Photo Rounds

Enlarged gums

A 31-year-old woman with a history of seizure disorder sought care from her family physician (FP) for increasing gum enlargement. She was unemployed, did not have dental insurance, and had not been to a dentist in at least 10 years. She said she brushed her teeth once a day, but did not floss. Since early childhood she’d been taking phenytoin, which successfully prevented her seizures.

What's your diagnosis?


 

The FP diagnosed gingival overgrowth (hyperplasia) secondary to the use of phenytoin.

Gingival overgrowth (GO) can be a hereditary condition or an adverse effect of certain systemic drugs, including phenytoin, cyclosporine, or calcium channel blockers. The estimated prevalence of GO is 15% to 50% among patients taking phenytoin, up to 70% in patients who take cyclosporine for more than 3 months, and 10% to 20% in patients treated with calcium channel blockers. In addition to its cosmetic effect, GO can make good oral hygiene more difficult to maintain.

Patients with GO should practice good oral hygiene, including going to the dentist for cleanings at least every 3 months to control plaque. In a 12-month study of pediatric transplant patients taking cyclosporine, a group that used a power toothbrush and received oral hygiene instructions had less severe GO than did the control group.

When possible, stopping a drug that induces GO may reverse the condition (except in patients taking phenytoin, for whom GO is not reversible). If the medication cannot be stopped, reducing the dose when possible may be an option, because GO can be dose-dependent. Patients with GO need to be monitored by a periodontist or oral medicine specialist for as long as they are taking a medication that can induce GO.

In this case, the FP recommended good oral hygiene, including going to the dentist for cleanings at least every 3 months to control plaque. The patient continued to take phenytoin to prevent seizures.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Gonsalves W. Gingival overgrowth. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:240-243.

To learn more about the Color Atlas of Family Medicine, see: http://www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking this link: http://usatinemedia.com/

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