Lamotrigine
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Gingival enlargment: case report A 24-year-old man developed gingival enlargement during treatment with lamotrigine for epilepsy. The man presented with gradually increasing swelling of the lower gums for 6 months. He also had difficulty brushing. He had been receiving lamotrigine 100mg [route not stated] for the past 3 years for epilepsy. At the current presentation, intraoral examination showed gingival enlargement in the mandibular anterior teeth, extending from #22 to #27. The gingival enlargement was considered as grade II according to Bokenkamp classification. The enlargement was fibrotic and firm, and the pink coloured interdental papillae were observed. Oral hygiene index-simplified (OHIS) score suggested poor oral hygiene. Periodontal examination showed a 5mm pseudopocket in all of the mandibular anterior teeth, except #26 that had 7mm pseudopocket. The findings were suggestive of lamotrigine-induced gingival enlargement. The treatment with lamotrigine was continued. The man was scheduled to receive periodontal therapy. He underwent initial nonsurgical periodontal therapy, and he was instructed about oral hygiene including brushing twice daily by modified Bass brushing technique. Additionally, the use of chlorhexidine was advised. At follow-up visit, OHIS score indicated poor oral hygiene. Subsequently, he underwent gingivectomy followed by treatment with ibuprofen with continuation of chlorhexidine oral rinse. Histopathology of the excised tissue showed pronounced acanthosis and hyperplasia of the epithelial cells. The elongated rete pegs extended into the connective tissues were observed. The connective tissue had dense infiltration of fibroblasts along with abundant blood vessels and polymorphonuclear leucocytes. At follow-up, he exhibited uneventful healing. The follow-up visits at 3 months and 6 months showed no recurrence of gingival enlargement, although papillary enlargement with subgingival calculus at #26 was observed at 6 months. The OHIS score indicated better oral hygiene. He was explained the need for supportive periodontal therapy, and he remained under regular maintenance care. Rajendran P. Lamotrigine-Induced Gingival Enlargement: An Older Problem Due to a Newer Drug - A Rare Case Report. Clinical Advances in Periodontics : 2020. Available 803507052 from: URL: http://doi.org/10.1002/cap.10123
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Reactions 17 Oct 2020 No. 1826
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