Therapeutic alternatives in phenytoin-induced gingival hyperplasia. A case report and discussion

The problem of phenytoin-induced gingival hyperplasia is dicussed within the context of consultative planning between oral care practitioners and the physician managing the epilepsy. The reluctance of the neurologist or of the patient to change an ongoing anti-convulsant program is often a response to a long history of tedious steps in medication adjustments to establish a level of seizure control without sacrificing alertness and mood control. Realistic indicators for discontinuing phenytoin are enumerated and therapeutic alternatives in treating phenytoin hyperplasia are discussed. A complicated case of seziure control is offered as an example of requirements in the medical control of epilepsy and the context in which periodontal therapy can be planned in conjunction with these medication adjustments. The mechanism of phenytoin induction of gingival hyperplasia is briefly discussed. Phenytoin (Dilantin) and a newer agent, valproic acid (Depakene), are compared as alternatives in seizure control.