This document discusses various causes and classifications of gingival enlargement. The main causes discussed include poor oral hygiene, smoking, systemic diseases, hormonal changes, medications, and genetic or blood conditions. Gingival enlargements are classified based on their etiology (inflammatory, drug-induced, associated with systemic diseases, neoplastic, or false), location (localized, generalized, marginal, papillary, or diffuse), and degree (grades I-III). Specific types of inflammatory and drug-induced enlargements are described along with their characteristics, etiologies, and treatment approaches. Enlargements associated with conditions like pregnancy, puberty, vitamin C deficiency, and leukemia are also outlined.
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
Phase I periodontal therapy is the first in the chronologic sequence of procedures that constitute periodontal treatment. It is also referred to as cause related therapy or non-surgical periodontal therapy.
BASIC CONCEPTS OF INFLAMMATION-STAGES OF INFLAMMATION-ALL ABOUT GINGIVAL INFLAMMATION-CLINICAL FEATURES AND STAGES OF GINGIVITIS-HOW TO MANAGE-ALL IN ONE-FOR B.D.S LEVEL PROJECTS AND SEMINARS
*Increase in size of gingiva. Lead to false pockets.
*Difficulties associated with it are:
Difficulty in plaque control; Aesthetic concerns; Affect mastication
Interfere with speech
*TREATMENT:
Gingivectomy is the treatment of choice to remove false pockets.
In case of true pockets (osseous defects), gingivectomy with Flap surgery is done. First Gingivectomy is done. After that flap is raised and osseous surgery is performed (either osteotomy or regenerative depending upon the type of defect). Gingivectomy is done by scalpel or electro cautery/lasers (to minimize bleeding). Gingivectomy can be done only where at least 3mm of keratinized gingiva remains after completion of surgery. So it is contraindicated in patients with lack of sufficient keratinized gingiva
*REASONS OF RECURRENCE:
Responsible factors: Residual local irritation; and systemic or hereditary conditions causing noninflammatory gingival hyperplasia.
Recurrence of chronic inflammatory enlargements immediately after treatment indicates that all irritants have not been removed. Contributory local conditions like food impaction and overhanging margins of restorations are commonly overlooked.
If the enlargement recurs after healing is complete and normal contour is attained, inadequate plaque control by the patient is the most common cause.
Periodontal instruments are designed for speciic purposes, such as
calculus removal, bioilm removal, and root planing. On irst investigation,
the variety of instruments available for similar purposes appears
confusing. With experience, however, clinicians select a relatively
small set that fulills all requirements.
Classification of Periodontal Instruments
Periodontal instruments are classiied according to the purposes they
serve, as follows:
1. Periodontal probes are used to locate, measure, and mark pockets,
as well as determine their course on individual tooth surfaces.
2. Explorers are used to locate calculus deposits and caries.
3. Scaling, root-planing, and curettage instruments are used for
removal of bioilm and calciied deposits from the crown and
root of a tooth, removal of altered cementum from the subgingival
root surface, and debridement of the soft tissue lining the poc ket.
Scaling and curettage instruments are classiied as follows:
• Sickle scalers are heavy instruments used to remove supragingival
calculus.
• Curettes are ine instruments used for subgingival scaling,
root planing, and removal of the soft tissue lining the pocket.
• Hoe, chisel, and ile scalers are used to remove tenacious
subgingival calculus and altered cementumT. heir use is limited
compared with that of curettes.
• Implant instruments are plastic or titanium scalers and curettes
designed for use on implants and implant restorations.
• Ultrasonic and sonic instruments are used for scaling and
cleansing tooth surfaces and curetting the soft tissue wall of
the periodontal pocket.42,43,66
4. Periodontal endoscopes are used for deep visualization into
subgingival pockets and furcations, thereby alloinwg the detectio n
of deposits.
5. Cleansing and polishing instruments, such as rubber cups, brushes,
and dental tape, are used to clean and polish tooth surfaces.
Air-powder abrasive systems are also available for supragingival
and subgingival cleaning and polishing of tooth, root, and implant
surfaces.
The wearing and cutting qualities of some types of steel used in
periodontal instruments have been tested,88,89,157 but speciications
vary among manufacturers.157 Stainless steel is used most often in
instrument manufacture. High–carbon content steel instruments are
available and are considered by some clinicians to be superior. Newer
advanced proprietary manufacturing processes for heat treating and
cryogenically tempering stainless steel are producing blades that ar e
sharper and longer lasting than ever before. In addition, ohter processes
produce stainless steel instruments with titanium nitride or other
surface coatings that are not embedded or diffused into the base
material. Their cutting edges are sharp when new, but these coatings
wear down during normal use and cannot be resharpened. Each
group of instruments has characteristic features; individual therapist s
often develop variations with which they operate most effectivelyuuw
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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1. Dr Jaffar Raza Syed Page 1
Gingival Enlargement
What are the possible causes?
• Poor dental hygiene
• Smoking, mouth breathing and overcrowded teeth
• Systemic diseases
• Hormonal states: pregnancy, puberty
• Nutritional deficiency: scurvy (vitamin C deficiency)
• Medications
• Genetic conditions, often present at birth (all rare conditions)
• Blood conditions such as acute leukaemia
2. Dr Jaffar Raza Syed Page 2
Classification
According to
etiological and
pathological changes
According to
location and
distribution
3. Dr Jaffar Raza Syed Page 3
Inflammatory
enlargement
•Acute
•Chronic
Drug-induced
enlargement
or Non
inflammatory
gingival
enlargement
Enlargement
associated
with systemic
diseases
•Conditioned
enlargement
•Systemic
diseases causing
gingival
enlargements
Neoplastic
Enlargement
False
Enlargement
CLASSIFICATION
A. According to etiologic factors and pathologic changes
I. Inflammatory enlargement
a. Chronic
b. Acute
II. Drug-induced enlargement
4. Dr Jaffar Raza Syed Page 4
Inflammatory
enlargement
• Acute
• Chronic
Drug-induced
enlargement or
Non inflammatory
gingival
enlargement
Enlargement
associated with
systemic diseases
• Conditioned
enlargement
• Systemic diseases
causing gingival
enlargements
Neoplastic
Enlargement
False Enlargement
III. Enlargements associated with systemic diseases
a. Conditioned enlargement
(i) Pregnancy
(ii) Puberty
(iii) Vitamin C deficiency
(iv) Plasma cell gingivitis
(v) Nonspecific conditioned enlargement (Granuloma pyogenicum)
b. Systemic diseases causing gingival enlargements
(i) Leukemia
(ii) Granulomatous diseases
5. Dr Jaffar Raza Syed Page 5
Inflammatory
enlargement
•Acute
•Chronic
Drug-induced
enlargement or
Non
inflammatory
gingival
enlargement
Enlargement
associated with
systemic
diseases
•Conditioned
enlargement
•Systemic diseases
causing gingival
enlargements
Neoplastic
Enlargement
False
Enlargement
IV. Neoplastic enlargement (Gingival tumors)
a. Benign tumors
b. Malignant tumors
V. False enlargement
6. Dr Jaffar Raza Syed Page 6
B. According to location and distribution
Localized : Gingival enlargement limited to one or more (group of) teeth.
Generalized : Entire mouth, the gingiva is enlarged
Marginal : Limited to the marginal gingiva
Papillary : Confined to the interdental papilla
Diffuse : Involves all the parts of the gingiva, i.e. marginal, attached and
Interdental gingiva
Discrete : Isolated sessile or pedunculated tumor-like enlargement
7. Dr Jaffar Raza Syed Page 7
According to the Degree of Gingival Enlargement
Grade 0 : No sign of gingival enlargement
Grade I : Enlargement confined to the interdental papilla
Grade II : Enlargement involves papilla and marginal gingiva
Grade III : Enlargement covers three quarters or more of the crown
9. Dr Jaffar Raza Syed Page 9
INFLAMMATORY ENLARGEMENT
two types: a. Acute b. Chronic
Acute Inflammatory Enlargement
Signs and Symptoms
a. Rapidly expanding lesion, usually limited to marginal gingiva or interdental papilla.
b. red, painful swelling with teeth sensitive tom purcussion
c. The lesion becomes fluctuant and pointed with a surface orifice from which
purulent exudate may be expressed.
Treatment
--Vigourous OHM
--Removal of abscess by I&D
--Warm salt water mouthwashes used every 2 hours
--Any residual pocketing can be removed by subgingival curettage or localized gingivectomy
11. Dr Jaffar Raza Syed
Chronic Inflammatory Enlargement
Types are:
• Localized
• Generalized
• Discrete/Tumor-like.
Localized/Generalized
• It originates as a slight ballooning
• In the early stages, it produces a lifesaver
this bulge increases until it covers part of the crown
• It progresses slowly and painlessly unless it is
• discrete sessile or pedunculated
the interproximal/marginal/attached gingiv
Chronic Inflammatory Enlargement
ballooning of the interdental papilla or margin
lifesaver-like bulge around the involved tooth and
it covers part of the crown.
and painlessly unless it is complicated by acute infection or trauma
mass resembling a tumor. It may occur in
interproximal/marginal/attached gingiva
Page 11
papilla or marginal gingiva.
around the involved tooth and
complicated by acute infection or trauma.
mass resembling a tumor. It may occur in
12. Dr Jaffar Raza Syed
Etiology
--prolonged local irritation
--poor oral hygiene,
--abnormal relationships of adjacent teeth and
opposing teeth,
--lack of tooth function,
--cervical cavities,
--overhanging margins of dental restorations,
--food impaction,
--irritation from clasps or saddle are
--nasal obstructions,
--habits such as mouth breathing and tongue thrusting
relationships of adjacent teeth and
dental restorations,
or saddle areas of removable prosthesis,
habits such as mouth breathing and tongue thrusting.
Page 12
13. Dr Jaffar Raza Syed Page 13
Treatment
a. Scaling and curettage:
b. Surgical removal:
indicated for two reasons:
i. if it is fibrotic component
ii. If the size of the enlargement interferes with the access to the root surface deposits.
Surgical techniques include:
a. Gingivectomy technique.
b. Flap operation.
14. Dr Jaffar Raza Syed
convulsants
Phenytoin
Noninflammatory Gingival Enlargement (Fibrotic Gingival Enlargement)
produced by factors other than local irritation
Mostly are drug induced as
phenytoin,
cyclosporine,
nifedipine,
diltiazem,
verapamil and
sodium valproate Drug-induced
enlargement or
Non
inflammatory
gingival
enlargement
Anti-
convulsants
Phenytoin
Calcium
channel
blockers
Nifedipine
immunosup
pressant's
Cyclospori
ne
Noninflammatory Gingival Enlargement (Fibrotic Gingival Enlargement)
produced by factors other than local irritation.
Page 14
immunosup
pressant's
Cyclospori
ne
Idiopathic
Gingival
Fibromatosi
s
Noninflammatory Gingival Enlargement (Fibrotic Gingival Enlargement)
15. Dr Jaffar Raza Syed
Phenytoin-induced Gingival Hyperplasi
--overgrowth usually becomes apparent
--starts as a painless, bead-like enlargement
and interdental papillae.
--As the condition progresses, the marginal and papillary
into a massive tissue fold covering a considerable portion of the crown and may
interfere with the occlusion
--hyperplasia is usually generalized
--secondary inflammatory process
induced Gingival Hyperplasia
usually becomes apparent in the first three months after phenytoin dosage
ike enlargement of facial and lingual gingival margins
As the condition progresses, the marginal and papillary enlargement unite and develop
covering a considerable portion of the crown and may
d but severe in max and mand anterior regions
secondary inflammatory process will complicates gingival hyperplasia caused by the dru
Page 15
in the first three months after phenytoin dosage
of facial and lingual gingival margins
enlargement unite and develop
covering a considerable portion of the crown and may
but severe in max and mand anterior regions
gingival hyperplasia caused by the drug
16. Dr Jaffar Raza Syed
Treatment
--Oral hygiene reinforcement
--Possible drug substitution
--Professional recalls
--surgical therapy
a.Small areas of enlargement with no attachment loss
b.Large areas of enlargement with presence of osseous
Small areas of enlargement with no attachment loss
(Gingivectomy)
Large areas of enlargement with presence of osseous defect
(periodontal flap)
Page 16
defects
18. Dr Jaffar Raza Syed
Enlargement in Pregnancy
--Aggravation of previous inflammatio
--Pregnancy does not cause the condition. The altered
pregnancy accentuates the response
--bright-red or magenta, soft and friable and has a smooth, shiny surface
--Bleeding occurs spontaneously or on slight provocatio
--Tumor-like Gingival Enlargement or
ggravation of previous inflammation
Pregnancy does not cause the condition. The altered tissue metabolism in
pregnancy accentuates the response to local irritation usually generalize
friable and has a smooth, shiny surface
or on slight provocation
like Gingival Enlargement or Pregnancy Tumor
Page 18
tissue metabolism in
usually generalized
friable and has a smooth, shiny surface.
19. Dr Jaffar Raza Syed Page 19
Treatment
--Aim is to minimize the potential exaggerated inflammatory response related to
hormonal alteration
--Meticulous plaque control
--The second trimester is the safest time in which treatment may be performed.
However, long stressful appointment and periodontal surgical procedures should
be postponed until postpartum
--Fully reclining position should be avoided
--Medication and radiographs should not be prescribed.
--In case of marginal and interdental enlargement, scalingnand curettage can be performed.
--In case of a tumor-like enlargement, surgical excision is required
21. Dr Jaffar Raza Syed
Nonspecific Conditioned Enlargement
tumor-like gingival enlargement that is considered
to be an exaggerated conditioned response
to minor trauma.
lesion varies from a discrete, spherical
tumor-like mass with a pedunculated attachment
to a flattened, keloid-like enlargement with a broad bas
Treatment includes
removal of the lesion along with the elimination
local irritating factors.
Nonspecific Conditioned Enlargement (Granuloma Pyogenicum)
like gingival enlargement that is considered
be an exaggerated conditioned response
lesion varies from a discrete, spherical
mass with a pedunculated attachment
like enlargement with a broad base
removal of the lesion along with the elimination of
Page 21
22. Dr Jaffar Raza Syed
Systemic Disease Causing Gingival
Leukemia
The enlargement may be
Diffuse
marginal,
localized or generalized.
It may appear as an oversized extension
of the marginal gingiva or a discrete tumor
interproximal mass.
Appearance bluish-red with a shiny surface.
The consistency is moderately firm
hemorrhage occurring either spontaneously or on sli
True leukemic enlargement occurs commonly in acute
subacute leukemia. It seldom occurs in chronic leukemia
Systemic Disease Causing Gingival Enlargement
It may appear as an oversized extension
marginal gingiva or a discrete tumor-like
red with a shiny surface.
consistency is moderately firm.
either spontaneously or on slight provocation.
True leukemic enlargement occurs commonly in acute leukemia but may also be seen in
seldom occurs in chronic leukemia
Page 22
leukemia but may also be seen in
23. Dr Jaffar Raza Syed Page 23
Treatment
remove the local deposits
control inflammatory component of the enlargement
scaling and curettage
OHM and OHI
Antibiotics
Refer the patient to the physician for medical evaluation and treatment
Prior to chemotherapy, a complete periodontal treatment plan should be prepared
Monitor hematological lab values daily
During acute phases of leukemia, patients should receive only emergency periodontal
care
25. Dr Jaffar Raza Syed Page 25
Benign Tumors of the Gingiva
• Fibroma
• Papilloma
• Peripheral giant cell granuloma
• Central giant cell granuloma
• Leukoplakia
• Gingival cyst
Malignant Tumors of the Gingiva
• Malignant melanoma
• Sarcoma most commonly Kaposi's sarcoma
• Metastasis
26. Dr Jaffar Raza Syed
Scoring of gingival enlargement
Grade 0
• No sign of gingival enlargement
Grade 1
• Enlargement confined to the
Grade 2
• Enlargement involves papilla and marginal
Grade 3
• Enlargement covers three quarters or more of the crown
Scoring of gingival enlargement
No sign of gingival enlargement
Enlargement confined to the interdental papilla
Enlargement involves papilla and marginal gingiva
Enlargement covers three quarters or more of the crown
Page 26
papilla
gingiva
Enlargement covers three quarters or more of the crown
27. Dr Jaffar Raza Syed Page 27
False Enlargement
not true enlargements of gingival tissues
appear as a result of increase in size of the underlying
osseous or dental tissues.