Prevention of Phenytoin Associated Gingival Enlargement—A 15‐Month Longitudinal Study

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Abstract
The purpose of the present study was to investigate on a longitudinal basis, the effectiveness of a specific preventive dental program for outpatients who were taking phenytoin for seizure control. Plasma, mixed and parotid saliva were also monitored in relation to each other and gingival enlargement. The results confirmed that a preventive dental program consisting of frequent prophylaxis and oral hygiene reinforcement was effective in minimizing gingival enlargement associated with phenytoin therapy. However, a small but statistically significant increase in anterior gingival enlargement occurred within the first 6 months of phenytoin therapy. No further enlargement developed during the subsequent 9 months. Control subjects not receiving phenytoin demonstrated no change in the coronal position of the free gingival margin about anterior segments of the dentition. In the posterior segments, the control group exhibited statistically significant gingival recession which became evident at 12 months. Individuals taking phenytoin did not demonstrate any change in the coronal position of the free gingival margin within the posterior segments of the dentition. Combined with the dental prophylaxis, improvement in plaque control appeared to be consistent with the prevention of clinically significant gingival enlargement. Parotid and mixed salivary levels of phenytoin were approximately 10% that of plasma values. Both salivary levels rose when plasma levels increased as reflected by the relatively high coefficient of correlation between these parameters. Furthermore, neither plasma, mixed or parotid levels of phenytoin were correlated to the minimal degree of gingival enlargement which occurred in the anterior segments of individuals taking phenytoin.

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