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Gingivectomy After Drug Failure — ORE Part 1 MCQ

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ModeratePeriodontologyGingivectomy After Drug FailureORE Part 1

A patient taking phenytoin has moderate fibrotic gingival overgrowth despite good plaque control. The prescribing clinician confirms that phenytoin cannot be substituted. Following oral-hygiene reinforcement and professional periodontal debridement, the enlargement persists and impairs plaque removal. What is the most appropriate next step?

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Correct answer: E — Perform gingivectomy and arrange periodontal maintenance

**A is correct.** Phenytoin-induced gingival overgrowth is first managed by reducing plaque-related inflammation and discussing drug substitution with the prescriber. Here, these measures have been exhausted: hygiene and professional periodontal care have been provided, substitution is not possible, and persistent fibrotic enlargement prevents effective plaque removal. Gingivectomy is therefore appropriate, followed by periodontal maintenance because recurrence can occur while phenytoin continues. Chlorhexidine may be a short-term adjunct but is not definitive long-term treatment. Observation is inappropriate because the enlargement is impairing hygiene. Systemic antibiotics do not reduce drug-related fibrotic enlargement in the absence of infection, and topical corticosteroids have no established role in its management.

Reference: Seymour RA, Ellis JS, Thomason JM. Drug-induced gingival overgrowth and its management. J R Coll Surg Edinb. 1993;38(6):328-332. https://pubmed.ncbi.nlm.nih.gov/7509397/