Swollen gums in patients taking phenytoin require urgent nursing action.

Outline sketch

• Hook: A quick question that mirrors real-world care scenarios.

• Core answer: Swollen gums (gingival hyperplasia) in a patient taking phenytoin demands immediate nursing action.

• What phenytoin does to the mouth: a plain-language look at why gums swell.

• Why this matters now: risks to hygiene, infection, nutrition, and comfort.

• What nurses do in real time: a practical action plan.

• The broader picture: coordinating care between medicine and dentistry.

• Quick takeaways: key reminders to carry into clinical care.

Which symptom needs quick nursing action? Let’s cut to the chase

If you’re reviewing for the Evolve Endocrine content and you stumble on a scenario with a client on phenytoin, the telltale symptom is swollen gums. C is the correct pick. Gingival hyperplasia—gum tissue overgrowth—can pop up with phenytoin use, sometimes quite noticeably. This isn’t just a cosmetic concern. It can complicate brushing, eating, and even speaking. Left unchecked, swollen gums can invite infections and make it harder to keep the mouth clean. So yes, this sign right here deserves prompt nursing attention.

Phenytoin and the mouth: what’s going on anyway?

Phenytoin is a workhorse anticonvulsant. It’s effective for many people, but like a lot of long-term meds, it wears a little path in the body. In the mouth, that path can manifest as gingival hyperplasia. The basic idea is this: the gum tissue grows thicker and more swollen, and it can cover more of the tooth surface than before. The exact reason isn’t crystal-clean science, but several factors are thought to contribute:

• Fibroblast activity increases in the gum tissue.

• Inflammation from plaque buildup can amplify the overgrowth.

• Longer duration of phenytoin use and higher doses tend to raise risk.

• Age and genetic predisposition matter too.

The result? Gums that look puffy and red, that may bleed with brushing, and that create a tricky environment for oral hygiene. If you’ve ever tried to floss around inflamed tissue, you’ll get why this matters beyond appearances.

Why immediate intervention is important

This isn’t about making a patient uncomfortable for a moment; it’s about stopping a loop that can spiral.

• Oral hygiene challenges: Overgrown gums trap more plaque and bacteria. That can spark infections, bad breath, and periodontal problems.

• Eating and swallowing: If gum tissue crowds the teeth, chewing can become awkward or painful, nudging people toward softer, less nutritious choices.

• Infection risk: Swollen gums can bleed and become a doorway for bacteria to enter the bloodstream, which is especially important for anyone with other health concerns.

• Long-term dental health: Untreated gingival hyperplasia can require more intensive dental work down the line—think professional cleaning, dental procedures, or even surgical reduction in severe cases.

How a nurse can respond in the moment

Think of this as a short, targeted action sprint. Here’s a practical checklist you can carry into care:

• Assess and document: Note the size, color, and texture of the gum swelling. Check for redness, bleeding on probing, tenderness, and any ulcers. Record any changes in appetite or swallowing that might be linked to the swelling.

• Review the meds with the care team: Confirm the patient’s phenytoin dose and duration. If there are other meds that can trigger gum overgrowth (some calcium channel blockers or immunosuppressants), flag that to the physician. While the nurse isn’t changing the prescription alone, you’re the signal that something deserves a closer look.

• Coordinate with dental care: Contact a dentist or periodontist for an urgent evaluation. Early dental input can guide hygiene strategies and determine if a professional cleaning is appropriate or if a change in the anticonvulsant plan should be considered in coordination with the physician.

• Teach and support oral hygiene: Offer a plan that’s realistic for daily life.

• Use a soft-bristled toothbrush and gentle strokes.

• Consider a toothpaste formulated for sensitive gums.

• Floss carefully, if tolerable, to reduce plaque between teeth.

• Rinse with an alcohol-free, antiseptic mouthwash to help cut bacteria without drying the mouth.

• Avoid tobacco products, if possible, as they worsen gum health.

• Diet and comfort: If swelling makes chewing painful, suggest soft, nutrient-dense foods and small, frequent meals. Hydration matters too—saliva helps keep the mouth clean.

• Documentation and follow-up: Record the plan and timeline for follow-up. If the swelling worsens, or if the patient develops fever, severe pain, or signs of systemic infection, escalate care per protocol.

A few things to keep in mind while you’re at it

• It’s not just about the gums: While swollen gums are the standout symptom in this scenario, keep an eye on other side effects that can pop up with long-term phenytoin use—headaches, changes in appetite, or anxious feelings. They aren’t as urgent as swelling, but they matter for overall well-being and can affect adherence and comfort.

• Communication matters: The nursing voice isn’t just about medical orders. It’s about reassurance and clear guidance. Patients often worry that gum changes are permanent or that their medication is “to blame.” Calm explanations about why gingival hyperplasia happens and how hygiene helps can ease anxiety and encourage proactive care.

• A team approach pays off: Dentistry and medicine aren’t silos here. A quick consult with the dentist and the prescribing clinician can lead to a plan that preserves seizure control while limiting oral health risks. In some cases, dental interventions (like meticulous cleaning or even minor tissue reduction) and pharmacy adjustments can both feature in the plan.

A broader look at the big picture

Gingival hyperplasia from phenytoin isn’t uncommon, but it’s one of those symptoms that highlights the need for holistic care. Seizure management is vital, yet it doesn’t happen in a vacuum. The mouth is part of the body’s first line of defense; it tells a story about hydration, nutrition, and inflammation. When you see gum swelling, you’re not just noting a side effect—you’re spotting a signal that invites a broader, multidisciplinary response.

Putting it into practice: tips for students and care teams

• Know the red flags beyond the obvious swelling: increased pain, fever, or spreading redness around the gums should prompt urgent dental or medical evaluation.

• Build a simple patient education sheet: explain gingival hyperplasia in plain terms, outline daily oral care steps, and when to seek care. A little handout can make a big difference in adherence.

• Foster collaboration with dental professionals: even a quick referral or a joint note can align care. The goal is to protect both seizure control and dental health, and that’s a win-win.

• Keep it patient-centered: recognize that every patient’s experience is different. Some may have a milder bite on the gums; others may struggle with profound discomfort. Tailor the plan with empathy and practical options.

A quick take-home

When a client on phenytoin shows swollen gums, you’ve got to treat that as a priority. It’s a tangible symptom that touches daily life—eating, speaking, brushing, and overall comfort. Immediate nursing intervention means assessing the gum changes, coordinating with dental care, optimizing oral hygiene routines, and keeping the patient’s nutrition and seizure management in balance. It’s not just about stopping a side effect; it’s about preserving quality of life and paving the way for healthier long-term outcomes.

If you want a memorable way to remember this, think of the mouth as a tiny landscape: the gums are the soil, the teeth are the landmarks, and plaque is the weather. Phenytoin can tilt the climate toward overgrowth, and that’s where diligent nursing care steps in—checking the environment, guiding the patient to better habits, and pulling in the right specialists when needed. In other words, a swollen gum isn’t a minor footnote. It’s a call to action that can shape care well beyond a single shift.

So next time you encounter phenytoin in a scenario, listen for the oral health cue. A focused response on gum swelling isn’t just about comfort—it’s about safeguarding holistic health and supporting people as they navigate long-term treatment.