Gingival overgrowth associated with phenytoin use

a case report

Abstract

Introduction: Phenytoin is an anticonvulsant drug that can cause gingival overgrowth as a side effect due to altered inflammatory and immune responses within periodontal tissue. Objective: Describe a clinical case of gingival overgrowth associated with phenytoin administration and treatment. Case Report: A 44-year-old male patient with a medical history of neurological and motor sequelae due to prior meningitis, along with frequent seizure episodes, was included. During anamnesis, the continuous use of phenytoin, valproic acid, phenobarbital, and diazepam has been reported. Physical examination revealed generalized gingival overgrowth with a lobulated appearance indicative of phenytoin-induced changes. The dental treatment plan included improved oral hygiene through prophylaxis, supra/subgingival periodontal instrumentation, rinsing with 0.12% chlorhexidine solution twice daily for 14 days, and oral hygiene instructions using an electric toothbrush. Results: After non-surgical periodontal treatment, a gingivectomy was performed to remove gingival overgrowth. The patient demonstrated adequate control of gingival growth and biofilm accumulation one year after surgical intervention. Conclusion: Non-surgical and surgical periodontal therapies are effective strategies to manage phenytoin-associated gingival overgrowth and should be combined with biofilm control measures to prevent long-term relapses.