Phenytoin and Dental Health: How to Prevent Gum Problems

If you're taking phenytoin for seizures or nerve pain, you might not realize your gums are at risk. Up to 50% of people on long-term phenytoin develop swollen, overgrown gums-a condition called gingival hyperplasia. It’s not just cosmetic. These gums bleed easily, trap food, hurt when you eat, and can lead to infections or even tooth loss. The good news? You can stop it in its tracks with the right habits. You don’t have to accept sore, swollen gums as just another side effect.

Why Phenytoin Causes Gum Problems

Phenytoin doesn’t directly attack your gums. Instead, it messes with how your body handles bacteria and tissue growth. When you take phenytoin, your gums start reacting more strongly to plaque-the sticky film of bacteria that forms on teeth every day. Normally, your immune system keeps plaque in check. With phenytoin, that system goes into overdrive. The gum tissue starts growing extra cells, thickening and puffing out around your teeth.

This isn’t just about poor brushing. Even people who brush twice a day and floss can get it. That’s because phenytoin changes how your cells respond to the normal bacteria in your mouth. It’s like your gums think they’re under constant attack, so they keep building more tissue to protect themselves. The result? Gums that look like they’ve swollen over your teeth, making it harder to clean, and easier for bacteria to hide.

Signs You’re Developing Gum Overgrowth

Early signs are easy to miss. You might notice your gums feel tender when you brush. Or maybe your dentures don’t fit like they used to. As it gets worse, you’ll see visible changes:

• Gums that look puffy or bulbous around the front teeth
• Bleeding when brushing or flossing-even with gentle pressure
• Difficulty chewing because gums get in the way
• Bad breath that doesn’t go away with mouthwash
• Teeth that feel loose or shift position

If you’ve been on phenytoin for more than six months and notice any of these, don’t wait. The earlier you act, the easier it is to reverse.

Brushing and Flossing: The Non-Negotiables

Good oral hygiene isn’t optional when you’re on phenytoin. It’s your first line of defense. But you can’t just brush harder. You need to brush smarter.

Use a soft-bristled toothbrush and brush for two full minutes, twice a day. Angle the brush at 45 degrees where your gums meet your teeth. Use small circular motions, not back-and-forth scrubbing. Electric toothbrushes with pressure sensors work better-they stop if you’re pressing too hard, which helps prevent gum damage.

Flossing is even more critical. Plaque builds up between teeth where your brush can’t reach. If you struggle with regular floss, try a water flosser. Studies show water flossers remove up to 90% more plaque between teeth than string floss alone in people with gum overgrowth. Use it once a day, right after brushing.

Don’t skip days. Missing one day of flossing lets bacteria re-establish. And with phenytoin, those bacteria grow faster and trigger more tissue growth.

Professional Cleanings Every Three Months

Home care isn’t enough. You need professional help every three months-no exceptions. Most dentists recommend cleanings every six months. But if you’re on phenytoin, that’s too long. Plaque hardens into tartar in as little as 12 weeks. Once it’s there, you can’t remove it at home.

Ask your dentist for a periodontal cleaning. This isn’t just a polish. It’s deep scaling and root planing to remove tartar below the gumline. Some people need more frequent visits-every six to eight weeks-especially if gum overgrowth is already visible. Your dentist should check your gum depth, bleeding, and tissue growth at every visit.

Don’t delay. If you wait until your gums are severely overgrown, you might need surgery to remove the excess tissue. That’s expensive, painful, and doesn’t guarantee it won’t come back if you’re still on phenytoin.

Diet and Lifestyle Changes That Help

What you eat matters. Sugary foods and drinks feed the bacteria that cause plaque. Cut out soda, candy, and even fruit juices. Choose water, unsweetened tea, or milk instead.

Crunchy vegetables like carrots and celery act like natural toothbrushes. They help scrub plaque off while you chew. Eat them raw as snacks. Avoid sticky foods like dried fruit, caramel, or chewy breads-they cling to gums and stay there for hours.

Don’t smoke. Smoking reduces blood flow to your gums, making healing harder and overgrowth worse. If you use tobacco, talk to your doctor about quitting. There are programs and medications that can help.

Stress also plays a role. High stress raises cortisol, which weakens your immune response. That means your body is less able to fight off the bacteria that trigger gum growth. Try walking, meditation, or breathing exercises-even 10 minutes a day helps.

When to Talk to Your Doctor About Switching Medications

If you’ve done everything right-brushed, flossed, cleaned regularly, changed your diet-and your gums are still growing, it’s time to talk to your neurologist or prescribing doctor. Phenytoin isn’t the only option for seizures or nerve pain.

Newer medications like lamotrigine, levetiracetam, or gabapentin have much lower risks of gum overgrowth. In fact, studies show less than 5% of people on these drugs develop gingival hyperplasia. If your seizures are well-controlled, switching might be a safe option.

Never stop phenytoin on your own. Stopping suddenly can cause life-threatening seizures. But you can ask: “Is there another medication that works just as well but won’t hurt my gums?” Many doctors don’t bring this up unless you do. Be your own advocate.

What to Expect if You Already Have Severe Gum Overgrowth

If your gums are already covering half your teeth, don’t panic. Treatment is still possible. Your dentist may refer you to a periodontist-a gum specialist. They’ll remove the excess tissue with a laser or scalpel. The procedure is usually done under local anesthesia and takes less than an hour.

After surgery, you’ll need to be even more careful with oral hygiene. The gums will heal in about two weeks, but they can grow back if you don’t keep up with brushing, flossing, and cleanings. Many people see improvement within weeks after surgery-but only if they stick to the routine.

Some patients need multiple surgeries over time. That’s why ongoing care is essential. Think of it like managing diabetes: you can’t just treat the symptoms-you have to control the cause.

Real Stories: What Works

Maria, 42, started phenytoin after a brain injury. Within a year, her gums were so swollen she couldn’t smile without embarrassment. She switched to a water flosser, started seeing her dentist every three months, and cut out soda. In six months, her gums shrank back by 70%. She still takes phenytoin-but now she controls the side effect.

James, 58, waited too long. His gums were so overgrown, he lost two teeth. He had surgery, but didn’t follow up with cleanings. Within a year, the gums came back worse. He finally switched to lamotrigine. His gums improved within four months. Now he says, “I wish I’d asked about alternatives sooner.”

These aren’t rare cases. They’re the norm for people who don’t know what to do.

Phenytoin saves lives. But it doesn’t have to wreck your smile. With the right care, you can keep your gums healthy while staying on the medication you need. The key isn’t perfection-it’s consistency. Brush. Floss. Clean. Talk to your doctors. And don’t let swollen gums become your new normal.