Periodontal Management of Phenytoin Induced Gingival Enlargement: A Case Report

Gingival enlargement or gingival overgrowth is the abnormal growth of periodontal tissues. Drug induced gingival enlargement is one of the most common cause of enlarged gingiva. Drugs associated with gingival enlargement are divided in to three major groups namely anticonvulsants, immunosuppressant and calcium channel blockers [1]. Among the anticonvulsants, phenytoin is most commonly associated with gingival enlargement, with a prevalence rate of 50%, although different authors have reported incidences from 3% to 84.5% [2,3]. Dilantin is a hydantoin, introduced by Merritt & Putnam in 1938 for the treatment of all forms of epilepsy, except the petit mal [4]. Kimball in 1939 was the first to report drug associated gingival enlargement with the chronic use of antiepileptic drug phenytoin [3], imbalance in collagen degradation, rather than an increase in collagen synthesis has been suggested for its etiology [5]. A possible relationship between tumor necrosis factor-alpha (TNF-a) production and phenytoin in human gingival fibroblasts has also been suggested [6]. The host’s response to pathogens associated with the biofilm may also play a role. Excessive gingival overgrowth itself can also change the gingival contour, impeding oral function and speech and having an anti-aesthetic effect [7]. Additionally, it can also compromise effective oral hygiene and may have negative implications for the systemic health of affected patients. Several approaches for the treatment of gingival overgrowth including oral prophylaxis, nonsurgical and surgical (gingivectomy or a flap procedure) have been proposed [8]. The aim of this report is to present a case of gingival enlargement due to phenytoin with combined nonsurgical and surgical approach.