Gum enlargement is reported to occur in about 50% of patients receiving phenytoin with varying incidences ranging from 3 to 85 percent.This report describes a case of gingival enlargement in a patient taking phenytoin for the past 15 years and a brief review of literature for the standard treatment guidelines for its clinical management and the constraints in the public secondary health care setup. Naranjo's causality assessment algorithm was used to assess this adverse effect and antiepileptic drugs were found as probable cause of gum enlargement with the score of 8. The standard treatment guidelines for such conditions cannot be followed in a public secondary care set up as the alternate drugs are not available in the hospital formulary and no drug concentration measurement services available. Hence, within this constraint condition, the clinical pharmacists are supposed to give advice about oral hygiene and life style modifications apart from empirical reduction of phenytoin dose.