Treating epileptic patients – Mark Allen Coltene
Featured Products Promotional FeaturesPosted by: Dental Design 27th December 2018
Over the course of your career you will see all manner of patients, from run of the mill individuals who rarely need more than a scale and polish to those with more complex dental and health needs. One condition to be aware of that can pop up from time to time is epilepsy.
Epilepsy is a neurological condition where the electrical signals in the brain become scrambled, occasionally causing sudden bursts of electrical activity leading to seizures. The possible symptoms can vary, typically manifesting as either: impaired consciousness; abrupt loss of muscle tone and consciousness resulting in sudden collapse; jerking of arms and/or legs and impaired consciousness; and repetitive jerking, stiffening and loss of consciousness. The condition is thought to affect around 600,000 people in the UK, often for the entirety of their lives once diagnosed.[i]
Naturally the risk of a seizure occurring whilst in the dental chair is a consideration that you should give thought to with all epileptic patients, as there are a number of risk assessments and safety precautions that you will need to have in place. However, you should also consider how epilepsy can affect patients orally. Due to an increased risk of dental caries, periodontal disease, canker sores and lesions, delayed healing, gingival hyperplasia and xerostomia thanks to side effects of anti-seizure medications, it is likely that epileptic patients will need extra monitoring and possibly intervention. Six monthly check-ups and a personalised oral health programme are therefore essential to maintain the oral health of these patients, as is regular confirmation of medications and dosage levels.
Seizures can also have a devastating effect on the patient orally as there is a high risk of tongue laceration, trauma-induced tooth avulsion and temporomandibular disc location, as well as oral trauma such as chipped and broken teeth. One study found that 52.4% of subjects experienced oral trauma of some description during an epileptic seizure. Of those, 18% suffered from a cracked tooth and 17% from a tooth fracture.[ii]Another discovered that generalised tonic-clonic, generalised and non-classified seizures were strongly associated with trauma within the 159-strong control group. The most common injuries were fractures, tooth avulsion, tooth luxation and fracturing of prostheses in edentulous patients.[iii]
All of the above can be extremely painful for the patient and have a huge impact on their quality of life. As such it is important to intervene as quickly as possible. Of course, the treatment that you provide will all depend on the type of trauma that the patient has experienced. In some instances, it may be possible to treat the affected tooth or teeth restoratively depending on the extent of the damage and whether the pulp is involved and healthy. This pathway is generally much less invasive for the patient and offers a promising prognosis. In other cases it may be necessary to perform root canal therapy, or even possibly remove the tooth if it cannot be saved.
One possible scenario in which restorative treatment might be possible is if the trauma in question is a ‘fractured cusp’ – where the cusp is separated from the rest of the tooth either by a complete or incomplete fracture.Indeed, it is believed that as long as enough of the tooth structure remains and the pulp is unaffected it may be feasible to provide a direct restoration or an inlay, onlay or build-up and crown, depending on what the assessment reveals. Factors to take into consideration include: the amount of tooth and enamel available; whether or not it is possible to isolate the tooth; and if margin placement is likely to be a concern. The long-term implications of each pathway on surrounding teeth must also be taken into account as well as the material choice.
A restorative pathway may also be taken (if the pulp is healthy and intact) to prevent a ‘cracked tooth’ from worsening, as long as the restoration covers the entire crack and provides cuspal coverage and support. A cracked tooth is defined as being an incomplete fracture that starts from the crown and extends subgingivally. Thanks to new and improved materials and bonding techniques, it is possible to save more of the tooth and manage with bonded direct or indirect restorations.
COLTENE is amongst those providing high-performance restorative materials with high abrasion resistance, high compressive strength, excellent handling and application, and more. With the addition of superb polishability, gloss retention and long-lasting aesthetics, materials such as BRILLIANT EverGlow®, Fill-up!™and the BRILLIANT Crios CAD/CAM bloc can help to make optimal results achievable.
You may never come across a patient with epilepsy, but in the event that you do, be sure to take into consideration how the condition might affect their oral health, and treatments that could be provided to restore their dentition. With the right techniques and materials it may be possible to make the teeth and gingiva one less thing for them to worry about.
To find out more visit www.coltene.com, email info.uk@coltene.comor call 01444 235486
[i]Epilepsy Action: Epilepsy facts and terminology. Accessed online August 2018 athttps://www.epilepsy.org.uk/press/facts
[ii]Gawlak D, Luniewska J, Stojak W, Hovhannisyan A, Stróżyńska A, Mańka-Malara K, Adamiec M, Rysz A. The prevalence of orodental trauma during epileptic seizures in terms of dental treatment – Survey study. Neurol Neurochir Pol. 2017; 51 (5): 361-365. Accessed online August 2018 at https://www.ncbi.nlm.nih.gov/pubmed/28711375
[iii]Nonato ER, Borges MA. Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population. Arq Neuropsiquiatr. 2011; 69 (3): 491-5. Accessed online August 2018 at https://www.ncbi.nlm.nih.gov/pubmed/21755128
