Can treatment with valproic acid or carbamazepine cause caries and gingival abscesses?/nA 25-year-o

Fråga: Can treatment with valproic acid or carbamazepine cause caries and gingival abscesses?

A 25-year-old man with epilepsy, post-polio syndrome and possibly also a cerebral paresis, has been treated with valproic acid, 600 mg daily, for several years. Before, he was treated with carbamazepine. He now has a very poor periodontal condition with caries and abscesses.

Sammanfattning: There is no evidence in the literature that carbamazepine or valproic acid causes caries or gingival abscesses. However, it cannot be excluded that carbamazepine-induced xerostomia in part have contributed to the poor periodontal status in the present case.

Svar: Neither of the two drugs valproate or carbamazepine are known to cause periodontal side-effects. In an earlier Drugline document, it is stated that it is highly unlikely that the combined treatment with carbamazepine and ethosuximide should have caused teeth destruction in a 6-year-old boy with severe caries, but that carbamazepine-induced xerostomia may possibly have contributed (1). According to the Swedish PDR, dry mouth is a common-side effect of carbamazepine treatment (2). However, this effect is poorly documented in the literature and the relationship seems unclear (1).

Valproate has very rarely been reported to cause gingival hyperplasia in children (3).

Periodontal condition was examined in 84 epileptic children treated with phenytoin, carbamazepine and/or valproate, and compared with 30 age-matched healthy controls. A Gingival Index and a Sulcus Bleeding Index were higher for the treated children, whereas a Plaque Index did not differ (4).

In 40 adult epileptic patients, receiving long-term treatment with either carbamazepine or phenytoin, no differences were seen in alveolar bone los, plaque score, or gingival inflammation whereas phenytoin treated subjects had a larger degree of gingival overgrowth (5). 1 Drugline no 14116 (year 1997) 2 FASS 2002 (The Swedish catalogue of approved medical products) 3 Davies DM, Ferner RE, de Glanville H, editors. Davie´s textbook of adverse drug reactions. 5th ed. Philadelphia: Lippincott-Raven Publishers; 1998. p. 240. 4 Galas-Zgorzalewicz B, Borysewicz-Lewicka M, Zgorzalewicz M, Borowicz-Andrzejewska E. The effect of chronic carbamazepine, valproic acid and phenytoin medication on the periodontal condition of epileptic children and adolescents. Funct Neurol 1996;11:187-93. 5 Dahllöf G, Preber H, Eliasson S, Ryden H, Karsten J, Modeer T. Periodontal condition of epileptic adults treated long-term with phenytoin or carbamazepine. Epilepsia 1993;34:960-4.