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 the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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