Periodontal Management to Improve Oral Health-related Quality of Life in an Adolescent Girl with Phenytoin-induced Gingival Enlargement: A Case Report.

Aims and background: Gingival enlargement is a common adverse effect of phenytoin medication prescribed for epilepsy. This case report, for the first time, presents the impact of severe phenytoin-induced gingival enlargement (PGE) on the oral health-related quality of life (OHRQoL), which assesses the physical, social, and psychological effects of the disease. This case illustrates the importance of simple measures like drug substitution in conjunction with nonsurgical periodontal therapy (NSPT) as the keystone in the periodontal management of PGE.

Case description: A 15-year-old girl presented with a generalized, severe, disfiguring PGE involving the entire maxillary and mandibular arch, causing an impairment of oral hygiene, mastication, speech, and esthetics. Clinical indices and oral health impact profile-14 were recorded at baseline, 1, 6, 9, 12, and 18 months. Phenytoin was replaced by the drugs levetiracetam and oxycarbamazepine. NSPT was initiated, which included plaque control measures and oral prophylaxis. There was a consistent improvement in OHRQoL scores from baseline (score 52 out of 56) to 6 months (score 15; 70% improvement) and a decrease of subscale scores (score 8-2) for psychological discomfort, psychological disability, and social disability, following drug substitution and NSPT. Thereafter, the relatively smaller, nonresponsive, persistent growth was treated with gingivectomy. Complete restoration of gingival health and no signs of recurrence were seen at 18 months (score 0).

Conclusion: PGE can impact both the physical and psychological well-being of the patient. The synergism of NSPT and drug substitution can cause a substantial reduction in PGE, thus improving OHRQoL.

Clinical significance: Local plaque control, routine dental visits, and long-term maintenance are essential for every patient undergoing phenytoin therapy for controlling the severity and recurrence of phenytoin-induced gingival overgrowth.

How to cite this article: Dawar A, Gumber B, Makker K. Periodontal Management to Improve Oral Health-related Quality of Life in an Adolescent Girl with Phenytoin-induced Gingival Enlargement: A Case Report. Int J Clin Pediatr Dent 2025;18(5):599-605.