From the Guidelines
Phenytoin is the antiseizure drug most commonly associated with gingival hyperplasia. This side effect occurs in approximately 50% of patients taking phenytoin [also known by the brand name Dilantin] 1. The gingival overgrowth typically begins within 2-3 months after starting the medication and is characterized by painless enlargement of the gums, particularly in the anterior regions. The mechanism involves phenytoin's effect on fibroblast proliferation and collagen production in gingival tissue, along with decreased collagenase activity, resulting in excessive gum tissue growth.
Key Points to Consider
- Other antiseizure medications that can cause gingival hyperplasia, though less frequently, include valproate and carbamazepine.
- Good oral hygiene can help minimize this side effect, and patients taking phenytoin should be advised to maintain regular dental care.
- In severe cases, surgical reduction of the excess gingival tissue may be necessary, though the condition often recurs if the medication is continued.
- If gingival hyperplasia becomes problematic, consultation with a neurologist about alternative antiseizure medications may be warranted. Some studies have shown that cyclosporine A, an immunosuppressant, can also cause gingival hyperplasia 1, but this is not an antiseizure drug.
Treatment Options
- D Phenytoin is the correct answer, as it is the antiseizure drug most commonly associated with gingival hyperplasia.
- The other options, A Phenobarbital, B Cenobamate, C Tiagabine, and E Epidiolex, are not as commonly associated with this side effect. It is essential to weigh the benefits and risks of each medication and consider alternative options if gingival hyperplasia becomes a significant issue 1.
From the FDA Drug Label
Patients should be instructed to call their physician if skin rash develops. The importance of good dental hygiene should be stressed in order to minimize the development of gingival hyperplasia and its complications The antiseizure drug associated with the idiosyncratic adverse effect of gingival hyperplasia is D Phenytoin 2.
From the Research
Antiseizure Drug Associated with Gingival Hyperplasia
The antiseizure drug (ASD) associated with the idiosyncratic adverse effect of gingival hyperplasia is:
- D Phenytoin
Evidence from Studies
Studies have shown that phenytoin is associated with gingival hyperplasia, including:
- A cross-sectional study on epileptic patients, which found that phenytoin was significantly associated with gingival overgrowth in 50% of cases 3
- A study on out-patients with epilepsy, which found that approximately 76% of patients showed either mild or no gingival hyperplasia, and that lesion severity was associated with increasing dosage of phenytoin per unit of body weight and the duration of phenytoin administration 4
- A clinical evaluation of gingival overgrowth in children on antiepileptic drug therapy, which found that phenytoin caused gingival overgrowth in a significant number of children (53.6%) within 3 months 5
- A review of drug-induced gingival hyperplasia, which noted that phenytoin is a well-documented cause of this condition 6
Other Antiseizure Drugs
Other antiseizure drugs, such as lamotrigine, oxcarbazepine, and phenobarbital, have also been associated with gingival overgrowth, but the evidence is not as strong as it is for phenytoin 3