2014 self-study course two course The Ohio State University College of Dentistry is a recognized provider for ADA, CERP, and AGD Fellowship, Mastership and Maintenance credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit house by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education ABOUT this FREQUENTLY asked COURSE… QUESTIONS… Q: Who can earn FREE CE credits? . READ the MATERIALS. Read and review the course materials. A: EVERYONE - All dental professionals in your office may earn free CE contact . COMPLETE the TEST. Answer the credits. Each person must read the eight question test. A total of 6/8 course materials and submit an questions must be answered correctly online answer form independently. for credit. us . SUBMIT the ANSWER FORM Q: What if I did not receive a ONLINE. You MUST submit your confirmation ID? answers ONLINE at: A: Once you have fully completed your p h o n e http://dent.osu.edu/sterilization/ce answer form and click “submit” you will be directed to a page with a . RECORD or PRINT THE 614-292-6737 unique confirmation ID. CONFIRMATION ID This unique ID is displayed upon successful submission Q: Where can I find my SMS number? of your answer form. A: Your SMS number can be found in t o l l f r e e the upper right hand corner of your 1-888-476-7678 monthly reports, or, imprinted on the back of your test envelopes. The SMS number is the account number for ABOUT your your office only, and, is the same for f a x FREE CE… everyone in the office. 614-292-8752 Q: How often are these courses available? . TWO CREDIT HOURS are issued for successful completion of this self- A: FOUR TIMES PER YEAR (8 CE credits). e - m a i l study course for the OSDB 2014-2015 biennium totals. [email protected] . CERTIFICATE of COMPLETION is used to document your CE credit and is mailed to your office. w e b . ALLOW 2 WEEKS for processing and www.dent.osu.edu/ mailing of your certificate. sterilization Page 1 GINGIVAL PATHOLOGY 2014 The primary focus of this study centers on abnormal proliferations and course disease processes that can involve the gingiva, either exclusively or as a part of their spectrum. While we are unable to discuss all of these entities, we will limit the current discussion to some of the more common ones. two INTRODUCTION Oral health professionals are given the task of maintaining gingival health. Gingivitis and periodontitis are the most common gingival pathology and, in most cases, remediation can be simply achieved by enforcing vigorous plaque control measures. Considering the extensive knowledge of dentists and Source: www.brown.edu dental hygienists about plaque- Fibroma related pathology, we are excluding the discussion on gingivitis and in patients older than 50 years of periodontitis in this study. age. Facial gingiva of the mandibular canine and premolar Topics that will be covered in this region is more frequently study include: involved. They appear as small, smooth surfaced, blue swellings • Cysts and Tumors that are primarily asymptomatic. • Reactive Proliferations • Hyperplasia Treatment • Infections • Autoimmune Processes Conservative surgical excision is • Pigmented Lesions the treatment of choice. • Premalignant and Malignant Recurrence rates are negligible. Processes FIBROMA: CYSTS AND TUMORS Fibroma is a benign proliferation written by GINGIVAL CYST: of fibrous connective tissue identified in areas undergoing amber kiyani, dds A gingival cyst is classified as an chronic irritation or trauma. odontogenic cyst arising from remnants of dental lamina, the band Clinical Features of epithelial tissue which gives way edited by for developing teeth. It is Fibromas show no age or sex rachel a. flad, bs considered a soft tissue counterpart predilection. They are commonly of a lateral periodontal cyst, due to karen k. daw, mba, cecm identified in the buccal and labial remarking similarity in their mucosa, tongue, and gingiva. histopathologic features. They appear as mucosal colored, sessile nodules that are firm on Clinical Features palpation. Presence of surface ulceration may be accompanied Gingival cysts are usually identified by some pain and discomfort. Page 2 Treatment mucosal colored nodules that appear on lingual mandibular attached gingiva of canines. The Conservative surgical excision with submission of lesions are frequently bilateral and are mostly tissue for histopathologic examination is identified in children. They tend to disappear as recommended. the person ages. They show striking clinical and histopathologic similarity to giant cell fibromas. INFLAMMATORY FIBROUS HYPERPLASIA: Treatment Inflammatory fibrous hyperplasia, or denture epulis, are benign proliferations of fibrous The lesion requires conservative surgical excision connective tissue that develop in association with for treatment. The excised giant cell fibroma an ill-fitting dental prosthesis. should be submitted for histopathologic examination to confirm diagnosis. Clinical Features INTRA-OSSESOUS CYSTS AND TUMORS: This process is usually identified in older individuals, and women tend to be more It is not uncommon for intra-osseous cysts and commonly affected. It appears as mucosal colored benign and malignant tumors to erode through folds of hyperplastic tissue that correspond with the cortical bone and appear as soft tissue the ill-fitting flange of the denture. The masses. A radiograph is usually sufficient to hyperplastic tissue is firm and fibrotic on determine an osseous origin. Benign cysts and palpation. While most lesions are primarily tumors tend to exhibit distinct margin, while asymptomatic, occasional reports of pain and malignancies are locally destructive with ill- discomfort may be noted when ulceration is defined margins. present. The size of the lesion can be highly variable, ranging between a few millimeters to the REACTIVE PROLIFERATIONS entire length of the vestibule. PARULIS: Treatment Parulis (gum boil) is a collection of granulation Surgical excision of hyperplastic tissue with tissue at the site of the sinus tract opening of a remaking or relining of the dental prosthesis is dental abscess. recommended. The excised tissue should be submitted for histopathologic examination to rule Clinical Features out any significant pathology mimicking this benign process. Parulides can be seen in patients over a wide age range. They present as small, red or yellow GIANT CELL FIBROMA: colored nodules on the alveolar or palatal mucosa. Patients usually report recurrent Giant cell fibroma is a benign fibrous neoplasm episodes of enlargement and compression of the that does not show an association with trauma. nodule. Compression is accompanied by discharge of foul-tasting pus. Clinical Features Treatment Giant cell fibromas are more frequently seen in younger patients. A female predilection is noted The offending tooth can be identified by pulp in some studies. Most lesions are identified on the testing the teeth in the vicinity. If pulp testing gingiva, but other sites of occurrence include the does not yield favorable results, insertion of a tongue and the palate. The lesion appears as a gutta percha point into the sinus tract followed by small, mucosal colored, papillary nodule that can radiographic imaging may aid in identifying the often be mistaken for a squamous papilloma. responsible non-vital tooth. Endodontic treatment or extraction of the offending tooth Retrocuspid papilla is a name given to small, leads to complete resolution of symptoms. Page 3 PERIPHERAL OSSIFYING FIBROMA: Treatment Peripheral ossifying fibroma is a common, reactive Surgical removal is the primary treatment. 10- proliferation of fibroblasts that occurs exclusively 15% of the lesions may recur locally. on the gingiva. Despite the similarity in names, this lesion is distinct from a central ossifying PYOGENIC GRANULOMA: fibroma; a benign intraosseous neoplasm. Despite the highly suggestive name, pyogenic Clinical Features granuloma has no association with microbial infections. It is a reactive proliferation of The lesion is identified more commonly in women granulation tissue, possibly induced due to low in their 20s. Peripheral ossifying fibroma appears grade irritation or trauma. as a smooth, pink, and sessile nodule. Surface ulceration and erythema are frequently noted. It Clinical Features is relatively smaller in size and rarely enlarge beyond 2 centimeters. The lesion is firm to hard Pyogenic granulomas can be seen in patients of in palpation depending on the amount of bone all ages. Some studies have suggested a strong formation. female predilection. Gingiva is the most frequent site of involvement. The lesion may also be Treatment identified on the tongue, lips, and buccal mucosa. Cutaneous involvement with this process is Conservative surgical excision is the treatment of common. It appears as a red, lobulated growth choice. Histopathologic examination is necessary that is frequently ulcerated, and it tends to bleed in order to establish diagnosis. A small easily on manipulation. The ability of rapid percentage of peripheral ossifying fibromas tend growth in pyogenic granulomas can occasionally to recur. generate concerns about malignancy. PERIPHERAL GIANT CELL GRANULOMA: Pyogenic granulomas are a frequent finding on the gingiva of pregnant women and may be Similar to peripheral ossifying fibroma, peripheral referred to as a pregnancy tumor. Hormonal giant cell fibroma is also a reactive proliferation changes are considered an etiological factor in that exclusively involves the gingiva. Some the pathogenesis of this process. These lesions studies have suggested that peripheral giant cell tend to enlarge over the course of the pregnancy. granuloma is the soft tissue counterpart of central Once the child is delivered, remission is usually giant cell granuloma.