Management of phenytoin-induced gingival enlargement: a case report

Self-Instruction Exercise No. 339
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Exercise No. 339
Subject Code: 490
Periodontics

The 15 questions for this exercise are based on the article, “Management of phenytoin-induced gingival enlargement: a case report”, on pages 61-67. This exercise was developed by Gustav Gates, DDS, MAGD, in association with the General Dentistry Self-Instruction Committee.

Reading the article and successfully completing the exercise will make enable you to:

  • identify the applications for high-powered magnification in general dentistry;
  • recognize the advantages of using high-powered magnification in general dentistry; and
  • understand how high-powered magnification can enhance patient treatment.

Answers for this exercise must be received by August 31, 2014.

  1. Gingival enlargement can be caused by all of the following medications except one. Which is the exception?

    A. H2 blockers
    B. anticonvulsants
    C. immunosuppressants
    D. calcium channel blockers

  2. Calcium channel blockers treat all of the following cardiovascular conditions except one. Which is the exception?

    A. hypotension
    B. angina pectoris
    C. coronary artery spasms
    D. cardiac arrhythmias

  3. Nifedipine causes gingival enlargement in ____ % of patients.

    A. 20
    B. 30
    C. 40
    D. 50

  4. All of the following anti-hypertensive drugs have been reported to induce gingival overgrowth except one. Which is the exception?

    A. felodipine
    B. isradipine
    C. nitrendipine
    D. nicardipine

  5. Successful use of cyclosporine A has been limited by the development of fibrosis of the __________.

    A. liver
    B. lungs
    C. small intestine
    D. kidneys

  6. Gingival enlargement frequently appears within 1 to 3 __________ after initiation of treatment with associated medications.

    A. days
    B. weeks
    C. months
    D. years

  7. Gingival enlargement starts as a painful bead-like enlargement of the interdental papilla. As the condition progresses, the marginal and papillary enlargements unite.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  8. Secondary inflammation of the gingival lesion produces an increase in size and __________.

    A. less bleeding
    B. deeper fissures
    C. a bluish red discoloration
    D. a pedunculated lesion

  9. The size of the secondary enlargement increases dramatically. The enlargement can be surgically removed without reoccurrence.

    A. Both statements are true.
    B. The first statement is true; the second is false.
    C. The first statement is false; the second is true.
    D. Both statements are false.

  10. Males are ____ times more likely to have gingival enlargement.

    A. 2
    B. 3
    C. 4
    D. 5

  11. The pathogenesis of gingival enlargement induced by phenytoin links to all of the following except one. Which is the exception?

    A. activation of collagenase
    B. genetic predisposition
    C. plaque-induced inflammation
    D. specific fibroblasts

  12. Prevention of drug-associated gingival enlargement includes __________.

    A. 4-month periodontal maintenance
    B. use of 0.12% sodium fluoride applications
    C. detailed oral hygiene instruction
    D. light rubber cup polishing monthly

  13. A short course of __________ has been used for nonsurgical treatment for slight to moderate gingival enlargement following CsA therapy.

    A. amoxicillin
    B. clindamycin
    C. azithromycin
    D. tetracycline

  14. Gingivectomy treatment of gingival enlargement allows for __________.

    A. technique simplicity
    B. painless surgery
    C. osseous recontouring
    D. sparing of the keratinized tissue

  15. It is recommended that at least ____ mm of keratinized tissue in the apico-coronal direction remain after a gingivectomy.

    A. 2
    B. 3
    C. 4
    D. 5


Evaluation

Please respond to the statements below, using the following scale:
1 Poor; 2 Below average; 3 Average; 4 Above average; 5 Excellent

Practicality of the content 1 2 3 4 5
Benefit to your clinical practice 1 2 3 4 5
Quality of illustrations 1 2 3 4 5
Clarity of objectives 1 2 3 4 5
Clarity of exercise questions 1 2 3 4 5
Relevance of exercise questions 1 2 3 4 5
 
Did this exercise achieve its objectives? Yes No
Did this article present new information? Yes No
How much time did it take you to complete this exercise? mins


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