Salivary composition, phenytoin ingestion and gingival overgrowth

Unstimulated and stimulated whole and unstimulated and stimulated parotid saliva were collected from subjected in three groups: I, control; II, seizure subjects ingesting phenytoin and without gingival overgrowth; III, seizure subjects receiving phenytoin and with grades 1 and 2 gingival overgrowth. Unstimulated whole saliva was obtained from mentally retarded donors with grade 3 phenytoin associated gingival overgrowth. The samples were analyzed for protein, lysozyme, lactoperoxidase, lactoferrin and aggregation capacity towards Streptococcus sanguis. Differences occurred in the salivary composition of patients ingesting phenytoin. No deficiencies of flow rate, protein or the specific proteins were found in subjects ingesting phenytoin. Instead, the only changes in these parameters were greater concentrations or secretion rates. Several differences occurred only in subjects with gingival overgrowth. These latter differences were prominent in unstimulated whole saliva. The data demonstrate changes in the oral cavity environment of patients ingesting phenytoin. These differences, however, do not have an obvious relationship to development of phenytoin associated gingival overgrowth. Some of the salivary changes occurred in patients undergoing therapy for seizures both with phenytoin and with other drugs. Increased amounts of unstimulated whole saliva components likely are due to excess tissue rather than a phenytoin effect on salivary gland secretions. In addition, most of the changes in salivary composition would not be expected to produce an environment the encourages plaque accumulation.