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Drug-Induced Gingival Overgrowth Management — NDEB AFK MCQ

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ModeratePeriodontologyDrug-Induced Gingival Overgrowth ManagementNDEB AFK

A 55-year-old patient on long-term phenytoin presents with severe gingival overgrowth causing difficulty eating and speaking. Initial treatment has included oral hygiene instruction and scaling with no improvement. What is the most appropriate next step?

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Correct answer: E — Consult the patient's physician about switching phenytoin to an alternative anticonvulsant

When drug-induced gingival overgrowth does not respond to conservative measures (oral hygiene instruction, scaling, chlorhexidine), consultation with the patient's physician about drug substitution is the most appropriate next step. Phenytoin can often be replaced with an alternative anticonvulsant (e.g., carbamazepine, valproic acid, newer agents) that does not cause gingival overgrowth. Drug substitution combined with meticulous oral hygiene often results in significant regression. If overgrowth persists after drug change, gingivectomy is then considered.

Reference: Newman – Newman and Carranza's Clinical Periodontology, 13th ed., 2019