Inspect the Gingivae

Normal gingivae are stippled, pink, and firm. Does the gingival tissue completely occupy the interdental space? Are the roots of the teeth visible, indicating recession of the periodontal tissue? Is there pus or blood along the gingival margin? Are the gingivae swollen? Is there

Figure 12-19 Angiokeratomas of the buccal mucosa. Figure 12-20 Erythroplakia of the gingiva (right).

evidence of bleeding? Is gingival inflammation present? Is abnormal coloration present? Erythroplakia is an area of mucous membrane on which there are granular, erythematous papules that bleed. Erythroplakia has a greater potential for malignancy than does leukoplakia. Figure 12-20 shows the mouth of a patient with erythroplakia of the gingiva (on the right) and inflammatory gingivitis (on the left).

There are many causes of gingival hyperplasia, including heredity, hormonal imbalances of puberty and pregnancy, medications, and leukemia. Gingival hyperplasia is common in patients taking phenytoin (Dilantin), an antiepilepsy medication, and in those taking nifedi-pine, a calcium channel blocker. It has been estimated that gingival hyperplasia develops in 30% to 50% of all patients taking phenytoin. The hyperplastic gingival changes of hormonal imbalances usually recede once the hormones have returned to their normal, lower levels. Figure 12-21 depicts marked gingival hyperplasia in a patient who was taking phenytoin. Dense leukemic infiltration of the gingiva is commonly seen in acute monocytic and acute monomyelocytic leukemia. Figure 12-22 shows gingival enlargement and bleeding caused by acute monomyelocytic leukemic infiltration.

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