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provided, including supra and subgingival scaling, prophylax- 3. Bagul AS, Bokade CM, Saruk PV, Supare MS. Peters plus
is and oral hygiene instructions. 7,16 syndrome-like phenotype. J Clin Neonatol. 2015;4:193-5.
Although phenytoin is an anticonvulsant that causes gingival 4. Siala O, Belguith N, Fakhfakh F. An unusual case of Peters
hyperplasia in about 40-50% of the patients who have been on plus syndrome with sexual ambiguity and absence of
mutations in the B3GALTL gene. Iran J Pediatr. 2013;23:485-8.
the drug for at least 3 months, 18-19 primidone and, less frequent- 5. Meyer I, Rolim H, Medeiros A, Paiva L, Galvão Filho R.
ly, valproate may also induce gingival growth in some patients. Anomalia de Peters, seus aspectos clínicos e terapêuticos:
Phenobarbital-induced gingival hyperplasia has been described relato de caso. Arq Bras Oftalmol. 2010;73:367-9.
20
by Lafzi, Farahani and Shofa as a rare condition. However, phe- 6. Schoner K, Kohlhase J, Müller AM, Schramm T, Plassmann M,
nobarbital, similarly to phenytoin and primidone, is metabolized Schmitz R, et al. Hydrocephalus, agenesis of the corpus
to 5- (4-hydroxyphenyl) 5-phenylhydantoin (4-HPPH). The serum callosum, and cleft lip/palate represent frequent associations
concentration of this metabolite can explain the abnormal gin- in fetuses with Peters-plus syndrome and B3GALTL
mutations. Fetal PPS phenotypes, expanded by Dandy Walker
gival growth caused by phenobarbital, which can be differentiat- cyst and encephalocele. Prenat Diagn. 2013;33:75-80.
ed from that caused by other anticonvulsant drugs because it is 7. Hatahira H, Abe J, Hane Y, Matsui T, Sasaoka S, Motooka Y, et
uniform without lobulations of the interdental papillae. 7 al. Drug-induced gingival hyperplasia: a retrospective study
In the present case, we contacted the neurologist and phe- using spontaneous reporting system databases. J Pharm
nobarbital was replaced by a new drug, which improved the Health Care Sci. 2017;3:19.
21
clinical condition in 2 weeks. In cases of non-reversibility of 8. Moyer VA, US Presentive Services Task Force. Prevention of
the condition for 6 to 12 months, periodontal surgery may be dental caries in children from birth through age 5 years: U. S.
Preventive services Task Force recommendation statement.
performed to increase the clinical crown, such as gingivecto- Pediatrics. 2014;133:1102-11.
my/gingivoplasty, which is the most frequently used proce- 9. Steel K. How effective is the application of topical fluoride
dure. It is often necessary to perform other surgeries to control varnish in preventing dental caries in children? a literature
recurrent growth. 7,19 Patients who present with gingival hy- review. Prim Dent J. 2014;3:74-6.
perplasia should be carefully monitored, and meticulous oral 10. Twetman S, Dhar V. Evidence of effectiveness or current
7
hygiene is imperative. The patient is being monitored, and his therapies to prevent and treat early childhood caries. Pediatr
Dent. 2015;37:246-53.
oral condition has improved.
11. American Academy of Pediatric Dentistry. Guideline on
Management of Dental Patients with Special Health Care
Needs. Reference Manual. 2016;38:171-6.
Ethical disclosures 12. Dharmani CK. Management of children with special health
care needs (SHCN) in the dental office. J Med Soc.
Protection of human and animal subjects. The authors declare 2018;32:1-6.
that no experiments were performed on humans or animals 13. Weh E, Reis LM, Tyler RC, Bick D, Rhead WJ, Wallace S, et al.
Novel B3GALTL mutations in classic Peters plus syndrome
for this study. and lack of mutations in a large cohort of patients with
similar phenotypes. Clin Genet. 2014;86:142-8.
Confidentiality of data. The authors declare that they have
followed the protocols of their work center on the publication 14. Chi DL, Scott JM. Added Sugar and Dental Caries in Children:
A Scientific Update and Future Steps. Dent Clin North Am.
of patient data. 2019;63:17-33.
15. American Academy of Pediatric Dentistry. Guideline on
Right to privacy and informed consent. The authors have ob-
tained the written informed consent of the patients or sub- periodicity of examination, preventive dental services,
anticipatory guidance/ counseling, and oral treatment for
jects mentioned in the article. The corresponding author is in infants, children, and adolescents. Reference Manual.
possession of this document. 2013:37:123-30.
16. Bharti V, Bansal C. Drug-induced gingival overgrowth: The
nemesis of gingiva unravelled. J Indian Soc Periodontol.
Conflicts of interest 2013;17:182-7.
17. Trackman PC, Kantarci A. Molecular and clinical aspects of
drug-induced gingival overgrowth. J Dent Res. 2015;94:540-6.
The authors have no conflicts of interest to declare.
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