A common side effect of this drug is the development of moderate to severe gingival hyperplasia in tooth-bearing areas, which can cont Treatment of phenytoin-induced gingival hyperplasia by electrosurgery J Oral Surg. 1980 Apr;38(4):306-11. Authors C R. Gingival overgrowth (GO) comprises any clinical condition in which an increase in the size of the gingiva is observed. Such enlargement can be caused by a multitude of stimuli and stands as a singular complaint in the dental office. Among the drugs that induce GO, the antiepileptic agent phenytoin has been widely related to this condition Aim: To ascertain the prevalence and severity of phenytoin-induced gingival enlargement (PIGE) as well as the relationship between PIGE and risk factors. Method: An outpatient population of patients on phenytoin treatment and attending the epilepsy clinic at Prince Mshiyeni Memorial Hospital (PMMH) in Durban, South Africa, was requested to participate Gingival overgrowth occurs as a side effect of some systemic medications. It is now well established that phenytoin is one such agent. It has multiple therapeutic indications ranging from convulsive disorders and neuralgias to cardiac arrhythmia
Figure 4 illustrates gingival overgrowth on a patient who has been taking phenytoin for several years. Studies of patients taking this anticonvulsant drug suggest that bacterial plaque is an important determinant of the severity of phenytoin-induced gingival overgrowth and stress the importance of institutin 3. Gosavi DD.A case of phenytoin induced gum enlargement.Asian J Pharm Clin Res. 2012; 5:10-11. 4. Chacko LN, Abraham S.Phenytoin induced gingival enlargement.BMJ Case Rep. 2014:1-3 5. Gurgel BC de V, Morais C. RB de, RochaNeta PC da, Dantas EM, Pinto LP, Costa A de LL. Phenytoin induced gingival overgrowth management with periodontal treatment
. This can be a cosmetic problem, interfere with eating and speech, impede effective tooth cleaning or force the teeth out of alignment Gingival overgrowth (GO) comprises any clinical condition in which an increase in the size of the gingiva is observed. Such enlargement can be caused by a multitude of stimuli and stands as a singular complaint in the dental office. Among the drugs that induce GO, the antiepileptic agent phenytoin has been widely related to this condition [ An Update on the Mechanisms of Phenytoin Induced Gingival Overgrowth. 1. INTRODUCTION. Gingival Enlargement (GE) or Gingival Overgrowth (GO) is a clinical condition that alters the position of the gingival margin and comprises an increase in the size of the gingiva [ 1. Gittaboyina S, Mana TK, Koduganti RR, Reddy PV In case 1, Phenytoin-induced drug enlargement was managed by substituting with sodium valproate and a subsequent change in gingival tissue was evident within a week with scaling and root planing. In case 2 (combined enlargement) there was no drug substitution; periodontal treatment alone yielded a satisfactory clinical response
An increasing number of medications are associated with gingival enlargement [1,2]. Drugs associated with gingival enlargement can be broadly divided into three categories: anticonvulsants, calcium channel blockers, and immunosuppressant's . Phenytoin remains the drug of choice for treatment for grand mal, tempora . Patient was referred to her physician intimating him about the gingival enlargement caused due to intake of Phenytoin and to opine whether an alternate drug or dosage of the same drug could be altered
Gingival enlargement is known side effect of certain medications like anticonvulsants, calcium channel blockers and immunosuppressant. Phenytoin is one of the most common drugs associated with gingival overgrowth. The present case report describes a successful management of phenytoin induced gingival enlargement in 13 year old female by combine ANTIEPILEPTIC DRUGS THAT CAUSE GINGIVAL ENLARGEMENTIn 1938, Merritt and Putnam published their noteworthy data using phenytoin to treat major, absence and psychomotor seizures. 37 Since that time, phenytoin has been demonstrated to be a highly effective anticonvulsant. Phenytoin has been investigated as a treatment for more than 100 diseases Phenytoin is a commonly prescribed medication for the treatment of patients with epilepsy. Kato et al. (5) have suggested that Phenytoin-induced gingival overgrowth (PIGO) was probably due to an imbalance in collagen degradation, rather than an increase in collagen synthesis
Phenytoin-induced gingival enlargement is caused by unwanted effects of systemic medication on the periodontal tissues. For an effective control of this problem, proper treatment protocol would be necessary, which includes drug substitution and control of local inflammatory factors Gingival overgrowth occurs as a side effect of some systemic medications. It is now well established that phenytoin is one such agent. It has multiple therapeutic indications ranging from convulsive disorders and neuralgias to cardiac arrhythmia. The incidence rate of phenytoin-induced gingival overgrowth ranges from 3% to 93%, but 50% of patients on long-term therapy are prone to develop. . Luvizuto ER, da Silva JB, Campos N, Luvizuto GC, Poi WR, Panzarini SR. J Craniofac Surg, 23(3):e174-6, 01 May 2012 Cited by: 1 article | PMID: 2262742 An increasing number of medications are associated with gingival enlargement. 1,2 Drugs associated with gingival enlargement can be broadly divided into three categories: anticonvulsants, calcium channel blockers, and immunosuppressant. 1 Phenytoin remains the drug of choice for treatment of grand mal, temporal lobe, and psychomotor seizures since it was first introduced in the 1930s. 3-5 The. Gingival enlargement or overgrowth is a common disease of gingiva. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. They commonly present as bulbous interdental gingival, diffuse swelling of gingival. Due to the unaesthetic appearance of the overgrown gingiva, treatment becomes inevitable
As with most medication, side effects are associated with the use of Phenytoin. 1 . Considered a common side effect associated with Dilantin use, signs of gingival overgrowth and enlargement usually begin to appear one to three months after the introduction of the medication and tend only to involve the gum tissue that is firmly attached to. Get Your Instant Free Coupon Now. Save up to 80% on Prescriptions. No credit card or sign-up required to use GoodRx®. It's simple to save today
as gingival enlargement, which is most often reported. This case reports the successful treatment of a young patient with phenytoin-induced gingival enlargement. Keywords: Drug-Induced, Epilepsy, Gingival Enlargement, Phenytoin. Introduction Phenytoin induced gingival enlargement is seen in almost 50-100% of patients and severity of phenytoin induced gingival enlargement starting from the beginning of phenytoin treatment. Hence, the present study was designed to investigate the association of phenytoin induced gingival enlargement with serum folate levels in phenytoin treated epileptic patients. 2. Objectives of the Study 1
The pathogenesis of drug-induced gingival enlargement is uncertain and there appears to be no unifying hypothesis that links together the three commonly implicated drugs. Phenytoin-induced gingival overgrowth is a well known and frequently reported gingival lesion, which was first detected in 1939 Phenytoin-Induced Gingival Enlargement A 12 year-old male presented with complaints of generalized swollen gums associated with bleeding since 3 years (Fig. 1). His medical history revealed epilepsy since childhood, which was controlled with phenytoin 100 mg BID. Oral examina-tion revealed poor hygiene with pale pink, enlarged, an Gingival overgrowth was observed after the patient started taking the phenytoin treatment. Then, after the withdrawal of the phenytoin gingival overgrowth was slowly normalized and the patient is prescribed with new drugs to treat epilepsy. In many literature evidence, it was observed that phenytoin was the main causative agent for gingival
for seizure and presented with complaints of gingival hypertrophy with bleeding gum, maloccluded teeth and hirsutism. Based on the clinical examination, her condition was diagnosed as phenytoin induced multiple adverse drug reaction. The clinical symptoms improved on withdrawing the offending agent and were started with sodium valproate The incidence of phenytoin-induced gingival enlargement as reported by a study by Kimball was found to be 57% while other studies in relation to incidence of phenytoin-induced gingival enlargement have revealed wide incidence range of 20-40%[9 30] in some studies to 6-79% in others[4 13 14 21 26 30] while 3-93% in few other studies[18 19] and.
Treatment of Gingival Enlargement Shruti Bhatnagar Abstract Gingival enlargement or overgrowth is a common disease of gingiva. The causative factors may range from inflammation due to local factors to conditioned enlargement and neoplastic enlargements. They commonly present as bulbous interdental gingival, diffuse swelling of gingival This teenage girl has phenytoin-induced generalized gingival enlargement. FIGURE 2. This woman has severe gingival overgrowth associated with the use of nifedipine, a calcium channel blocker used to treat hypertension, angina and supraventricular cardiac arrhythmias A case of phenytoin-induced gingival enlargement was treated accordingly i.e consultation with patient's physician, substitution/titration of the drug, phase I therapy followed by electrosurgery and supportive periodontal therapy treatment of epilepsy. As a result the prevalence of phenytoin-induced gingival overgrowth should be decreasing. Rarely, DIGO has also been reported in those taking other antiepi-leptic drugs such as valproic acid, phenobar-bital and carbamazepine, however, these drugs appear to cause milder gingival enlargement. 28 Calcium channel blocker Gingival hypertrophy is estimated to affect 25% to 81% of patients taking cyclosporine and usually manifests within 6 months of initiation of treatment. 1,2 Other than being an aesthetic concern, cyclosporine-induced gingival hypertrophy can meaningfully limit functional capability, as experienced by this case
Surgical intervention to reduce phenytoin-induced gingival enlargement should wait until at least 18 months after cessation of therapy because: Some patients experience additional reduction in the enlargement after the 1-year period gingival tissue components is influenced by several risk factors. DIGO has high recurrence rate due to chronic usage of the listed medications and other risk factors.(11) This is a case report of the management of a patient with phenytoin-induced gingival overgrowth by both non-surgical and surgical approaches. Case Repor Majola MP, McFadyen ML, Connolly C, et al. Factors influencing phenytoin-induced gingival enlargement. J Clin Periodontol 2000; 27:506. Bökenkamp A, Bohnhorst B, Beier C, et al. Nifedipine aggravates cyclosporine A-induced gingival hyperplasia. Pediatr Nephrol 1994; 8:181
gingival enlargement remains unsatisfactory. The problem is compounded by the high recurrence rate arising from chronic usage of the listed medications and persistence of risk factors. The present case report describes the treatment of a patient with a phenytoin-induced gingival enlargement and its management which includes bot This is the most effective treatment of drug-induced gingival enlargement. It usually takes few weeks to resolve the gingival lesions [ 34 , 35 ] but response to this method varies [ 36 ]. Usually reduction in gingival overgrowth is noticed where a structurally different calcium channel blocker is used List the treatment options available for gingival enlargement. Gingival health can be negatively affected by bacteria, viruses, neoplasms, and certain drugs. Gingival enlargement, defined as an increase in the growth of the gingival tissue, raises the risk of infection, caries, and periodontal diseases, and negatively affects the esthetics of.
In addition to gingival enlargement, phenytoin can accelerate megaloblastic anemia. In non-convulsive people, phenytoin can accelerate gingival wound healing and increase the tensile strength of abdominal wounds (2). 1.6. Treatment Studies found that gingival enlargement disappeared spontaneously 4 months after stopping the drug (8). Treatment Phenytoin is an anticonvulsant which is seen to cause gingival enlargement in human patients with a reported incidence of 50%. 1,4 Two experimental studies in cats and one clinical canine patient with phenytoin-induced gingival enlargement have been documented. 11,12,14 In humans, the extent of enlargement is dependent on the presence of. A 28-year-old woman developed gingival enlargement superimposed with periodontitis during treatment with phenytoin. The woman at the age of 30 presented to the outpatient department with a 2-year history of generalised swollen gums which bled on slight provocation Drug-induced gingival enlargement (DIGE) associated with chronic use of the AED phenytoin was first reported in 1939 by Kimball. 10 In the same year, Faurbye and in 1959, Strean & Leoni suggested that the alkalinity of phenytoin might be the cause of the gingival side effect. 11,12 In 1948, Brandon hypothesized that phenytoin had a direct.
Phenytoin-induced Gingival Overgrowth: A Case Report. Drug-induced gingival enlargement manifests as an abnormal growth of the gingiva due to an adverse drug reaction in patients treated with anticonvulsants, immunosuppressants and calcium channel blockers. The enlargement affects the normal oral hygiene practice and may even interfere with. Gingival enlargment and its treatment 1. Presented by: Surbhi Kapoor MDS 2nd year 2. Gingival enlargement is the proliferation and intensification of the gingiva which is a prevailing character of the diseased gingival tissues. Thus, increase in size of the gingiva is a common feature of gingival disease. Accepted current terminology for this condition is GINGIVAL ENLARGEMENT OR GINGIVAL. pathogenesis of phenytoin-induced gingival enlargement, as subpopulation mixtures are altered by conditions within the connective tissue milieu. This could result from stimulation of a subpopulation(s) characterized by elevated collagen synthesis or, alternatively, from inhibition of a subpopulation(s) characterized by low growth and synthetic. Drug-influenced gingival enlargement (DIGE) is a reaction to specific medications, namely phenytoin, ciclosporin and calcium channel blockers. DIGE is encountered increasingly in clinical practice due to the widespread use of calcium channel blocker drugs particularly. Approaches to its management are discussed in this review Phenytoin and its metabolites have phenytoin-induced gingival overgrowth range from 3% a direct action on the high activity fibroblast to 84.5%,[1-3] but 50% of patients on long-term therapy population present in the gingiva leading to a is prone to develop gingival overgrowth.[4
Gingival overgrowth/hyperplasia can be attributed to several causes, but drug-induced gingival overgrowth/hyperplasia arises secondarily to prolonged use of antihypertensive drugs, anticonvulsants and immunosuppressants. The management is complex in nature considering the multitude of factors involved such as substitution of drug strict plaque control along with excision of the tissue to be. Inflammatory gingival enlargement is most common type of over growth, which manifest because of increase in volume of gingival tissue in response to local microbial irritation.Inflamatory enlargement may be acute or chronic. Fibrotic gingival enlargement or non-inflammatory fibrous gingival over growth is belived to be the result of genetic. Objective: Gingival hyperplasia (GH) is one of the side effects of anticonvulsant drugs. The aim of this study was to verify the prevalence of GH associated with the use of anticonvulsant, through a systematic review. Material and Methods: Systematic search was done at databases Pubmed and Embase between January 1984 and March of 2020 for identification of articles addressing the prevalence of. The gingival enlargement can persist, despite drug substitution and good plaque control, and in this case, surgical management to restore normal gingival contours is performed. These modalities of treatment, although effective, do not always prevent the recurrence of the enlargement
For example phenytoin induced gingival overgrowth in children taking this medicine as treatment for epilepsy can occur in 3 months after taking the medicine. Treatment Of Drug Induced Gingival Enlargement. Improvement in oral hygiene is key in any type of gingival overgrowth, this also includes drug induced gingival enlargement This is the most effective treatment of drug-induced gingival enlargement. It usually takes few weeks to resolve the gingival lesions [34,35] but response to this method varies . Usually reduction in gingival overgrowth is noticed where a structurally different calcium channel blocker is used Among the causes for drug-induced gingival enlargement, PNT is the most common agent.  ,  Other causative drugs are phenobarbitone, amlodipine, nifedipine, and cyclosporine. Gingival enlargement associated with chronic use of the PNT was first reported in 1939 by Kimball [Figure 1]
The oral health of patients undergoing treatment with AEDs was measured with all or some of the following methods in the studies reviewed: The gingival index, which assesses the colour of the gingiva; and the presence of edema, bleeding on palpation or spontaneous bleeding, inflammation and ulcerations. 7 The plaque index, which assesses the presence of plaque in the gingiva, teeth and. The cause of phenytoin-induced gingival enlargement is likely due to the direct effects of the drug and its metabolites on the gingival fibroblasts. Other factors which can contribute to phenytoin-induced gingival enlargement include adrenocortical axis suppression, alterations in the metabolism of calcium, low serum folic acid levels, and. Gingival enlargement in appearing about children who developed enlarged gingiva due to treatment of epilepsy using phenytoin. This condition was also described in children born of epileptic mothers who were being treated with sodium valproate. These children were branded to be suffering phenytoin induced gingival hyperplasia. Arch Oral. The incidence of phenytoin-induced gingival enlargement as reported by a study conducted by Kimball was found to be 57%, while other studies conducted in relation to incidence of phenytoin-induced gingival enlargement have revealed wide incidence ranges of 20-40%, , in some studies to 6-79% in others, , while 3-93% in few other studies. well understood. Phenytoin induced gingival enlargement is a usual term for all gingival lesions related to hyperplasia . Extra Cellular Matrix (ECM) is accumulated by collagenous components of gingival connective tissues in the presence of inflammations and gingival overgrowth is among the most prevalent side effects of Phenytoin 
Phenytoin-induced gingival overgrowth is character- ized by initial enlargement of the interdental papil- Table 1. Drugs associated with gingival overgrowth Agent Trade name Other Nirnot~f@~ Sular@ Not reported* Cardkern@ Dilacor @14 Others 'Abbott Laboratories, North Chicago, IL; 3andoz Pharmaceuticals Corp. The effect of a plaque control programme on the development of phenytoin-induced gingival overgrowth. A 2year longitudinal study. J Clin Periodontol 1986; 13 : 845-849 Marijuana Induced Gingival Enlargement Case Report diagnosis of combined inflammatory + marijuana induced gingival enlargement was made. Treatment consisted of scaling and root planing followed by sextant wise gingivectomy. Results were stable until three months follow-up. in cases of phenytoin-induced and gingival fibromatosi