Effects of anti‐epileptic drug treatment with carbamazepine or phenytoin on the oral state of children and adolescents

Abstract

Oral conditions were studied in 48 children and adolescents who, during short or long periods, had been assigned to anti-epileptic drug treatment with carbamazepine or phenytoin. The individuals were diagnosed as suffering from partial seizures or generalized tonic-clonic seizures and were distributed between three test groups according to the drug selected for treatment; patients on active carbamazepine (I) or phenytoin (II) medication, and patients previously treated with phenytoin (III). Untreated, newly diagnosed epileptics served as controls. The results showed that individuals treated with carbamazepine for an average of 3 years displayed no intra-oral side-effects from the drug treatment. Compared with those on carbamazepine medication the subjects treated with phenytoin demonstrated a significantly greater number of gingival units with increased probing depths, lower saliva secretion rates and lower salivary buffer capacities. In all groups a majority of the individuals showed unsatisfactory plaque control. As a consequence of the results of the investigation it appears justified, from a dental point of view, to support carbamazepine as the first drug of choice for treatment of the types of seizures mentioned.

Drug‐induced gingival overgrowth: a study in the French Pharmacovigilance Database

“…Carbamazepine alone does not produce this ADR (Lundstrom et al. ): we did not found any case in the FPVD.…”

Gingival Enlargement Induced by Drugs

“…A change to another agent with similar pharmacological actions is possible when there is an alternative agent to treat the underlying condition. [13,119) In patients with epilepsy, for example, phenytoin could be replaced by carbamazepine [45] or valproic acid.l 44 ] For most patients in whom reduction, discontinuation or changing the drug is not possible and prophylactic measures have failed, surgical excision of gingival tissue is the recommended treatment. [141] This includes gingivectomy by conventional periodontal surgery (the most frequent procedure), [142,143) by means of chemosurgical techniques [144) using paraformaldehyde 5% or potassium hydroxide (those methods has fallen into disuse), by means of electrosurgery, [135] or use of a carbon dioxide (C02) laser.…”

Prevalence and risk of gingival enlargement in patients treated with anticonvulsant drugs

“…Mephenytoin and primidone [40,41] are referred to in some texts as gingival‐overgrowth inducers, but the evidence seems to be anecdotal. Gingival overgrowth has not been associated with carbamazepine a useful alternative medication in the treatment of patients with seizures that have, or are at risk of, gingival enlargement [42].…”