Epilepsy

1. Dental Considerations for
the Epileptic Patient
Prepared & Presented by
Dr Randa Youssef
Ass. Prof . Of Pediatric Dentistry & Dental Public
Health, Cairo university

2. Epilepsy
 Epilepsy is a brain disorder that
causes people to have recurring
seizures. The seizures happen when
clusters of nerve cells, or neurons, in
the brain send out the wrong signals.
 People may have strange sensations
and emotions or behave strangely.
They may have violent muscle
spasms or lose consciousness.

3. In Egypt: 50-72.5 per 100,000

4. Symptoms
 vary from person to person.
 Some people may have simple staring
spells,
 others have violent shaking and loss of
alertness.
 Most of the time, the seizure is similar to
the previous one.
 Some people have a strange sensation
(such as tingling, smelling an odor that
isn't actually there, or emotional
changes) before each seizure
aura.

5.  Clinically the seizure is initiated by
sudden cry which is caused by the
spasm of the diaphragmatic muscles,
followed by loss of consciousness and
falling on the ground.
 Once the attack started the jaws are
clamped tightly and cannot be
opened.
 The tonic phase is characterized by
generalized rigidity while the clonic
phase is characterized by
uncoordinated movements of the head
and the limbs.
 The patient then become comatosed

6. Dental Consideration
Oral Findings
Dental Management

7. Phenytoin-Induced Gingival
Overgrowth:

8. Etiology
 The antiepileptic agent phenytoin.
 This agent remains as one of the most
commonly prescribed medications to
treat epilepsy.
 about 30 to 50% of patients taking
phenytoin develop significant gingival
alterations.

9.  Other anticonvulsants have also been
associated with GO.
 Other drugs, such as the
immunosuppressant cyclosporine A
and some calcium channel blockers.
 PGO occurs early within 3 months and
equilibrium often occurs within the first
year.
 PGO seems to be more prevalent in
children & teenagers, regardless of
gender or ethnic groups.

10.  PGO incidence and severity is greater in the
buccal surface of both upper and lower
anterior teeth.
 Clinically, gingival enlargement begins in the
interdental papillae, which increase and
coalesce.
 Tissue appearance may range from a normal
aspect to a hyperemic state.
 Growth is slow but in more severe cases it
may go so far as to cover the whole tooth
crown.
 Few cases have also been reported in
edentulous patients and around deciduous
teeth.
 Likewise, there were some reports of GO in
areas of dental implants.

11. Pathology
 Microscopic analysis of PGO biopsies
reveals a redundant tissue of
apparently regular composition or with
an increased amount of collagen and
number of fibroblasts.
 Frequently, the overlying surface
epithelium presents rete pegs
elongating into the underlying lamina
propria.

12. Mechanism
 Phenytoin induces a decrease in the
Ca2+ cell influx leading to a reduction
in the uptake of folic acid, thus limiting
the production of active collagenase.

13. Dental Management of the
Epileptic Patient:
 Specific considerations:
GO Trauma

14.  If patients are adequately controlled
with their medication, routine dental
therapy is relatively simple and
straight forward.
 Patients whose seizure activity does
not respond to anticonvulsants may
have to have a consultation with a
neurologist prior to a dental
appointment.

15.  The clinician should keep in mind
stress is one of the factors that can
trigger a seizure.
 Appointments should be scheduled
during a time of day when seizures
are less likely to occur, if predictable,
and to minimize stress and anxiety
during the appointment.

16.  Light can be a trigger in inducing an
epileptic seizure. Therefore, dark or
colored glasses can be used as eye
protection and the operating light must
be controlled so it is directed only into
the mouth and not flashed into the
patient’s eyes.

17. Treatment Planning Considerations:
 Their recall and hygiene interval may be
more frequent.
 Prosthetic treatment ;resistant to
damage or displacement during an
epileptic attack. Displacement of a
prosthesis risks possible aspiration into
the upper respiratory tract.
 Cast gold fixed bridges or implant
restorations are ideal. They offer the
least chance of displacement or fracture.
 All porcelain/ceramic restorations
present a high risk of fracture.

18.  conscious sedation and general
anesthesia is not contraindicated in
patients with epilepsy. In some
situations nitrous oxide or intravenous
sedation may be necessary to safely
and effectively provide dental care.

19.  If a patient has a seizure during a
dental appointment, the only thing to
do is to allow them to go through their
seizure while minimizing any
unintentional injury during the event.

20. Steps to minimize risk of
injury during an epileptic
seizure:
 safely done quickly remove all foreign
material from the patient`s mouth.
 supine position.
 turn the patient to their side in order to
minimize aspiration of foreign bodies or
secretions.
 Use passive restraint only to prevent
injury that may occur by the patient
hitting nearby objects or to prevent them
from falling out of the chair.

21.  Most seizures do not constitute an
emergency. But if the seizure has any of the
following characteristics, then it does
constitute an emergency and medical help
needs to be rendered and/or summoned.
1. A seizure that continues for more than five
minutes without the patient gaining
consciousness between attacks (Status
Epilepticus).
2. Breathing difficulties after a seizure.
3. Persistent confusion or unconsciousness for
more than five minutes
4. Injuries sustained during a seizure
5. A first seizure.

22. Drugs used in Dentistry whose
activity can be altered by
anticonvalscents:
 Acetomminophen
 Doxycycline

23. Drugs contraindicated in
epilepsy:
 Alcohol
 Chloromazine
 Enflurane
 Flumazenil
 Fluxeline
 Ketamine
 Lidocaine
 Metrnidazole
 Quinolones
 Tramadol
 Tricyclicantidepressants

24. Summary:
 Patients with epilepsy can be safely
managed in a general dental office by an
informed practitioner.
 A good health history to fully understand
the patient’s disease and the
medications they are taking is essential.
 A proper oral exam to uncover any
dental problems and possible oral effects
of anti-epileptic drugs is necessary.
 Some simple and straightforward
treatment planning considerations will
insure the Patient’s oral health is
properly maintained.