Epilepsy and Dentistry
By Hoda Ossoble
The subject of dental health is an important concern for all individuals, but it is of particular concern for children and adults who suffer from epilepsy because of the many health complications that can occur during a trip to the dentist's office. At a seminar held in Hamilton on Tuesday March 15, a group of 110 dental hygienists and nurses were schooled on the possible complications that can arise while a patient with epilepsy is in their care. What exactly can a dentist do when your child begins to have a seizure while under the knife? How do potential drug interactions play a role in your safety? Should doctors monitor their patients with epilepsy? Many of these questions were discussed and answered, in order to help the group understand the basics in case such an incident should ever occur.
Most readers already know that epilepsy is a neurological condition that, from time to time, produces brief disturbances in the normal electrical functions of the brain. When someone has epilepsy, this normal pattern may be interrupted by intermittent bursts of electrical energy that are much more intense than usual. (1) To ensure that the patient is safe, the following steps must be followed:
1) Protect the patient from injury;
2) Remain calm;
3) Move all dental equipment out of the way;
4) Remove everything from patient's mouth;
5) Do not attempt to move patient;
6) Place chair in supine position;
7) Turn patient to side to control airway;
8) Administer oxygen and
9) Summon medical assistance if seizure lasts more than five minutes. (2)
When the seizure is over you must be sensitive to the patient- reassure him or her. Reschedule the dental appointment for another day, and be sure that the patient has safe transportation home.
Sound simple? Not exactly, you see, a dentist must first be aware of the patient's condition and of which type of seizures their patient has, this information is best acquired through an interview or a private meeting between the patient and his/her doctor. Some of the things a dentist should be asking about are the patient's medical history, the current medication he/she is on, if they have ever been hospitalized for having a seizure, and if there are any predominant signs that one will have a seizure. Once the doctor has recognized that the patient has epilepsy and now understands the types of seizures they experience, the dental hygienist must understand the risks associated with drug interactions. Dental complications have been closely associated with the use of Dilantin. The drug is an antiepileptic drug, prescribed to control grand mal seizures. Dilantin can produce gingival hyperplasia, a condition which results in painfully swollen red gums. This complication is more common among children who are on this medication. If a patient is taking Dilantin in high doses, the position of the teeth and supporting bone structure can also be damaged. Some other side-effects that are common include increased incidence of infection, Xerostomia (dry mouth), delayed healing, bleeding gums, as well as postoperative bleeding. Other medications that dental hygienists should be aware of include Tegretol (also known as carbamazepine). Propoxyphene and erythromycin should not be administered to patients taking Tegretol because of its interference with the metabolism of Tegretol; which can lead to toxicity. Zarontin produces mouth ulcers and some gingival hypertrophy in patients when other drugs are interactive. Lastly Orlept, Epilum (also known as sodium valproate) can cause blood problems such as slow healing, and risk of infection. (3)
Many steps can be taken to avoid medical complications for those who have epilepsy as long as the dentists and nurses are made aware of the special needs of this patient and can provide the necessary steps needed to be taken in case of emergency. Dental heath is vital for all people. Therefore, every practitioner of oral hygiene must do all they can to provide the highest quality of care possible for all of their patients.
Sources:
1) All about Epilepsy. 2003. Epilepsy Ontario. Available at http://www.epilepsyontario.org/client/EO/EOWeb.nsf/web/All+About+Epilepsy
2) Epilepsy and Dental Management. 1993.University of Louisville, School of Dentistry. Available at http://www.dentalcare.com/soap/intermed/epilpg.htm
3) Guide to Prescription Drugs- Encylepedia of medicine- Dilantin. 2004. Healthsquare.com. Available at http://www.healthsquare.com/newrx/dil1136.htm
