Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Epilepsy generally begins in childhood, potentially impeding education, employment, social relationships, and the development of a sense of self-worth. The number of decayed and missing teeth, the degree of abrasion, and periodontal indices are significantly worse in patients with epilepsy. Epileptic patients require special care during dental treatment.
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1.THE EPILEPTIC Patient And How To Manage Them In Dentistry.pptx
1. THE EPILEPTIC
PATIENT
Definition : Any irritation to the brain may cause
a seizure. Recurring seizures (called Epilepsy).
May affect tiny area of the brain causing no
seizure, or affect large area of brain causing
convulsion/jerking and spasm of muscles of
whole body (2 to 5 minutes).
2. How do you identify them?
•Patient can tell you…
•Epilepsy is detected by
electroencephalogram (EEG) test.
•Abnormal electric activity or magnetic
resonance imaging (MRI).
•Reveal small scarring in the brain.
3. Continued
•May be caused by brain injury at birth or later,
or inherited or
•idiopathic/not known with no evidence of
scar.
•Child(+/-2years) may have seizures (infantile
seizures/salaam seizures)
• caused by brain defects, chemical imbalance
or high fevers.
4. Types of Seizures
• Simple partial seizure: Begins with electrical discharges to small area
of brain; person experiences abnormal sensation, movements or
psychic abnormalities. Depending on which part of brain is affected.
• Complex partial seizure: Person looses touch with surrounding,
staggers moving arms and legs purposeless; resists help; meaningless
sounds uttered, confusion for several minutes (1 to 2minutes),
followed by recovery.
• Convulsive seizure ( grand mal or tonic-clonic seizure): begins by
abnormal electrical discharge to small area of brain but spreads to
other parts of brain; brain malfunction.
5. Continued
• Status epilepticus: Wide spread electrical discharge;
Serious non-stop seizure; a medical emergency;
convulsions, intense muscle contractions,, cannot breath
properly; heart and brain become overworked and can be
damaged and person die.
• Primary-Generalized epilepsy: electrical discharge over
wide area of brain, wide brain malfunction; convulsion of
body; severe muscle spasm and jerking of body; head
turning intensely to one side; clenching teeth; may bite
tongue; temporary loss of consciousness
6. Continued
•Petit mal(absence)seizure: takes place
in childhood; no convulsions; no
dramatic symptoms but just fluttering
eyelids and twitching facial muscles;
no loss of consciousness or jerking
movements.
7. Oral cavity indications
•Bruxism of teeth
•Bitten tongue;
•Scars of Bitten lips or cheeks;
•Sharp teeth lacerating tissues; needing
smoothening;
•Fractured teeth affecting even pulp;
8. Continued
•Gingival overgrowth due to antiepileptic
medication (Dilantin hyperplasia)or
(phenytoin-induced hyperplasia);
•Gingival growth seen more in younger
patients;
•Gingival growth is seen more at anterior
gingivae than at posterior;
9. Continued
•Growth is more at facial and
proximal/interdental than at lingual
area;
•Overgrowth may also occur at
edentulous areas and
•Around dental implants;
10. Clinical features in
oral cavity
•Painless lesion: Enlargement of interdental
papillae with signs of inflammation.
•Tissue becomes fibrotic, pink and stippled, with a
mulberry appearance;
•Advanced lesion: Tissue increases in size,
extends to include the marginal gingiva, and
covers a large portion of the anatomic crown.
11. Clinical features Continued
• Severe lesion: Large, bulbous gingiva may cover the
enamel, tend to wedge the teeth apart, and interfere
with mastication.
12. Effects of gingival overgrowth/ Hyperplasia
o Poses dental biofilm control problem
o May interfere with mastication
o May alter tooth eruption
o May interfere with speech
o May cause serious esthetic concerns
13. Complicating factors
o Dental Biofilm/plague and Gingivitis
o Biofilm/plague most important determinant of
the severity of phenytoin-induced gingival
enlargement.
o Adequate biofilm control, if started before the
administration of phenytoin, helps control the
extent of gingival overgrowth.
14. Contributing factors
o Mouth-breathing
o Overhanging and other defective restorations
o Large carious lesions
o Calculus and other biofilm - retaining factors
encourage gingival overgrowth.
15. Treatment Methods
1.Surgical Treatment
• Gingivectomy if sufficient band of attached gingiva exists.
• Periodontal flap procedure of choice for healing and
esthetics.
• Prior to surgery – regulated programme of biofilm control
introduced and continued after surgical dressings have been
removed.
16. Continued
Change in drug prescription prior to surgical
removal
2. Nonsurgical Treatment
• Scaling to control biofilm may help early lesions
regress.
•Treatment must include removal of contributing
factors by polishing overhangs, placing or replacing
restorations, and removing calculus.
•Prevention and control should be started prior to or
simultaneously with the initial administration of
18. DENTAL HYGIENE CARE PLAN
Patient History- continuous
•Most patients with epilepsy have regular,
thorough medical examinations.
•Physician must be contacted:
•-if patient is unable to provide needed
information or is non-compliant,
19. Continued
•-if seizure activity has increased or changed,
•- if treatment for epilepsy is impacting dental
treatment, such as gingival overgrowth.
•Well controlled patient with epilepsy may still
have a seizure.
• Seizure prone – patient should wear the
Medical Alert jewelry.
20. I. Information to obtain
•Medical history
• Physician name and phone number
• Emergency contact person and
phone number.
21. Continued
• Enquire about recent seizures
• Medications taken and effectiveness of it.
• Adherence to treatment.
• Type of seizure, severity and duration
22. II. Information to obtain
• Age at onset of seizures
• Precipitating factors/Causes
• Frequency of seizures
• Description of prodrome/pre-,
aura/sensation if known
23. Continued
• Experience alteration/changes or loss of
consciousness.
• Characteristic motor movements
• Urinary or fecal incontinence/inability to control
• History of injuries, including oral injuries, broken
teeth, tongue lacerations.
24. III. Patient approach
•Provide a calm, reassuring, atmosphere
and treat with patience and empathy.
• Encourage self-expression particularly if
the patient tends to be quiet and
withdrawn
25. Continued
•Recognize possible impairment of
memory when reviewing personal oral
care procedures
• Help the patient develop an interest
in caring for the mouth; commend all
little successes.
26. Prior to and at the start of
Phenytoin Therapy``
•Accurate biofilm control programme and
complete scaling are introduced in preparation
for phenytoin therapy.
•Patient and caregivers must understand that,
controlled oral hygiene and its emphasis at all
phases of prevention, reduce gingival overgrowth
to a large degree.
27. DENTAL MANAGEMENT
1. Slight or mild gingival overgrowth
• Nonsurgical treatment, including frequent thorough scaling,
can be expected to lead to tissue reduction, provided the
patient cooperates to daily biofilm control.
• Weekly appointments for complete biofilm control instruction
and scaling are planned with the ffg. objectives:
• Frequent maintenance appointments can contribute to
function and comfort with minimum periodontal
involvement.
28. Continued
2. Moderate gingival overgrowth
•Weekly biofilm instruction and scaling, reevaluation of the
tissue to determine whether further procedures are
needed.
• Changing medication may attain Optimum level of oral
health; and continuing frequent maintenance
appointments.
•Frequent maintenance appointments can contribute to
improved function and comfort with minimum
29. Continued
3. Severe fibrotic overgrowth
•Initial scaling and biofilm control are carried
out to prepare the mouth for perio surgery.
• Plans for changing the drug or altering the
dose should be discussed with the patient’s
physician.
•Refer to Periodontist for surgery.
30. Maintenance appointment intervals
•Frequent appointments on a 1,2 or 3 month plans are
indicated, depending on the severity of the gingival
enlargement and the ability and motivation of the
patient to maintain the oral health.
•Most patients need continuing assistance and
supervision, and their response is influenced by the
instruction and devotion of the dental personnel.
31. Prevention
•Daily biofilm removal and fluoride therapy, the
use of pit and fissure sealants, and dietary control
all have a vital part in the care of the patient with
a seizure disorder.
• Initiation of preventive measures as soon as
possible after the disorder has been diagnosed
can contribute to the total health and well-being
of the patient.
32. Minor Oral Surgery/Restorative Treatment
•If patient requires an extraction or conservative
treatment, ensure that the medication was taken
in the morning and observe patient for onset of
seizures.
•Restores fractured teeth if fracture involves
enamel and dentine, refer if fracture involves
pulp for root canal therapy/extraction
•Repair fractured restorations and overhanging
34. EMERGENCY CARE
I.Objectives
•To prevent body injury and accidents related
to the oral structures, such as
•Tongue bite
•Broken or dislocated teeth
•Dislocated or fractured jaw
35. Emergency Procedure
•The office team should have assigned
responsibilities during any emergency.
•When a convulsion occurs,
•Terminate procedure and call for
assistance
36. Continued
•Do not attempt to stop the convulsion or
to restrain the patient .
•Protect the patient from injury.
•Position patient, lower chair and tilt to
supine, raise feet. Keep from falling out of
dental chair.
37. Continued
• Push aside sharp objects, movable
equipment , and instrument trays.
• Loosen tight belt , collar, necktie
• DO NOT place or force anything
between the teeth.
38. Continued
•Establish airway; check for breathing obstruction ;
provide basic life support when indicated . Place on
side recovery position. Use high-speed suction with
wide tip to remove any vomit.
• Monitor vital signs.
•If seizure is still occurring or has recurred within 5
minutes, activate emergency medical system.
39. After seizure /Postictal phase
•Allow the patient to rest.
• Talk to patient in low, reassuring tone.
• Check oral cavity for trauma to teeth or
tissues.
40. Continued
• Contact the patient’s family to
accompany the patient if
requested.
•Record the emergency
• Leave patient in privacy.
41. Status Epilepticus
• Defined as one or more seizures that lasts longer than
30 minutes.
• This prolonged seizure may not end spontaneously;
brain injury may occur
• Generally a seizure lasting more than 5 minutes should
be considered to progress to status epilepticus unless
emergency intervention is taken.
42. Continued
•Emergency medical assistance must
be sought immediately, and the patient
must be transported to the emergency
department.
• Basic life support and intravenous
diazepam are given.
43. Stages of Epilepsy
• Aura – the warning stage to the patient. Differs from patient
to patient;
• Tonic stage- patient looses consciousness, falls, may get
injured by surrounding, whole body in spasm.
• Clonic phase- convulsion, jerking movements which may
also cause injuries, patient may loose control of
sphincters/body-valves.
• Recovery phase- Patient regains consciousness but may
sleep due to fatigue.
44. Precautionary measures expected.
• Are they on treatment...?
• Is the patient alone…?
• Seizures may be triggered by repetitive sounds,
flashing lights, certain drugs, alcohol, fatigue, stress,
low levels of oxygen/sugar in blood even in people
with no known epilepsy.
• Dental care provider must be trained for emergency
management;
45. Continued
•Have emergency equipment ever ready;
•Lay the patient safely on the floor with
head to the side,
•Remove dentures and all removable oral
appliances;
•Monitor airway and liquid discharge,
46. Continued
•Remove all dangerous objects away from
patient area,
•Do not restrain patient but guide movements
away from injury;
•Allow patient to recover fully before escorted
home;
•Advise to notify family doctor.
48. Post-operative precautions and care.
•Always emphasize precautionary measures;
•Emphasize prevention of diseases;
•Emphasize home oral health care practices;
•Have emergency numbers visible;
•Remove/avoid potentially harmful objects;
•Stay away from open fire.
