PEDODONTICS

1. GOOD MORNING !

2. EPILEPSY
YASMIN MOIDIN
2008 Batch
Al Azhar Dental College
Thodupuzha

3. The epilepsies are a group of disorders
characterized by chronic, recurrent
and
paroxysmal changes in neurologic function
caused by abnormalities in the electrical
activity of the brain

4. 
Each episode of neurologic dysfunction is
called a SEIZURE

The
seizure
may
be
accompanied by motor
convulsive
when
manifestations or
may be manifested by other changes in
neurologic function

5. ETIOLOGY
Epileptic disorders can occur due to :1.
Idiopathic :- the condition cannot be attributed to
any demonstrable
lesion of the brain and is
frequently of genetic origin
2.
Symptomatic :- the condition is associated with the
pathology of the brain due to developmental
anomalies such as brain malformation, injury or
disease such as fever, hypoxia, hypocalcaemia

6. CLASSIFICATION
The International League against epilepsy has
classified epileptic seizures as follows :
PARTIAL SEIZURES
•
Simple partial seizures
•
Complex partial seizures
•
Secondary generalized seizures

7. 
PRIMARY GENERALISED SEIZURES
•
Tonic clonic ( grand mal )
•
Tonic
•
Absence ( petit mal )
•
Atypical absence
•
Myoclonic
•
Atonic
•
Infantile spasms

8. 
•
•
•

•
•
•
STATUS EPILEPTICUS
Tonic clonic status
Absence status
Epilepsia partialis continua
RECURRENT PATTERNS
Sporadic
Cyclic
Reflex

9. SIMPLE PARTIAL SEIZURE




Consciousness is fully preserved
Motor, sensory, autonomic or psychic
symptoms
Jacksonian march
Todd’s paralysis- lasts for minutes to hours

10. COMPLEX PARTIAL SEIZURE




Consciousness is impaired in the form of
transient impairment in the patients ability to
maintain normal contact with the environment
Aura ( simple partial seizure)
Automatisms- lip
smacking, chewing, swallowing , picking
movements of the hand
Confused following seizure

11. PARTIAL SEIZURE WITH
SECONDARY GENERALIZATION

Starts with partial seizure & then becomes
generalized

12. ABSENCE SEIZURE

Sudden cessation of the ongoing conscious
activity without convulsive muscular activity or
loss of postural control

Lasts for a few seconds to minutes

Occurs in children of 6 to 14 years

Brief lapses of consciousness or awareness

13. TONIC CLONIC SEIZURE








Sudden loss of consciousness
Tonic contraction of muscles
Loss of postural control
Respiration arrests
Pupils dilate
After 10 to 30 seconds – tonic phase – clonic
phase – muscles contract – salivation –
perspiration – involuntary bladder – bowel
evacuation
Contractions become less violent and gradually
cease
Child then remains stuporous and goes into deep

14. ORAL MANIFESTATIONS
•
•
•
•
•
•
•
•
•
Soft tissue lacerations of tongue or buccal
mucosa
Facial fractures
Trauma to teeth
Subluxation of the TMJ
Injuries due to drug therapy
Gingival hyperplasia
Recurrent aphthous like ulceration
Anomalous dental development
Cervical lymphadenopathy

15. DENTAL MANAGEMENT






Complete medical history
Reduce stress on patients
Diazepam
Use of dental chair light is avoided
Avoid seizure promoting drugs
Drug therapy :- vigabatrin, lamotrigine and
topiramate

16. OFFICE MANAGEMENT OF
SEIZURE

•
•
•
•
•
•
If seizure occurs in dental chair –
Chair is lowered to supine position –
Patient is protected from injuring himself –
Mouthprop is inserted into oral cavity to
prevent tongue biting
Maintain a patent airway
Diazepam 1mg per kg IV slowly upto 10mg
Give oxygen

17. DENTAL TREATMENT

Appointments should be kept short

Importance of tooth brushing procedures and
regular dental review is required

If appliances are indicated for tooth movement
and tooth replacement , the fixed type are
preferred