The administration of folic acid to institutionalized epileptic adults with phenytoin-induced gingival hyperplasia

Brown, Ronald S.; Stanislao, Phillip T. Di; Beaver, William T.; Bottomley, William K.

doi:10.1016/0030-4220(91)90363-h

Cited by 40 publications

(20 citation statements)

References 18 publications

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“…chlorhexidine) in order to reduce gingival inflarnmationJI2o,121] The administration offolic acid Drug Safety 1996 Sep; IS (3) could ameliorate gingival overgrowth in some cases, but its specific role has not clearly been established. [122][123][124][125][126][127][128][129] It seems that topical application of folates (as oral rinses) is more effective than oral administration of these agents. A possible explanation of this fact could be that higher concentrations of folates in gingival fibroblasts are reached after topical use than after systemic administration.…”

Section: Managementmentioning

confidence: 99%

Gingival Enlargement Induced by Drugs

et al. 1996

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Gingival enlargement, an abnormal growth of the periodontal tissue, is mainly associated with dental plaque-related inflammation and drug therapy. Its true incidence in the general population is unknown. Gingival enlargement produces aesthetic changes, pain, gingival bleeding and periodontal disorders. Although gingival overgrowth has been traditionally recognised as an adverse effect of phenytoin therapy, it has recently been reported in association with the use of cyclosporin and calcium antagonists. These 3 classes of drugs produce important changes in fibroblast function, which induce an increase in the extracellular matrix of the gingival connective tissue. In the majority of those patients for whom dosage reduction, or drug discontinuation or substitution is not possible, and for whom prophylactic measures have failed, surgical excision of gingival tissue remains the only treatment of choice.

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Section: Managementmentioning

confidence: 99%

Gingival Enlargement Induced by Drugs

et al. 1996

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“…[19] Numerous studies in the past suggest the possible role of folic acid in the prevention of phenytoin-induced gingival enlargement as well as its recurrence following a surgical removal. [20][21][22] In a study conducted by Arya et al, 120 pediatric patients that developed gingival hyperplasia due to phenytoin use were included and followed up for 6 months. During the study, 62 patients were treated with folic acid against 58 patients who were kept on placebo.…”

Section: Discussionmentioning

confidence: 99%

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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“…[565758] In a study conducted by Arya et al ., a hundred and twenty paediatric patients that developed gingival hyperplasia due to phenytoin use were included and followed for 6 months. During the study, sixty-two patients were treated with folic acid against fifty eight patients who were kept on placebo.…”

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 administration of folic acid to institutionalized epileptic adults with phenytoin-induced gingival hyperplasia

Cited by 40 publications

References 18 publications

Gingival Enlargement Induced by Drugs

Gingival Enlargement Induced by Drugs

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

Phenytoin, folic acid and gingival enlargement: Breaking myths

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