An Update on the Mechanisms of Phenytoin Induced Gingival Overgrowth

Fathima Fazrina Farook1, 2, *, Mohamed Nuzaim M. Nizam3, Abdulsalam Alshammari1, 2
1 Department of Preventive Dental Science, College of Dentistry, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
2 King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
3 Department of Obstetrics and Gynecology, University of Malaya, Kuala Lumpur, Malaysia

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© 2019 Farook et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Preventive Dental Science, King Saud Bin Abdulaziz University for Health Sciences, 11426 Riyadh, Saudi Arabia / King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; E-mail:



Phenytoin induced gingival overgrowth, a side effect with multifactorial aetiology, is characterized by an increase in the volume of extracellular tissues, particularly collagenous components, with varying degrees of inflammation.


The aim of this paper is to review the available literature regarding the pathophysiological mechanisms of phenytoin induced gingival overgrowth.


A thorough literature search of the PubMed/ Embase/ Web of science/ Cochrane central database was conducted to identify the mechanisms involved in the process of phenytoin-induced gingival overgrowth using the following keywords: Phenytoin; Anticonvulsant; Gingival Overgrowth; Gingival Enlargement, Gingival Hyperplasia; Drug Induced Gingival Enlargement; Drug Induced Gingival Overgrowth


According to the available evidence, several mechanisms have been proposed addressing the pathophysiological mechanism of phenytoin induced gingival overgrowth both at a cellular and molecular level. Evidence suggests that the inflammatory changes in the gingival tissues orchestrate the interaction between phenytoin and fibroblasts particularly resulting in an increase in the extracellular matrix content.


However, the mechanism of production of inflammatory mediators is not fully understood. This, together with the high prevalence of Phenytoin induced gingival overgrowth, warrants further research in this area in order to develop treatment and preventive strategies for the management of this condition.

Keywords: Anticonvulsant, Gingival overgrowth, Gingival enlargement, Phenytoin, Drug induced gingival enlargement, Drug induced gingival overgrowth.