Folic acid supplementation for phenytoin-induced gingival overgrowth in children

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Gingival overgrowth is an important adverse effect of phenytoin (PHT) therapy, occurring in about half of the patients. This study aimed to evaluate the effect of oral folic acid supplementation (0.5 mg/day) for the prevention of PHT-induced gingival overgrowth (PIGO) in children with epilepsy aged 6–15 years on PHT monotherapy for 6 months.

Children aged 6–15 years started on PHT monotherapy within the previous  month were eligible for inclusion.  Those with preexisting gingival overgrowth use of other folic acid antagonists, and macrocytic anemia were excluded.  Patients were randomised receive either folic acid or placebo. The main outcome was the incidence of gingival overgrowth at 6 months. A total of 120 children were recruited (63 Folic acid , 58 Placebo).

The found that

  • Twenty-one percent of patients in the folic acid arm developed PIGO,  compared with 88% receiving placebo (p < 0.001).
  • Absolute risk reduction of PIGO by folic acid was 67% (95% CI 54%–80%), and relative risk reduction was 0.76

The concluded :-

Oral folic acid was found to decrease the incidence of PIGO in children on PHT monotherapy, in a statistically significant and clinically relevant manner.

Arya R, Gulati S, Kabra M, Sahu JK, Kalra V. Folic acid supplementation prevents phenytoin-induced gingival overgrowth in children. Neurology. 2011 Apr 12;76(15):1338-43. PubMed PMID: 21482950; PubMed Central PMCID: PMC3090066.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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