Dental concerns when taking Dilantin

My daughter is 3, and on Dilantin. How can I tell that her gums are becoming a problem?


Dear Danda,

Dilantin is a widely used drug to control most types of epilepsy, and one of its most common side effects is gingival hyperplasia. Gingival hyperplasia is essentially an overgrowth of gum tissue. Not all chronic users of Dilantin experience this side effect. The severity of gingival hyperplasia will also vary among patients. Most studies indicate that about 50% of those who take Dilantin develop gingival hyperplasia. Dilantin may impair the secretion of an enzyme that breaks down excess collagen. This is the suspected mechanism that causes overgrown gum tissue.

If a patient is going to develop this fibrous overgrowth of gum tissue, there is enlargement of the papilla (gum tissue between the teeth) and marginal gingiva (gum tissue closest to the crown of the tooth. This usually occurs within 2 weeks to 3 months after the initial administration of Dilantin. The fibrous growth may continue to the point that the teeth may be covered with gum tissue. If there is no gingivitis or periodontitis associated with the overgrowth, the tissue should appear firm and pink. If gingivitis is associated with it, which unfortunately is common, the tissue will appear boggy and red. Generally, the anterior area is affected more severely than the posterior area. Gingival growth is most pronounced during the first year of Dilantin use, and patients under the age of 30 years seem to be more susceptible to this side effect.

Many studies show that plaque build-up is a component of Dilantin gingival hyperplasia. Therefore, scrupulous oral hygiene is extremely important to help minimize this condition. Treatment to remove enlarged gingival tissue is surgical excision. This surgery must be carefully considered, however, because hyperplasia will quickly recur if careful oral hygiene is not maintained, and the surgical wounds can be somewhat painful. If Dilantin is discontinued, gradual regression of the tissue overgrowth can occur within 1 year.

Thank you for your question and best of luck

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