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27 Cards in this Set

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  • Back
What are the 3 elements that make up the structure of I&R Lesions?
1. Angioblastic elements
eg Capillaries and endothelial cell proliferation

2. Inflammatory Cells
Chronic - lymphocytes, macrophages, plasma cells
Acute - neutrophils
Foreign body giant cells

3. Fibroblastic elements
Fibroblasts and collagen
What is the cause of most I&R Lesions?
chronic irritation
What is Chronic Hyperplastic Gingivits and what is its cause?
It is a hyperplastic tissue response to chronic inflammation associated with local factors such as plaque, calculus and bacteria
Why and with What drugs does Drug-Mediated Gingival Hyperplasia occur?
There is an increased production of extra-cellular ground substance in the crevicular fluid which causes inflammation and subsequantly hyperplasia.

Some examples are:
Phenytoin (Dilatin) for epilepsy
Ca Channel Blockers (treat HT) eg Nifedipine
Cyclosporin (immunosupressant for organ transplants)

Also dependent on patient's oral hygiene
What are the clinical signs of Drug-Mediated Gingival Hyperplasia? (6)
- Marked localised or generalised gingival hyperplasia which appears to originate from an overgrowth of the interdental papillae

- Spreads over the labial/buccal/lingual/palatal surfaces of the crowns of the teeth

- More prominent anteriorly

- Firm tissue, show prominent stippling

- normal colour unless markedly inflamed

-Pseudopockets may result in plaque accumulation
What is the histology of DMGH?
- covered by overlying gingival SS
- underlying collagenous fibrous CT
- interspersed blood vessels
- variable chronic inflammatory cell infiltrate
What is the treatment of DMGH?
- Discontinue offending medication (under supervision of the attending MD)

- Substitution another drug

-Gingivectomy and vigorous oral hygiene, prevent re-development
What is a Pyogenic Granuloma?
A common, reapidly growing, painless, reddish mass, which appears tumour like. Its NOT due to pyogenic organisms, but rather an exuberant response to local irritation or trauma.

Can be anywhere on the body, bleeds easily. Gingiva, lips, tongue are all common sights.

Frequently occurs during pregnency
What is another name for a granuloma on the gingiva
What is the treatment for a PG?
Remove the irritant. Can excise, but best wait until it becomes fibrous, or better let a surgeon do it due to the heavy bleeding expected.

15% recur - this is due to not removing the cause/initiating factor
What is in a PG?
Granulation tissue = vessels + inflammatory cells + collagen
If women get a Pregnancy Granuloma, when is it most likely, and why does it ocur?
Begins in first trimester. Increases to the seventh month.

May be related to increasing levels of oestrogen and progesterone
What is the tx for a Pregnancy Granuloma?
May resolve post-partum. Will undergo fibrous maturation and develop into a fibrous epulis, can excise then.
Whats another name for Fibroepithelial Polyp?
Irritation Fibroma!!!
Whats another name for an Irritation Fibroma?
Fibroepithelial polyp!
What do PGCG's look like?
Usually less than 2cm, sessile or pedunculated, red-blue nodular mass similar to a Pyogenic Granuloma
What is the epidemiology of a PGCG?
60% in females. Mandible>Maxilla.
Peak incidence in 5th/6th decades
What are some histological aspects of a PGCG?
The (possibly ulcerated) SSE is seperated from the rest of the lesion by dense fibrous CT called the Grenz Zone

The core contains Fibrovascular stroma containing plump spindle shaped cells, osteoclast-like giant cells, erythrocytes and haemosiderin pigment

There may be reactive woven bone
What is the Treatment for a PGCG?
Conservative local excision.

10-15% recur. Scaling and polishing of adjacent teeth to remove source of irritation
What are other names for denture epulis?
Epulis fissuratum
Denture-induced fibrous hyperplasia
Inflammatory Fibrous Hyperplasia
What is Inflammatory Fibrous Hyperplasia/Epulis Fissuratum?
Usually single or multiple folds of hyperplastic tissue caused by the flange of an ill fitting denture

Can also take on a leaf like form, called Leaflike Denture Fibroma.
Describe Leaf-like Denture Fibroma
Usually found beneath a denture. Pedunculated with a serrated edge. Resembles a leaf, oddly enough
What is the histology of Inflammatory Denture Hyperplasia?
Elongated mucosal covered soft tissue containing a core of hyperplastic fibrous CT and possibly inflammation and salivary glands.
What is the treatment for Epulis Fissuratum?
Conservative excision, remake denture
What is Inflammatory Papillary Hyperplasia? What is it associated with?
Numerous asymptomatic red papules on the central region of the hard palatal mucosa.

It is associated with Candida infection
What is the histology of Inflammatory Papillary Hyperplasia?
Pseudoepitheliomatous hyperplasia may be seen.

Fine papillary projections with central connective tissue cores
Treatment of Inflammatory Papillary Hyperplasia???