Drug-Induced Gingival Overgrowth — ORE Part 1 MCQ

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ModeratePeriodontologyDrug-Induced Gingival OvergrowthORE Part 1

A 65-year-old man taking phenytoin for epilepsy has generalised gingival overgrowth. Oral-hygiene instruction and periodontal debridement have reduced plaque and gingival inflammation, but the enlargement persists and limits plaque removal. What is the most appropriate next step?

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Correct answer: E — Ask his GP to consider an alternative antiepileptic medicine

**A is correct.** Phenytoin is a recognised cause of drug-influenced gingival enlargement. Once plaque control and periodontal management have reduced the inflammatory component but enlargement remains clinically significant, SDCEP advises considering substitution of the causative medicine through discussion with the patient’s GP/physician. The dentist should not alter antiepileptic therapy independently. Gingivectomy may be required later for persistent functional or aesthetic enlargement, but surgery before addressing the drug risks recurrence. Long-term chlorhexidine and more frequent reviews may support plaque control but do not remove the drug-related driver. Systemic antibiotics are not indicated without evidence of bacterial infection.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Treatment of Periodontal Diseases in Primary Care: “Drug-influenced gingival enlargement”. Accessed July 2026. https://www.periodontalcare.sdcep.org.uk/guidance/managing-disease/other-periodontal-conditions/drug-influenced-gingival-enlargement/