Triple Drug Gingival Overgrowth — MFDS Part 1 MCQ

Correct answer: E — Generalised gingival overgrowth

Phenytoin, ciclosporin and nifedipine are each associated with drug-influenced gingival overgrowth. Importantly, the ciclosporin SmPC states that concurrent nifedipine may increase the rate of gingival hyperplasia compared with ciclosporin alone. The expected finding is therefore generalised gingival enlargement, often accentuated by plaque-induced inflammation and poor oral hygiene. Oral candidosis may occur in an immunosuppressed patient but is not the characteristic shared adverse effect of these three medicines. Dental caries and xerostomia are not their defining combined oral effects, and tooth fracture is not a typical direct oral adverse reaction. Management includes meticulous plaque control, professional periodontal care and, where clinically necessary, liaison with the prescribing medical team about possible medication modification; the dentist should not alter these medicines independently.

Reference: Electronic Medicines Compendium. Neoral Soft Gelatin Capsules, Summary of Product Characteristics, section 4.5, updated 11 March 2026. https://www.medicines.org.uk/emc/product/1034/smpc