Which medication combination is commonly linked to gingival overgrowth?

• A. Phenytoin, methotrexate, and calcium channel blockers
• B. Steroids
• C. IV bisphosphonates
• D. Sugar-containing syrups

Answer: (A)

Drug-induced gingival overgrowth happens when certain medications stimulate gingival fibroblasts and alter collagen turnover, leading to thickened, fibrous gum tissue. The most well-known culprits are phenytoin and calcium channel blockers. Phenytoin promotes fibroblast activity and extracellular matrix accumulation while reducing collagen breakdown, especially in the presence of inflammation from plaque. Calcium channel blockers also tend to increase fibroblast growth and can shift the balance of collagen production and degradation, producing a similar overgrowth in susceptible individuals. The inclusion of methotrexate in the option doesn’t typically drive gingival overgrowth on its own, but it doesn’t negate the strong association between phenytoin and calcium channel blockers. The other choices don’t fit as well: steroids aren’t a classic cause of true gingival enlargement, IV bisphosphonates are linked to osteonecrosis of the jaw rather than overgrowth, and sugar-containing syrups contribute to caries and gingivitis rather than true gingival enlargement.