Management of phenytoin-induced gingival enlargement in a patient with antiphospholipid antibody syndrome: A rare case report

Abstract

Antiphospholipid antibody (APLA) syndrome is a noninflammatory autoimmune disease, with innumerable clinical manifestations ranging from recurrent thrombosis and pregnancy morbidity to valvular lesions, transverse myelitis, thrombocytopenia, and hemolytic anemia. APLAs in antiphospholipid syndrome (APS) are well-known risk factors for cerebrovascular accidents. Stroke is the most common manifestation of APS in the central nervous system. Gingival enlargement is a known side effect of phenytoin which is an antiepileptic drug. This can have a significant effect on the quality of life as well as increasing the oral bacterial load by generating plaque retention sites. The management of gingival overgrowth seems to be directed at controlling gingival inflammation through a good oral hygiene regimen. Thus, this case report aims to describe the conservative management of phenytoin-induced gingival enlargement combined with inflammatory enlargement in a patient with APLA syndrome.

Drug induced gingival enlargement - phenytoin: an overview and case report

“…Several factors could influence these gingival alterations such as the kind of drug, its dosage, interactions with other medications, current oral health practices, plaque build-up, other periodontal conditions, and individual response variability of genetic variables influencing heterogeneity of gingival fibroblast [ 4 ].…”

“…They are classified as anticonvulsants (phenytoin [PHT], valproate, carbamazepine), immunosuppressants (cyclosporine, tacrolimus), and calcium channel blockers (nifedipine, verapamil). Among the drugs, PHT shows enlargement in up to 50% of patients who take this drug, as this has been widely related to treating epilepsy as an antiepileptic drug [ 4 ].…”

Phenytoin-induced gingival overgrowth

“…4 Phenytoin is the most common culprit, and gingival enlargement is reported in up to 50% of patients who take the drug. 5 It has a direct action on high-activity gingival fi broblasts, and the related severity of gingival enlargement is dose-dependent. 6 Drug-induced gingival overgrowth usually presents as enlargement of gingival tissue that encroaches on the tooth crowns.…”

Anatomical and Clinical Changes of Periodontal Tissues During Pregnancy

“…У беременных женщин при действии множества факторов отмечается противоположный процесс -гиперпластические изменения десны, сопровождающиеся образованием ложных карманов. Интенсивность развития воспалительного процесса в тканях пародонта при беременности напрямую зависит как от состояния и уровня гигиены полости рта, так и от ряда протекающих гормональных и сосудистых изменений в целом [4].…”