Gingival Enlargement MCQs

Gingival Enlargement: Clinical Overview and Classification

1. What is the preferred modern terminology for an abnormal increase in the size of the gingiva?
a) Gingival Hypertrophy
b) Gingival Hyperplasia
c) Gingival Overgrowth or Gingival Enlargement
d) Hypertrophic Gingivitis

2. According to the text, gingival enlargement can be caused by all of the following EXCEPT:
a) Local inflammation
b) Systemic disease
c) Excessive fluoride exposure
d) Drug administration

3. Which of the following is NOT a major classification category of gingival enlargement?
a) Inflammatory Enlargement
b) Drug-Induced Enlargement
c) Traumatic Enlargement
d) False Enlargement

4. A gingival enlargement that is confined to the interdental papilla is best described as:
a) Localized
b) Papillary
c) Marginal
d) Discrete

5. In the grading system provided, a Grade III enlargement covers:
a) No signs of enlargement
b) The interdental papilla only
c) The papilla and marginal gingiva
d) Three-quarters or more of the crown

6. Chronic inflammatory enlargement often begins as a slight ballooning of the interdental papilla and marginal gingiva, creating a characteristic shape best described as:
a) Mulberry-shaped
b) Life preserver-like
c) Cauliflower-like
d) Mushroom-like

7. The primary etiology of chronic inflammatory gingival enlargement is:
a) Genetic predisposition
b) Prolonged exposure to dental plaque
c) Hormonal changes
d) Drug side effects

8. Mouth breathing is most likely to cause gingival changes in which region?
a) Mandibular posterior region
b) Maxillary anterior region
c) Palatal surfaces
d) Lingual of mandibular incisors

9. A rapid-onset, localized, painful, expanding gingival lesion that is red and shiny is most likely a(n):
a) Drug-induced enlargement
b) Pyogenic granuloma
c) Gingival abscess
d) Idiopathic enlargement

10. A gingival abscess is often caused by:
a) Phenytoin use
b) Foreign body impaction
c) Vitamin C deficiency
d) Leukemic infiltration

11. Which of the following groups of drugs is NOT commonly associated with drug-induced gingival enlargement?
a) Anticonvulsants
b) Immunosuppressants
c) Calcium channel blockers
d) Antibiotics

12. Drug-induced enlargement typically begins as a:
a) Diffuse, edematous swelling of the attached gingiva
b) Bead-like enlargement of the interdental papilla
c) Localized, painful ulceration
d) Blanching of the marginal gingiva

13. The pathogenesis of drug-induced enlargement involves an interaction between the drug, inflammation, and:
a) Bacterial toxins
b) Fibroblasts
c) Epithelial cells
d) Salivary composition

14. Which anticonvulsant is most commonly associated with gingival enlargement, affecting approximately 50% of users?
a) Valproic acid
b) Ethosuximide
c) Phenytoin (Dilantin)
d) Carbamazepine

15. Compared to phenytoin-induced enlargement, cyclosporine-induced enlargement is typically:
a) Less vascularized
b) More vascularized
c) Only occurs in children
d) Not influenced by plaque

16. Which immunosuppressant is known to cause significantly less gingival enlargement than cyclosporine?
a) Azathioprine
b) Tacrolimus
c) Sirolimus
d) Prednisone

17. Which calcium channel blocker is specifically mentioned as being implicated in gingival enlargement in about 20% of users?
a) Verapamil
b) Diltiazem
c) Amlodipine
d) Nifedipine

18. Idiopathic gingival enlargement is also known by all of the following names EXCEPT:
a) Gingivomatosis
b) Hereditary gingival hyperplasia
c) Plasma cell gingivitis
d) Elephantiasis

19. A key clinical feature that distinguishes idiopathic enlargement from phenytoin-induced enlargement is that idiopathic enlargement involves:
a) Only the marginal gingiva
b) Only the interdental papillae
c) The attached gingiva, margin, and papillae
d) Only the palatal gingiva

20. Idiopathic gingival enlargement is characterized histologically by:
a) A dense plasma cell infiltrate
b) Densely packed collagen bundles and many fibroblasts
c) Immature leukocyte infiltration
d) Surface ulceration and necrosis

21. Conditioned enlargements occur when:
a) A systemic disease directly infiltrates the gingiva
b) Systemic conditions exaggerate the gingival response to plaque
c) A drug directly stimulates fibroblast activity
d) Underlying bone enlarges

22. The hormonal changes in pregnancy lead to gingival enlargement primarily due to:
a) A decrease in vascular permeability
b) An increase in progesterone and estrogen
c) A direct effect on collagen breakdown
d) A specific bacterial infection unique to pregnancy

23. A “pregnancy tumor” is a type of:
a) Malignant neoplasm
b) Pyogenic granuloma
c) Fibroma
d) Peripheral giant cell granuloma

24. Gingival enlargement during puberty is characterized by:
a) A firm, pale pink enlargement
b) Bulbous papillae that are out of proportion to local irritants
c) A mulberry-shaped surface
d) Generalized painful ulcerations

25. Vitamin C deficiency (scurvy) modifies the gingival response to plaque, leading to a gingiva that is:
a) Pale pink and firm
b) Bluish-red, soft, and friable
c) Shiny and clearly demarcated
d) Mulberry-shaped and non-bleeding

26. Plasma cell gingivitis is primarily a(n) ________ reaction.
a) Bacterial
b) Allergic
c) Viral
d) Traumatic

27. A key histologic feature of plasma cell gingivitis is:
a) Dense immature leukocyte infiltration
b) A dense plasma cell infiltrate
c) Densely packed collagen bundles
d) Multinucleated giant cells

28. A pyogenic granuloma is best described as a:
a) Malignant tumor
b) Nonspecific conditioned enlargement
c) Drug-induced lesion
d) False enlargement

29. In leukemia, gingival enlargement is most common in the ________ form.
a) Chronic
b) Acute
c) Lymphocytic
d) Myelogenous

30. Leukemic gingival enlargement often appears:
a) Pale pink and firm
b) Bluish-red, shiny, and hemorrhagic
c) Yellowish and crusted
d) White and keratotic

31. Wegener’s granulomatosis is a granulomatous disease that can present with oral signs such as:
a) Mulberry-shaped gingiva
b) Gingival enlargement and reddish-purple discoloration
c) Generalized, slow-growing, painless enlargement
d) Sessile, fibroma-like masses

32. The term “epulis” is used clinically to:
a) Describe a specific histologic diagnosis
b) Locate a discrete tumor or tumorlike mass on the gingiva
c) Describe a malignant gingival tumor
d) Refer to any inflammatory enlargement

33. According to the cited studies, what was the most common type of neoplastic tumor found on the gingiva?
a) Papilloma
b) Carcinoma
c) Fibroma
d) Giant cell tumor

34. Most lesions clinically diagnosed as “fibromas” are actually:
a) Malignant carcinomas
b) Inflammatory enlargements
c) Peripheral ossifying fibromas
d) Gingival cysts

35. A peripheral ossifying fibroma contains:
a) Mineralized tissue such as bone or cementum-like material
b) A dense plasma cell infiltrate
c) Multinucleated giant cells exclusively
d) Immature leukocytes

36. A papilloma is a benign proliferation of ________ and is often associated with ________.
a) Connective tissue; trauma
b) Surface epithelium; HPV
c) Salivary gland tissue; smoking
d) Bone; genetic factors

37. A key feature that differentiates a peripheral giant cell granuloma from a central giant cell granuloma is:
a) Its color
b) Its location (gingiva vs. within the jawbone)
c) The presence of multinucleated cells
d) Its response to surgery

38. Leukoplakia is defined as a white patch that:
a) Always represents a premalignant condition
b) Is caused exclusively by Candida albicans
c) Does not rub off and cannot be diagnosed as any other disease
d) Is always associated with tobacco use

39. What percentage of leukoplakic lesions are estimated to be malignant or premalignant?
a) 3%
b) 20%
c) 50%
d) 80%

40. A gingival cyst, when it becomes clinically apparent, is most common in the:
a) Maxillary anterior labial region
b) Mandibular canine and premolar areas
c) Palatal rugae area
d) Retromolar pad

41. Which of the following drugs is most commonly associated with gingival enlargement?
a) Phenytoin
b) Cyclosporine
c) Nifedipine
d) Digoxin

42. Drug-induced gingival enlargement is most frequently seen in:
a) Anterior region of the maxilla
b) Anterior region of the mandible
c) Posterior region of the maxilla
d) Posterior region of the mandible

43. Gingival enlargement due to drugs is usually:
a) Painful and ulcerated
b) Painless and firm
c) Fluctuant and red
d) Always associated with pus

44. Which factor strongly influences the severity of drug-induced gingival enlargement?
a) Age
b) Oral hygiene status
c) Gender
d) Genetic background

45. Which type of gingival enlargement is caused by increased deposition of collagen fibers?
a) Inflammatory enlargement
b) Drug-induced enlargement
c) Fibrotic enlargement
d) False enlargement

46. Which of the following systemic conditions is associated with gingival enlargement?
a) Hypertension
b) Asthma
c) Leukemia
d) Diabetes insipidus

47. Gingival enlargement associated with leukemia is due to:
a) Increased keratinization
b) Infiltration of leukemic cells
c) Excessive plaque accumulation
d) Trauma from occlusion

48. The gingival enlargement in Vitamin C deficiency is:
a) Fibrotic and painless
b) Drug-induced
c) Hemorrhagic and swollen
d) Discrete and localized

49. Idiopathic gingival enlargement is also called:
a) Gingival hypertrophy
b) Gingivomatosis
c) Gingival fibromatosis
d) Gingival hyperplasia

50. Which of the following statements is TRUE about idiopathic gingival enlargement?
a) It is painful and ulcerated
b) It is self-limiting and reversible
c) It is hereditary in many cases
d) It does not affect speech or mastication