Epilepsy in the oral and maxillofacial patient: current therapy

Oral Health Considerations and Dental Management for Epileptic Children in Pediatric Dental Care

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. A seizure episode in a dental clinic is a medical emergency, and it is imperative as an oral health care provider to have adequate knowledge about this condition in order to render safer dental care to epileptic patients. There is a paucity of information in the medical literature on the dental management of epileptic patients. The purpose of this case series is to elaborate on the oral health considerations in epileptic patients and educate oral healthcare providers on the diagnosis, treatment, and emergency management of epilepsy, along with special dental treatment needs in epileptic patients. The case series is a compilation of two cases of petit mal epilepsy and one case of generalized tonic-clonic seizure with detailed descriptions of preventive seizure measures and dental management undertaken during the treatment of patients.

How to cite this article

Goswami M, Johar S, Khokhar A. Oral Health Considerations and Dental Management for Epileptic Children in Pediatric Dental Care. Int J Clin Pediatr Dent 2023;16(1):170-176.

Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation.

Fever after maxillofacial surgery: a critical review

PURPOSE

The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature.

DISCUSSION

Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature.

CONCLUSION

Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.

Dental management of special needs patients who have epilepsy

Patients who have developmental disabilities and epilepsy can be safely treated in a general dental practice. A thorough medical history should be taken and updated at every visit. A good oral examination to uncover any dental problems and possible side effects from antiepileptic drugs is necessary. Stability of the seizure disorder must be taken into account when planning dental treatment. Specific considerations for epileptic patients include the treatment of oral soft tissue side effects of medications and damage to the hard and soft tissue of the orofacial region secondary to seizure trauma. Most patients who have epilepsy can and should receive functionally and esthetically adequate dental care.