Objectives: Dentulous mentally disabled and developmentally retarded (MR/DD) patients at the Hazelwood facility (n = 42) invariably had gingival hyperplasia when receiving Dilantin® to alleviate epileptic seizures. Severe gingival hyperplasia was not found in individuals not receiving Dilantin®. This report presents the findings for 21 patients following 12 to 18 months of intervention with alternative medications to Dilantin®. Methods: Following a baseline examination (seizure monitoring, periodontal charting, soft tissue characterization, radiographs and photographs) of a randomly selected jaw quadrant of the patient's mouth, supervised weaning of the patients from Dilantin® was initiated. Patients wee titrated with Topamax® and subsequently weaned from Dilantin®. The seizure frequency and any other adverse reactions were documented. If a patient could not tolerate Topamax®, another medication, Depakote®, was administered. When a patient was successfully removed from Dilantin®, they were given a new periodontal evaluation 4 months after the Dilantin® wean date. Results: Findings are now available for 21 patients who have been removed from Dilantin®. 19 of these 21 patients have seen an improvement in their soft tissue quality from moderate to severe gingivitis with friable and hemorrhagic gingivae and pocket depths of >5mm to diminished pocket depths combined with firm fibrous gingivae. With regard to seizure frequency, 3 experienced a decrease, 13 showed no change, and 5 experienced an increase following removal from Dilantin®. Five patients had to be removed from Topamax subsequent to appetite suppression that lead to a loss of 10 % or more in body weight. Body weight was regained subsequent to stopping Topamax medication. Conclusions: Preliminary findings from this ongoing clinical evaluation indicate a substantial oral health benefit from substituting alternative anti-epileptic drugs in place of Dilantin®. However, if the substituted drug is Topamax® especial care needs to be taken to assure that body weight is sustained.

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