Diphenylhydantoin‐induced Gingival Hyperplasia: its Relationship to Dose and Serum Level

Kapur, Rahul; Girgis, Suzette; Little, T; Masotti, R. E.

doi:10.1111/j.1469-8749.1973.tb05070.x

Cited by 60 publications

(10 citation statements)

References 11 publications

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“…The incidence of phenytoin-induced gingival enlargement as reported by a study by Kimball was found to be 57% while other studies in relation to incidence of phenytoin-induced gingival enlargement have revealed wide incidence range of 20-40%[930] in some studies to 6-79% in others[41314212630] while 3-93% in few other studies[1819] and 50% in institutionalized epileptic patients (Seymour, 1993) as reported in the literature. The incidence of gingival overgrowth in the normal population has been reported to be between 4% and 7.5%.…”

Section: Discussionmentioning

confidence: 91%

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

Nayyar

Khan²,

Vijayalakshmi³

et al. 2013

Surg Neurol Int

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Background:There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the antiepileptic therapy in the prevention of antiepileptic drug-induced gingival enlargement. However, studies in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin-induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy. The statistical analysis was done using t-test and the baseline serum folate levels and the serum folate levels obtained after 6 months of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula.Methods:A total of 25 patients aged between 18 and 50 years, clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was done prior to the start of and after 6 months of phenytoin therapy.Results:The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin-induced gingival enlargement.Conclusions:The results of the study suggest a higher incidence of gingival enlargement in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

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Section: Discussionmentioning

confidence: 91%

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

Nayyar

Khan²,

Vijayalakshmi³

et al. 2013

Surg Neurol Int

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show abstract

“…The incidence of phenytoin induced gingival enlargement as reported by a study conducted by Kimball was found to be 57% while other studies conducted in relation to incidence of phenytoin induced gingival enlargement have revealed wide incidence ranges of 20-40%[3637] in some studies to 6-79% in others[33343536373839404142] while 3-93% in few other studies[3543] and 50% in institutionalized epileptic patients (Seymour, 1993) as reported in the literature. The incidence of gingival overgrowth in the normal population has been reported to be between 4-7.5%.…”

Section: Discussionmentioning

confidence: 93%

“…[3132] Chronic administration of phenytoin has been associated with a number of adverse effects. [333435] Phenytoin-induced gingival overgrowth is one such most frequently reported gingival lesion which was first described in 1939. [2021]…”

Section: Discussionmentioning

confidence: 99%

Phenytoin, folic acid and gingival enlargement: Breaking myths

et al. 2014

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Background:Epilepsy is described as a chronic neurological disorder characterized by recurrent seizures of cerebral origin, presenting with episodes of sensory, motor or autonomic phenomenon with or, without loss of consciousness. A recent meta-analysis of published and unpublished studies puts an overall prevalence rate of epilepsy in India at 5.59 per 1,000 populations. There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the anti-epileptic therapy in the prevention of anti-epileptic drug induced gingival enlargement. However, studies conducted in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy so as to justify the use of folic acid as a routine adjuvant to the usual anti-epileptic therapy to prevent this inevitable adverse effect without destabilizing the ongoing regimen leading to the precipitation of seizures in an otherwise stable patient (breakthrough seizures).Materials and Methods:A total of 100 patients between the ages 18 and 50 years were clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was performed prior to the start of and after 1 year of phenytoin therapy.Statistical Analysis Used:The statistical analysis was carried out using t-test and the baseline serum folate levels and the serum folate levels obtained after 1 year of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula.Results:The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin induced gingival enlargement.Conclusions:The results of the study suggest a higher incidence of gingival enlargement with an early onset and increased severity in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

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“…The incidence of phenytoin-induced gingival enlargement as reported by a study conducted by Kimball was found to be 57%, while other studies conducted in relation to incidence of phenytoin-induced gingival enlargement have revealed wide incidence ranges of 20-40%, [31,32] in some studies to 6-79% in others, [13,15,[32][33][34][35] while 3-93% in few other studies [19,36] and 50% in institutionalized epileptic patients (Seymour, 1993) as reported in the literature. The incidence of gingival overgrowth in the normal population has been reported to be between 4% and 7.5%.…”

Section: Discussionmentioning

confidence: 97%

Risk assessment of folic acid supplementation in phenytoin-treated epileptic patients: A pilot study

Nayyar

Khan

Subhas

et al. 2013

Int J Nutr Pharmacol Neurol Dis

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Background:There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the antiepileptic therapy in the prevention of antiepileptic drug-induced gingival enlargement. However, studies conducted in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin-induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy. Subjects and Methods: A total of 25 patients aged between 18 and 50 years clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was done prior to the start of and after 6 months of phenytoin therapy. The statistical analysis was done using t-test and the baseline serum folate levels and the serum folate levels obtained after 6 months of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula. Results: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin-induced gingival enlargement justifying the judicious use of folate supplementation to prevent this inadvertent side effect of phenytoin administration. Conclusions: The results of the study suggest a higher incidence of gingival enlargement in phenytoin-treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

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Diphenylhydantoin‐induced Gingival Hyperplasia: its Relationship to Dose and Serum Level

Cited by 60 publications

References 11 publications

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

Phenytoin, folic acid and gingival enlargement: Breaking myths

Risk assessment of folic acid supplementation in phenytoin-treated epileptic patients: A pilot study

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