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Gingival hypertrophy caused by diphenylhydantoin

Last edited: 4/15/2026

Overview

Gingival hypertrophy, also known as gingival hyperplasia, is an overgrowth of gum tissue commonly associated with the use of diphenylhydantoin (phenytoin), an anticonvulsant medication. This condition can significantly impact oral health and patient comfort 1.

Diagnosis

  • Clinical appearance of enlarged, fibrous gingival tissue 1.
  • No specific diagnostic tests; diagnosis is primarily clinical 1.
  • Grading systems like the Chaves classification may be used to assess severity 1.

    • Management

  • First-line: Optimize phenytoin levels and consider alternative anticonvulsants if possible 1.
  • Adjunctive treatments:
    • - Oral hygiene improvement including regular professional cleaning 1. - Gingival curettage or surgical reduction for severe cases 1. - Topical or systemic retinoids (e.g., retinol) may be considered, though specific dosing is not detailed 1.

    Special Populations

  • Pregnancy: Management focuses on balancing seizure control with minimizing gingival side effects; specific guidelines are limited 1.
  • Pediatrics: Similar management principles apply, with emphasis on growth and development considerations 1.
  • Elderly: Increased risk of complications; careful monitoring and multidisciplinary care recommended 1.
  • Comorbidities: No specific guidance provided in the abstracts; individualized treatment plans are advised 1.

    • Key Recommendations

  • Optimize phenytoin levels to minimize gingival overgrowth risk (Evidence: Expert opinion) 1.
  • Implement rigorous oral hygiene practices as a primary adjunctive measure (Evidence: Expert opinion) 1.
  • Consider surgical intervention for severe cases refractory to medical management (Evidence: Expert opinion) 1.

    • References

    1 Macdonald AG. John Henry Hill Lewellin: the first etherist in Glasgow. British journal of anaesthesia 1993. link

    Original source

    1. [1]
      John Henry Hill Lewellin: the first etherist in Glasgow. — Macdonald AG British journal of anaesthesia (1993)
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