Gingival hyperplasia and folic acid deficiency from anticonvulsive drug therapy A theoretical relationship

The use of anticonvulsive drugs has been associated with hyperplasia of the gingival connective tissue in approximately 40% of individuals taking them. Inflammation from local etiologic factors, e.g. bacterial plaque, has been demonstrated to be a necessary requisite for this response. It therefore appears that anticonvulsive drugs predispose the gingival tissues to undergo an exaggerated inflammatory response, hyperplasia, in the presence of local irritants. These drugs have likewise been shown to illicit a folic acid deficiency in a large percentage of patients. It has been reported that a deficiency of this vitamin can lend the gingival tissues susceptible to inflammation by causing degenerative changes in the gingival sulcular epithelium, the principle physical barrier against local irritants. Therefore, a cause and effect relationship between anticonvulsive drug induced folic acid deficiency and gingival hyperplasia associated with the use of these drugs is being proposed. Though the concepts in this paper focus on the relationship between folic acid deficiency and gingival hyperplasia from anticonvulsive drugs, they may be applied to other phenomena. A high incidence of folic acid deficiency has been reported to be associated with pregnancy and with the use of oral contraceptives, both of which have also been associated with exaggerated inflammatory responses of the gingiva and with atypical cellular changes in other organs, most notable the uterus.