case study of an epilecptic patient emphasizing points on how to handle these cases and manage seizures when occuring in dental office.

1. Case presentation
of an Epileptic Patient
Presented by :
Mohamad Halabi

2. Patient Personal Info
Name: T.K
AGE: 32
GENDER: MALE
OCCUPATION: SALESMAN IN SMALL STAND
NATIONALITY: LEBANESE
MARITAL STATUS: SINGLE
MENTAL STATUS: not stable

3. chief complaint
 The RPD is slipping when he eats

4. MEDICAL HISTORY & Medication
 Epileptic patient( seizures started
when he was 7 affected his mental
growth)
 Takes anti-epileptic medications for
more than 20 years:
a) NEUROTOP RETARD 300mg
b) Gardenal 100mg

5. Dental History
2 RCT
Multiple extractions
RPD
Prosthodontic bridge

6. HABITS& ORAL HYGIENE
PRACTICES
Smokes shisha daily
He occasionally brushes teeth
Bruxism due to spasms and seizures
he gets
Cheek biting

7. Oral tissue examination
 Palate: yellowish pigmentation
 Cheek: cheek bitten
 Lips: normal
 Floor of mouth: normal
 Tongue: - fissured &glossitis
(because of Biting during seizures)
-yelowish pigmentation due
to chromogenic bacteria stuck in
fissures)

10. Teeth examination

11. TEETH EXAMINATION:
i. MISSED:
#24,28,38,37,36,35,44,45,47,48
ii. DECAYED:18,17,25,26,27,34,46
iii. FILLED: X

12. PERIODENTAL
EXAMINATION
 GINGIVA:
I. Moderate generalized gingivitis
II. Mild inflamation(not sever because he
stopped taking his medication from 2
months)
 Oral hygiene:
I. Poor oral hygiene
II. Extrinsic stains
 No fremitus
 No tenderness on percussion

13. Treatment Plan

14. STEP#1: ETIOTROPIC
COUNSELING
 Patient education
 ORAL HYGIENE INSTRUCITONS
 Diet counseling
 Scaling and Root planning

15. STEP#2: SURGICAL&ENDO
TREATMENT
 EXTRACTION OF hopeless teeth
#18,17,25,26,27
 Endo treatment of #34

16. Step#3:RESTORATIVE
TREATMENT
OPERATIVE treatment of #46
RPD instead of extracted maxillary
teeth
*(implant is unaffordable)
Post&crown for #34
Fixing old RPD(change slippery
clasp)

17. Epileptic Patient
 What is epilepsy and what are
Its types?
Epilepsy is a brain disorder characterized by
excessive neuronal discharge that can produce
seizures, unusual body movements, and loss o
changes in consciousness.
 Prevalence
1. < 1%
2. 75% no known etiology
3. Higher frequency in males

19. ORAL MANIFESTAIONS OF
EPILEPTIC PATIENTS
 Increased risk for:
1. dental caries
2. oral trauma
3. laceration, including bite injuries to
tongue
4. Broken anterior teeth(because his
parents put a spoon in his mouth during
seizures to prevent tongue swallowing
thus he bites heavily on metal)

20.  5-trauma-induced TMJ disc dislocation
requiring reduction
 6- trauma-induced tooth avulsion
 7-attrition of teeth due to grinding of teeth
during seizures

21. 1. ulcerations and glossitis as a result of
medication-induced B-12 deficiency
2. Medication-induced gingival hyperplasia,
bleeding gums, xerostomia& delayed
healing
3. Drug interaction with metronidazole&
erythromycin
ANTI-EPILEPTIC DRUGS ORAL SIDE-
EFFECTS

22. Precautions taken in dental office
 Maximum precautions should be taken to prevent
occurance of seizures:
1. Collecting info about seizure and their occurrence
2. Taking short appointments in time of day where
seizure occur the least
3. Minimize stress and anxiety and prevent doing
actions that disturb the patient

23.  4-Explaining procedure for patient before
starting
 5-Light triggers epileptic shock so prevent
light from entering the patients eyes or use
dark eye protection

24. What to do if seizure occurs in
office?
Remove all foreign objects from mouth
Remove all intsruments next to him or her
Place chair in supine position
Turn the patient on his side if possible to
prevent tongue swallowing
Do not put fingers in mouth because they
might be bitten

25. When the seizure takes too long!!
 If the seizure takes more than 5 minutes:
1. Call 911
2. Administer oxygen at rate of 6-8L/minute
3. Administer:
a. 10mg diazepam IM or IV
b. 2mg ativan IV or IM

26. ONCE THE SEIZURE IS OVER
1. STOP any dental treatment in the day
2. Talk to patient & evaluate conscious phase
3. Do not restarin the patient and try not to
embaress him or her
4. Do not allow the patient to leave office
before completely restoring conscious
(better if relative called to take him home)
5. Do brief oral examination for any seizure
related injuries

27. Thank you