Drug-Induced Gingival Overgrowth — ORE Part 1 MCQ

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EasyPeriodontologyDrug-Induced Gingival OvergrowthORE Part 1

A patient with epilepsy taking phenytoin presents with gingival overgrowth. Which area of the mouth is typically affected first?

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Correct answer: A — Interdental papillae

The answer is A (Interdental papillae). Phenytoin-induced gingival overgrowth characteristically initiates in the interdental/interproximal gingival region, appearing within 1–3 months of drug initiation, and progressively extends outward to involve the free gingival margin and eventually the entire gingiva in more severe cases. This pattern mirrors that of other drug-induced gingival enlargements (cyclosporine, calcium channel blockers). **Why distractors fail:** (B) The free gingival margin is affected secondarily as overgrowth progresses; (C) Attached gingiva enlarges later in the disease course; (D) Alveolar mucosa is not typically involved in phenytoin-induced overgrowth; (E) The retromolar pad area is rarely affected and is not a site of initial presentation. Distinguishing the anatomical pattern of progression is a key clinical-anatomical skill for ORE Part 1 periodontology.

Reference: Phenytoin-Induced Gingival Overgrowth with Predominant Involvement of Hard Palate and Floor of Oral Cavity: A Case Report and Review of Literature. PubMed, https://pubmed.ncbi.nlm.nih.gov/32367993/, 2020. See also Periodontal Microbiological Status Influences the Occurrence of Cyclosporine-A and Tacrolimus-Induced Gingival Overgrowth. PMC6784123, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784123/, 2019.