Certain medications used to control seizures may cause an oral condition known as gingival enlargement or gingival overgrowth, increasing the risk of periodontal disease, tooth decay, and oral infections. According to the Epilepsy Foundation, 3 million Americans have some form of seizure disorder or epilepsy with 200,000 new cases diagnosed each year.
Gingival Overgrowth and Enlargement - Beyond Your ControlDilantin (Phenytoin) is an antiepileptic or anticonvulsant drug used to control seizures in certain types of epilepsy. It is also used to prevent seizures during or after surgery. As with most medication, side effects are associated with the use of Phenytoin.
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 tends to only involve the gum tissue that is firmly attached to the teeth and bone; known as attached gingiva. Patients experiencing gingival overgrowth may experience the following:
- Enlargement of the interdental papilla especially in the anterior or front of the mouth
- As the tissue begins to enlarge, it may become more fibrotic, or dense
- Inflammation in areas of enlarged tissue may begin to interrupt speech, eating, and esthetics
- Painful areas in the mouth, bleeding gums, tooth movement, and changes in the occlusion or how the teeth bite together are common
- Enlarged gingival tissue may begin to impose on the crown of the tooth. This causes the patient difficulty when trying to brush and floss the teeth thoroughly
- Tooth decay and periodontal disease may become more prevalent due to the interference of the excessive gum tissue
Treating Gingival Overgrowth and EnlargementPatients who are experiencing drug-associated gingival enlargement are treated according to the extent of the overgrowth of tissue. Your dentist may recommend treatments such as:
- Regularly scheduled hygiene appointments as frequently as every three months, to ensure the thorough removal of plaque and calculus in area that are inaccessible with a toothbrush and floss
- Mouth rinse consisting of .12% chlorhexidine may be prescribed as an aide in reducing the enlargement of tissue
- The brushing technique used by the patient may be modified by the dentist to allow for the slight recession of the gum tissue from the toothbrush
- Surgical removal of the excessive tissue known as a gingivectomy, may be preformed at the discretion of the dentist
- Antifungal medication and certain antibiotics may be prescribed depending on the severity of the overgrowth
- Changes in medication may be suggested by the doctor, although this may not be an option for all patients and will depend on the individual situation of each patient.
Patients with gingival enlargement secondary to medications will most likely be referred to see a periodontist; a dentist that specializes in diagnosing, preventing and treating gum disease.
Your Best DefenseAlthough patients may not be able to directly control the overgrowth of their gum tissue, the best way to help eliminate uncomfortable side effect is to pay close attention to plaque removal. It may be wise to consider brushing and flossing after every meal and to significantly reduce or eliminate unnecessary sugars and carbohydrates in the diet. Book regular dental visits and follow the recommended frequency for professional cleanings as suggested your dentist or dental hygienist. Discuss alternative medications and treatments with your doctor and never discontinue your prescribed medication without consulting your doctor.
American Academy of Periodontology. "Informational paper: drug-associated gingival enlargement." J Periodontol. 2004; 75:1424-31.
Epilepsy Foundation. "What is Epilepsy: Prevalence and Incidence"
Epilepsy Foundation. "Specific Medications: Dilantin."
Journal of Epilepsy and Clinical Neurophysiology. "Drug-induced gingival enlargement – Part II. Antiepileptic drugs: not only phenytoin is involved."