Background: Persons living with epilepsy (PWE) may present with poorer oral health outcomes compared to the general population, partly due to the effects of anti-seizure medications (ASM) and challenges related to oral hygiene practices. Gingival enlargement resulting from medication poses a clinically significant threat to oral health and treatment adherence. This study aims; to determine the prevalence of gingival enlargement among PWE compared with healthy controls, to evaluate periodontal status and oral hygiene practices, and to identify factors associated with gingival enlargement. Materials and Methods: We conducted a hospital-based case-control study at Yaoundé Central Hospital and Yaoundé General Hospital, Cameroon. Thirty-five PWE receiving ASM were enrolled and matched by age and sex with 35 healthy controls. Gingival enlargement (MB index), calculus index, plaque index, and gingival bleeding index were tools utilized in oral hygiene status assessment. A structured questionnaire was developed to aid in the collection of data on oral hygiene practices and ASM regimens. Bivariate and multivariate analyses permitted the identification of associations between gingival enlargement and clinical variables. Results: Seventy participants were included in the study (mean age 32.44±11.43 years; 64% male). Out of the 70 participants, 10.0% of participants had gingival enlargement, with an increased frequency among PWE compared with controls (17.1% vs 2.9%, p=0.046). All cases were classified as grade 1 enlargement. PWE had a significantly worse periodontal status, as evidenced by a higher plaque index (p=0.009), gingival bleeding index (p=0.003), calculus index (p=0.027), as well as a worse overall oral hygiene status (p=0.012). Gingival enlargement occurred exclusively among participants with the highest plaque index scores and was significantly associated with periodontal indices (p<0.001). No statistically significant associations were observed between gingival en