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Module 6 - Periodontology > Periodontitis and Systemic Disease 2 > Flashcards

Periodontitis and Systemic Disease 2 Flashcards

1
Q

What is desquamative gingivitis? What is its clinical appearance?

A
  • A CLINICAL DESCRIPTION - gingivae are red, glazed with ulceration and desquamation of the attached gingivae.
  • NOT plaque induced.
  • NOT a diagnosis.
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2
Q

What causes pemphigoid and pemphigus? What is their clinical appearance?

A
  • Associated with problems in the CELL to CELL attachment in the epithelium.
  • VESICULAR BULLOUS CONDITION.
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3
Q

Name 5 diseases thst can present as desquamative gingivitis?

A
  • Lichen planus.
  • Benign mucous membrane pemphigoid.
  • Pemphigus vulgaris.
  • Plasma cell gingivitis.
  • Erythema multiforme.
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4
Q

What is lichen planus? what is a common oral clinical presentation?

A
  • Inflammatory condition.
  • Buccal mucosa (white striae).
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5
Q

How is a diagnosis of desquamative gingivitis made?

A
  • History, examination and BIOPSY (to identify underlying cause).
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6
Q

How are the diseases that cause desquamative gingivitis classified in the 2017 classification?

A

Gingival diseases: Non dental biofilm induced - section 3 inflammatory conditions and lesions.

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7
Q

What is the role of the biofilm in desquamative periodontitis?

A
  • NOT plaque induced.
  • Poor OH will EXACERBATE/ WORSEN it, thus patients receive perio treatment as part of management.
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8
Q

What does DIGE stand for?

A

Drug influenced gingival enlargements.

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9
Q

What causes DIGE?

A

Aberrant (abnormal) effects not expected from the known pharmacological actions of the drug when given in normal therapeutic doses.

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10
Q

How is DIGE classified in the 2017 classification?

A

Gingivitis: Dental Biofilm induced - C. drug influenced gingival enlargements.

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11
Q

3 disadvantages of DIGE?

A
  1. Difficult to maintain OH (increases perio risk).
  2. Aesthetic problems.
  3. Functional problems (patient occluding into excessive gingival tissues).
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12
Q

What does hyperplasia mean?

A

Increase in the number of cells.

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13
Q

Name the 3 main groups of drugs associated with gingival enlargements?

A
  1. Anti epilectic drugs.
  2. Calcium channel blockers.
  3. Immune regulators.
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14
Q

2 anti epileptic drugs associated with DIGE?

A
  1. PHENYTOIN.
  2. Sodium valproate.
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15
Q

5 Calcium channel blockers associated with DIGE?

A
  1. Nifedipine.
  2. Amlodipine.
  3. Verapamil.
  4. Diltiazem.
  5. Felodipine.
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16
Q

What are calcium channel blockers used for?

A

Hypertension

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17
Q

1 immune regulator associated with DIGE? Who is it used by?

A

Cyclosporine.
- Used for immunosuppression in transplant patients.

18
Q

What causes DIGE?

A
  • Lack of understanding of underlying mechanisms.
  • PLAQUE BIOFILM is required alongside the drug (plaque-induced inflammation needed).
19
Q

What is a known cellular/ molecular mechanism of DIGE?

A
  • Target cells affected are GINGIVAL FIBROBLASTS.
  • Increased production of EXTRACELLULAR MATRIX PROTEINS.
  • REDUCED COLLAGENASE production leading to REDUCED TISSUE TURNOVER.
20
Q

What age group is usually affected by DIGE? What part of the mouth? How long after starting medication? What is its effect on LoA?

A
  • Higher prevalence in YOUNGER AGE GROUP.
  • Tends to affect ANTERIOR REGION, PAPILLA FIRST.
  • Within 3 MONTHS of starting medication.
  • No associated LoA.
21
Q

What is the difference between Phenytoin vs Cyclosporine vs Calcium Channel Blockers in terms of oral clinical presentation?

A
  • Phenytoin: FIBROTIC enlargements.
  • Cyclosporine: high INFLAMMATION (vascular, bleeding) with LITTLE FIBROSIS.
  • CCB: Both FIBROSIS and INFLAMMATION.
22
Q

Approximate incidence of DIGE for all 3 drugs?

A
  • Phenytoin: 50%.
  • Cyclosporine: 30%.
  • CCB: 15%.
23
Q

Which patients are at increased risk of developing DIGE?

A

KIDNEY TRANSPLANT
- Cyclosporine for transplant.
- CCB for renal problems.

INCREASES CHANCE OF GETTING GINGIVAL ENLARGEMENT.

24
Q

How can DIGE be prevented (3)?

A
  • 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!!!!!
25
Q

What is the effect of good plaque control on DIGE?

A

Good plaque control will NOT PREVENT overgrowth but may REDUCE SEVERITY.

26
Q

What can be used for phenytoin induced DIGE?

A

FOLIC ACID SUPPLEMENTATION (if plasma and RBC levels of folate are low).

27
Q

What healing do you get following open wound gingivectomy?

A

Get healing by SECONDARY INTENTION.

28
Q

What must be done after performing an open wound gingivectomy?

A
  • Pack with a PERIODONTAL PACK for 1-2 weeks to PROTECT the wound during healing.
  • Allows EPITHELIAZATION and PROTECTS THE HEALING WOUND.
29
Q

What is the management of DIGE?

A

OPEN WOUND/ FACE GINGIVECTOMY.

30
Q

What is the most common cause of gingival enlargement/ overgrowth?

A

PLAQUE INDUCED INFLAMMATION!!

31
Q

What causes a pregnancy epulis? What type of enlargement is it?

A
  • Hormonal changes during pregnancy result in EXCESSIVE REACTION TO PLAQUE/ CALCULUS.
  • Pyogenic granuloma.
32
Q

What is hereditary gingival fibromatosis? 2 clinical oral presentations.

A
  • Condition that causes the gingivae to constantly overgrow.
  • Gingivae make arches very wide (B-L direction).
  • Broad tuberosities.
33
Q

What is a hormonal cause of gingival overgrowth?

A
  • Pregnacy, puberty.
  • EPULIS!!!!!
34
Q

What is a neoplastic cause of gingival overgrowth?

A

Leukaemia.

35
Q

What condition has “strawberry gums” as its unique presentation?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

36
Q

What is Granulomatosis with polyangitis? What does it cause in the body? Another name for it?

A
  • Wegener’s granulomatosis.
  • RARE AUTOIMMUNE diseases which results in DISSEMINATED GRANULOMATOUS VASCULITIS of SMALL VESSELS.
  • Potentially fatal due to RESPIRATORY DISEASE and RENAL FAILURE.
37
Q

What is an oral symptom characteristic of Granulomatosis with polyangiitis?

A

Strawberry gums.

38
Q

Another term for factitious injury?

A

Gingivitis artefacta.

39
Q

How is factitious injury classified in the 2017 Classification?

A

Gingival Diseases: Non-
Dental Biofilm-Induced – Section G Traumatic lesions.

40
Q

What is the oral presentation of factitious injury (4)? What age group presents with it usually?

A
  • LOCALIZED lesions on gingiva.
  • May be ULCERATED
    or have MARGINAL KERATOSIS from chronic trauma.
  • May have NOTCHED RECESSION DEFECTS causing by nails, knives, pens etc.
  • YOUNG people.
41
Q

2 causes of factitious injury?

A
  • HABITUAL behavior.
  • ATTENTION SEEKING - psychiatric disorder.

Module 6 - Periodontology (3 decks)

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