug-Induced Gingivitis:

Drug-Induced Gingivitis Clinical Features:

  • It occurs 3 months after initiation of phenytoin therapy
  • Common in younger individuals
  • Generalized distribution but severe in the maxilla
  • The site involved- marginal gingiva and interdental papilla
  • Appears as a painless, bead-like enlargement
  • Interferes with occlusion
  • Has lobulated surface
  • Firm to resilient in consistency
  • No tendency to bleed

Drug-Induced Gingivitis Histopathology:

1. Epithelium:

  • Shows varying degrees of acanthosis
  • Elongated, thin rete pegs are present
  • Increased epithelial pearls
  • Presence of PMNs

2. Lamina propria:

  • The proliferation of fibroblasts present
  • There is an increase in collagen production

Question 2. Classify different gingival enlargements. Describe in detail acute inflammatory enlargement.
Answer:

Gingival enlargement Classification:

1. According to the etiology:

Inflammation:

  • Acute
  • Chronic

Drug-Induced:

  • Phenytoin
  • Cyclosporins
  • CCB’s

Systemic diseases:

  • Conditioned Vitamin C deficiency
  • Puberty
  • Pregnancy
  • Non-specific
  • Systemic diseases – Leukemia

Neoplastic:

  • Benign
  • Malignant
  • False enlargements

2. According to Location:

Localized: limited to one/more teeth

  • Generalized: Involves entire mouth
  • Papillary: Confined to interdental papilla
  • Marginal: Confined to the marginal gingiva
  • Diffuse: involves the entire gingiva
  • Discrete: Isolated lesions

3. According to the degree:

  • Grade 0: Normal gingiva
  • Grade 1: Involves interdental papilla
  • Grade 2: Involves marginal and interdental papilla
  • Grade 3: Covers 3/4th of the crown of teeth

Acute Inflammatory Enlargement:

  • Sudden localized painful expanding lesion occurring on biting of hard objects like apple or fish thorns

Etio-Pathogenesis:

Gingival Enlargements Etio-Pathogenesis

Gingival enlargement Features:

  • Site – Localized to the marginal gingiva
  • Color – Reddish
  • Surface – Smooth and shiny
  • Symptoms – Painful, expanding lesion
  • Sign – Bleeding on probing
  • Tender on percussion
  • Exudation of purulent material
  • Size – Swollen gums

Gingival enlargement Treatment:

  • Removal of etiological factors
  • Incision and drainage of abscess
  • In persistent cases, prescribe antibiotics

Gingival Enlargements Short Essays

Question 1. Pericoronal Abscess.
Answer:

  • It is a localized accumulation of pus covering the crown of unerupted/partially erupted teeth

Pericoronal Abscess Etiology:

  • Plaque accumulation around the impacted teeth

Pericoronal Abscess Features:

  • Red, swollen, erythematous gingiva around impacted teeth
  • Interferes with occlusion

Pericoronal Abscess Radiographic Features:

  • Radiograph shows impacted teeth

Pericoronal Abscess Treatment:

  • Flap removal
  • Impaction

Question 3. Dilantin sodium-induced hyperplasia.
Answer:

Dilantin Sodium-Induced Hyperplasia Clinical Features:

  • It occurs 3 months after initiation of phenytoin therapy
  • Common in younger individuals
  • Generalized distribution but severe in the maxilla
  • Site involved-marginal gingiva and interdental papilla
  • Appears as a painless, bead-like enlargement
  • Interferes with occlusion
  • Has lobulated surface
  • Firm to resilient in consistency
  • No tendency to bleed

Dilantin Sodium-Induced Hyperplasia Histopathology:

1. Epithelium:

  • Shows varying degrees of acanthosis
  • Elongated, thin rete pegs are present
  • Increased epithelial pearls
  • Presence of PMNs

2. Lamina propria:

  • The proliferation of fibroblasts present
  • There is an increase in collagen production

Question 4. Differentiate Acute and Chronic Inflammatory Enlargement.
Answer:

Gingival Enlargements Differentiate acute and chronic inflammatory enlargement

Question 5. Differentiate periapical, periodontal, and gingival abscesses.
Answer:

Gingival Enlargements Differentiate periapical,periodontal and gingival abscess

Question 6. Drug-induced Gingival Enlargement.
Answer:

Drugs Causing Enlargement:

Gingival Enlargements Drugs causing enlargement

Drugs Causing Enlargement Features:

  1. Duration – 3 months after initiation of drug therapy
  2. Location – Generalized
    • Severe in maxilla
  3. The site involved – Marginal gingiva and interdental papilla
  4. Appearance – Painless, bead-like enlargement
  5. Complication – Interferes with occlusion
    • Absence of inflammation
      • Mulberry shaped enlargement
      • Color-pale pink
    • Presence of inflammation
      • Color-red/bluish-red
      • Presence of increased bleeding
  6. Consistency – Firm and resilient
  7. Surface:
    • Lobulated
  8. Bleeding:
    • Absent

Drugs Causing Enlargement Pathogenesis:

  • The similarity in the structure of phenytoin and sub-population of fibroblasts
  • Thus, fibroblasts become sensitive to phenytoin
  • Results in increased collagen production

Drugs Causing Enlargement Treatment:

Step 1:

  • Oral prophylaxis
  • Substitute drug
  • Recall

Step 2:

  • Mild case – Gingivectomy
  • Severe destruction – flap surgery

Question 7. Leukemic Gingival Enlargement.
Answer:

Leukemic Gingival Enlargement Distribution:

  • Diffuse/marginal
  • Localized/Generalized

Leukemic Gingival Enlargement Appearance:

  • It increases in size gradually and covers the tooth crown
  • Tumor like enlargement
  • Color-bluish red
  • Surface-shiny
  • Consistency-moderately firm
  • Bleeding on probing – positive
  • Increased susceptibility to infections Associated symptoms: ANUG

Leukemic Gingival Enlargement Treatment:

  • Consult physician
  • Monitor hematological values
  • Antibiotic prophylaxis
  • Incision and drainage
  • Cleanse the area with cotton pellets soaked in hydrogen peroxide
  • Application of pressure with gauze

Question 8. Classify gingival enlargement. Add a note on idiopathic gingival enlargement.
Answer:

Gingival Enlargement:

  • It is an increase in the size of the gingiva

Classification:

1. Based on etiology:

  1. Inflammation
    • Acute
    • Chronic
  2. Drug-induced
    • Phenytoin
    • Cyclosporins
  3. Systemic diseases
    • Conditioned enlargements
      • Puberty
      • Pregnancy
      • Non-specific
  4. Systemic diseases
    • Leukemia
  5. Neoplastic
    • Benign tumors
    • Malignant tumors
  6. False enlargements
  7. Idiopathic

2. According to the location:

  1. Localized-limited to one/more teeth
  2. Generalized- involves the entire mouth
    • Papillary-confined to interdental papilla
    • Marginal- confined to the marginal gingiva
    • Diffuse- involves the entire gingiva
    • Discrete- Isolated lesions

Idiopathic Gingival Enlargement:

  • It is a rare condition of unknown etiology

Clinical Features:

  • It has diffuse involvement
  • Involves attached gingiva, marginal gingiva, and inter-dental papilla
  • The affected gingiva is firm, pink, and leathery in consistency and has a pebbled surface
  • Facial and lingual surfaces of the mandible and maxilla are generally affected
  • Teeth are almost completely covered by the gingival enlargement
  • The enlargement projects into the oral vestibule
  • Jaws appear distorted
  • Secondary inflammatory changes occur

Question 9. How will you differentiate between scorbutic gingival enlargement and leukemic gingival enlargement?
Answer:

Gingival Enlargements The differentiate between Features and Scorbutic enlargement Leukemic enlargement

Question 10. Compare drug-induced gingival enlargement and leukemic gingival enlargement.
Answer:

Gingival Enlargements Compare drug lnduced and leukemic gingival enlargemwnt.

Question 11. Compare drug Induced and Idiopathic gingival enlargement.
Answer:

Gingival Enlargements Compare drug lnduced and Idiopathic gingival enlargement

Question 12. Benign tumors of the gingiva.
Answer:

Benign Tumours Of Gingiva:

1. Focal fibrous hyperplasia:

  • It is present often in adults
  • It is a nodular lesion
  • Has dome-like growth with a smooth surface of normal color
  • Surface keratosis occurs
  • It is slow progressing lesion
  • It may remain the same size for many years
  • It is also known as peripheral fibroma

2. Peripheral ossifying fibroma:

  • It is a gingival nodule consisting of reactive hyperplasia of connective tissue containing focal areas of bone

Peripheral ossifying fibroma Clinical Features:

  • It represents a well-demarcated, encapsulated, ex-pantile, central jaw lesion
  • It is localized, painless, non tendered bony hard swelling.
  • It is a slow-growing lesion
  • It leads to the expansion and distortion of cortical plates
  • There may be displacement of regional teeth

3. Peripheral giant cell granuloma:

  • It is the hyperplastic reaction of gingival connective tissue in which the histiocytic and endothelial cellular components predominate

Peripheral giant cell granuloma Clinical Features:

  • Age- during the mixed dentition period
  • Sex- common in females
  • Site- interdental papilla
  • Appears as a small, exophytic, well-circumscribed, pedunculated lesion on the gingival surface
  • It is painless, firm, and lobulated
  • Surface- smooth or granular
  • Size-less than 2 cm in diameter
  • Color-purplish-red to dark-red in color
  • The overlying epithelium is ulcerated
  • Consistency-firm
  • Bleeding occurs spontaneously
  • Some lesions may develop with hour-glass shapes located between teeth and lobulated extremities projecting both buccally and lingually

4. Gingival cyst:

  • It is derived from the rest of the dental lamina

Gingival Cyst Clinical Features:

  • It occurs as firm, compressible, fluid-filled swelling on the facial gingiva usually in the anterior or premolar region
  • It usually develops as a solitary lesion
  • Color remains normal
  • Occurs on attached gingiva or interdental papilla

Question 13. Clinical features of drug-induced gingival enlargement.
Answer:

Drug-Induced Gingival Enlargement :

  • Phenytoin
  • Cyclosporins
  • CCB’s
    • It occurs 3 months after initiation of phenytoin therapy
    • Common in younger individuals
    • Generalized distribution but severe in the maxilla
    • The site involved- marginal gingiva and interdental papilla
    • Appears as a painless, bead-like enlargement
    • Interferes with occlusion
    • Has lobulated surface
    • Firm to resilient in consistency
    • No tendency to bleed

Gingival Enlargements Short Answers

Question 1. Periodontal abscess.
Answer:

  • The periodontal abscess is a localized accumulation of pus within the gingival wall of the periodontal pocket

Periodontal abscess Etiology:

  • Presence of plaque and calculus

Periodontal abscess Clinical Features:

  • Involves deep periodontal structures
  • Localized pain
  • Deep pockets
  • Vital tooth
  • Tender on lateral percussion
  • Tooth mobility
  • Associated fistula

Periodontal abscess Treatment:

  • Drainage
  • Flap surgery

Question 2. Conditioned Gingival Enlargements.
Answer:

  • Conditioned enlargements are caused by systemic conditions of the patient which exaggerates the usual ginger- val response to dental plaque

Conditioned Gingival Enlargements Types:

  • Hormonal
  • Nutritional
  • Allergic

Question 3. Angiogranuloma.
Answer:

  • Gingival enlargement in pregnancy is also known as angiogranuloma
  • It is an inflammatory response to local irritation
  • It is modified by the patient’s condition
  • It usually appears after the first trimester

Question 4. Drug-induced gingival enlargements.
Answer:

Drug-Induced Gingival Enlargements Clinical Features:

  • It occurs 3 months after initiation of phenytoin therapy
  • Common in younger individuals
  • Generalized distribution but severe in the maxilla
  • The site involved- marginal gingiva and interdental papilla
  • Appears as a painless, bead-like enlargement
  • Interferes with occlusion
  • Has lobulated surface
  • Firm to resilient in consistency
  • No tendency to bleed

Question 5. Write the difference between gingival and periodontal abscess.
Answer:

Gingival Enlargements Write difference between gingival and periodontal abscess

Question 6. Wegener’s Granulomatosis.
Answer:

  • It is a disease of unknown etiology
  • It basically involves the vascular, renal, and respiratory systems

Wegener’s Granulomatosis Clinical Features:

  • Occurs at any age
  • Common in males
  • Initially, there is the development of rhinitis, sinusitis, and otitis
  • The patient later develops cough and hemoptysis, fever, joint pain
  • Hemorrhagic or vesicular skin lesions are common

Wegener’s Granulomatosis Oral Manifestations

  • Affected gingiva is termed strawberry gingiva Gingival lesions may be ulcerations, friable granular lesions
  • It starts in the interdental papilla and spreads rapidly
  • This leads to bone loss and tooth mobility

Question 7. Developmental gingival enlargements.
Answer:

  • These enlargements are physiologic
  • During various stages of the eruption, the labial gingiva may show a bulbous marginal distortion caused by the superimposition of the bulk of the gingiva on normal enamel
  • This enlargement is known as developmental enlargement

Question 8. Differential diagnosis of epulis.
Answer:

  • Epulis refers to all discrete tumors and tumor-like masses of the gingiva
  • Differential diagnosis of it includes oral fibroma

Question 9. Leukemic gingival enlargement.
Answer:

Leukemic Gingival Enlargement Clinical Features:

Distribution:

  1. Diffuse or marginal
  2. Localized or generalized
    • It increases in size and gradually covers the tooth crown
    • It appears as a tumor-like enlargement
    • Color-bluish red in color
    • Surface-shiny surface
    • Consistency-spongy-like and friable
    • Gingiva bleeds spontaneously
    • Increased susceptibility to infections

Gingival Enlargements Viva Voce

  1. Three types of conditioned gingival enlargements are: hormonal, nutritional, and allergic
  2. Fibrotic gingival enlargement is a side effect of some anticonvulsants, calcium channel blockers, and immunosuppressant drugs
  3. Leukemic enlargement is generally bluish-red and has a shiny surface
  4. Administration of phenytoin may precipitate mega-holoblastic anemia and folic acid deficiency.
  5. Drug-induced gingival enlargement starts at the interdental papilla
  6. Cyclosporine causes highly vascularized gingival enlargement
  7. Systemic administration of phenytoin accelerates the healing of a gingival wound
  8. Tacrolimus can replace Cyclosporine
  9. Bacterial plaque is not necessary for the initiation of gingival enlargement in Wegener’s granulomatosis

 

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