Dental Root Abnormalities and Gingival Overgrowth in Epileptic Patients Receiving Anticonvulsant Therapy

Abstract

Forty-six mentally retarded epileptic patients being treated with phenytoin and phenobarbital were studied to determine the root/crown length ratios. Forty-five mentally retarded patients not receiving anticonvulsant drugs provided the controls. Further, because serum phenytoin levels have been related to severity of gingival hyperplasia, efforts were made to determine if the hyperplasia was associated with dental root abnormalities and also whether these abnormalities could be related to epilepsy per se. Results showed that in certain teeth there was a smaller root/crown ratio in the patients taking anticonvulsant medication. The male patients were more affected than the female. The unusually short roots were not necessarily related to high serum phenytoin but the severity of gingival overgrowth was. Histologic study of teeth from patients taking anticonvulsants revealed developmental abnormalities and resorption.

Effects of diphenylhydantoin on teeth in rabbit

“…The results of this study show that the two oral tissues measured in these rabbits, dentin and pulpal vasculature, were both affected by therapeutic doses of DPH, The response of dentin resembles certain other responses seen in Vitamin D or calcium deprivation studies (11,12,13), Further studies will be needed to elucidate the exact mecha- Fig. 4.…”

“…Other effects of DPH in man include abnormalities of the mineralized tissues, namely bones and teeth, such as osteomalaeia (8), decreased 25-hydroxycalciferol (9), and dental root abnormalities (10)(11)(12)(13). Apparently the first report of bone changes was published in 1967 when Schtnid described aberrations of ossification, including enlargement of the marrow spaces and rickets or ricket-Iike disturbances of the growth in children and adolescents (14).…”

“…Apparently the first report of bone changes was published in 1967 when Schtnid described aberrations of ossification, including enlargement of the marrow spaces and rickets or ricket-Iike disturbances of the growth in children and adolescents (14). The few published reports of dental root abnortnalities (12,13) described such morphologic changes as shortened crown-to-root ratio, blunted apices and marked resorption.…”

Oral and dental adverse drug reactions

“…The anti-epileptic drug phenytoin is reported to cause abnormalities in the roots of the teeth (25). Defects include shortening of the root, root resorption, and an increased deposition of cementum.…”

Drug-Induced Gingival Overgrowth—a Review

“…3) The prevalence rate of this disorder has been reported to vary: 10% to 50% for phenytoin 1,[4][5][6][7] ; 8% to 70% for cyclosporine A [8][9][10][11][12] ; and 0.5% to 83% for nifedipine. [13][14][15][16] The accurate determination of the prevalence rate in each drug category is difficult.…”