Not all CCBs affect the gingiva in the same way, however. These drugs derive their main therapeutic effects by preventing calcium ion influx through cell membranes. This class of drugs is widely used for managing hypertension, angina and supraventricular cardiac arrhythmias. Many patients are reluctant to substitute it with a new class of anticonvulsants, making it imperative that oral health professionals recognize the increased risk and are prepared to address phenytoin-induced gingival enlargement in these patient populations. Cases of gingival enlargement have been noted with these agents as well, but such reports are rare and poorly documented.ĭue to its effectiveness in controlling convulsive seizure disorders, as well as its low cost and wide availability, phenytoin is still the drug of choice for treating epilepsy - particularly for grand mal, temporal lobe and psychomotor seizures. Since 1938, several anticonvulsant agents have been introduced - including valproic acid, carbamazepine, phenobarbital and vigabatrin - in an attempt to overcome the adverse effects of phenytoin. 3 Gingival enlargement typically appears two months to three months after the first dose of phenytoin is taken, reaching its maximum severity approximately 12 months to 18 months later. For noninstitutionalized patients, the prevalence of gingival overgrowth caused by phenytoin is approximately 50%, and the condition most often affects the maxillary anterior teeth (Figure 1). Gingival enlargement induced by anticonvulsants is significantly higher among children and institutionalized patients. 2 Susceptibility to this drug is not universal, as the prevalence of benign enlargement varies among population subsets. 1 Shortly after its introduction, however, reports linking phenytoin to gingival overgrowth began to surface. The discovery of phenytoin in 1938 by Merritt and Putnam provided a major breakthrough in the management of patients with epilepsy. When substitution is not feasible, surgical excision of gingival tissue may provide temporary relief to patients affected by drug-induced gingival enlargement. In order to restore normal fibroblast function and gingival health, another drug may need to be substituted for the offending medication. These drugs - anticonvulsants, calcium channel blockers (CCBs) and immunosuppressants - promote changes in fibroblast function, which lead to an increase in the extracellular matrix of the gingival connective tissue (Table 1). Initiated by both systemic and inflammatory factors, gingival enlargement is often caused by common prescription medications. Gingival enlargement raises the risk of infection, caries and periodontal disease, and negatively affects smile esthetics. List the available options for treating this condition.īacteria, viruses, neoplasms and certain drugs can negatively affect gingival health.Explain the etiology and risk factors of drug-induced gingival.Identify the clinical features of gingival enlargement.Discuss the different types of drugs that may cause gingival enlargement.OBJECTIVESĪfter reading this course, the participant should be able to: This 2 credit hour self-study activity is electronically mediated. The authors have no commercial conflicts of interest to disclose. This course was published in the March 2016 issue and expires 03/31/19.