Drug-Induced Gingival Overgrowth — MFDS Part 1 MCQ

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ModerateHuman DiseaseDrug-Induced Gingival OvergrowthMFDS Part 1

A patient with epilepsy who takes phenytoin has marked generalised gingival overgrowth with plaque-associated inflammation, making effective plaque removal difficult. There is no purulence or systemic evidence of infection. Which is the most appropriate initial management?

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Correct answer: A — Provide non-surgical periodontal care and liaise with the prescriber about possible drug substitution

Phenytoin is a recognised cause of drug-influenced gingival enlargement, which is exacerbated by plaque-associated inflammation. SDCEP periodontal guidance recommends non-surgical management first: personalised oral hygiene instruction, professional removal of plaque, calculus and other retentive factors, and reassessment. Drug substitution should be considered and discussed with the patient's general medical practitioner, so option A is correct. Immediate gingivectomy (B) is inappropriate: surgery is reserved for enlargement persisting after inflammation is controlled, and recurrence is common in susceptible individuals. Systemic antibiotics (C) have no role without infection; there is no purulence here. Chlorhexidine alone (D) may adjunctively reduce plaque but cannot substitute for mechanical plaque control and periodontal instrumentation. Stopping phenytoin without medical consultation (E) risks breakthrough seizures; anticonvulsants must only be changed by the prescribing clinician.

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