The Effects of Dilantin on the Oral Cavity Over Time.

Abstract

The objective of this case presentation is to discuss the long-term effects of Dilantin in causing gingival hyperplasia as seen in a patient. Assessment: A 54 year old African American male patient presented to the Dental Hygiene Clinic at Indiana University School of Dentistry (IUSD) with a chief complaint of “I need to get my teeth cleaned for my three month appointment.” The patient was referred to our clinic from the IUSD Graduate Periodontal clinic for his three month periodontal maintenance appointment. Medical history indicates he suffers from epilepsy and has been taking Dilantin for over forty years. An intraoral examination revealed advanced localized periodontal disease in the lower right quadrant with probing depths ranging from 1-10mm and clinical attachment levels ranging from 1-8mm. Patient also presented with generalized healthy gingiva as evidenced by coral, firm, and stippled tissue. The intraoral radiographs reveal generalized mild bone loss as evidenced by 3-4mm from crest of bone to CEJ. The patient’s oral hygiene habits include: brushing twice a day, flossing once a day, and using an antimicrobial mouth rinse once a day. DH Care Plan: periodontal maintenance, topical fluoride varnish, review of oral hygiene, and review of the use of a water irrigator. Evaluation: The patient was referred to the Graduate Periodontal department for further evaluation due to the increase of gingival overgrowth on #31 distal and the presence of exudate. The dentist who performed the last dental exam in the Dental Hygiene Clinic feels the patient will need another gingivectomy. Conclusions: From the review of the evidence-based literature, the Dilantin is the cause of the gingival hyperplasia that this specific patient has been experiencing over the years and his need for continuous periodontal surgery.