Dental status and oral health of patients with epilepsy: an epidemiologic study

Is temporomandibular joint involvement more frequent in patients with epilepsy? A clinical study

STATEMENT OF PROBLEM

Epileptic seizures may affect the stomatognathic system via transmission of an increased load to the dentition and the temporomandibular joint (TMJ), resulting in temporomandibular joint dysfunction (TMD).

PURPOSE

The purpose of this clinical study was to assess whether TMD was more prevalent in patients with epilepsy than in those without epilepsy.

MATERIAL AND METHODS

A total of 107 participants diagnosed with epilepsy and 100 healthy controls were enrolled in the study. Those with epilepsy were divided according to their dental manageability into 3 subgroups: mild group, moderate group, and severe group. Following general, dental, and TMJ-related history, the range of maximal mouth opening (MMO), laterotrusion, possible deviation and deflection, and presence of crepitation and clicking was recorded, as suggested by the diagnostic criteria for temporomandibular diseases (DC/TMD). Pressure pain threshold (PPT) was also measured by using a pressure algometer on 3 points bilaterally.

RESULTS

Incidence of TMJ complaints was not significantly different between the control (30%) and the group diagnosed with epilepsy (33%); however, the number of complaints experienced was significantly higher in the epilepsy group (C: 3%, E: 16% had 3 or more complaints; P<.001). Joint clicking was significantly more prevalent in the entire epilepsy group (P=.012) and in the mild group (P=.004) than in controls. Crepitation and joint pain were not significantly more common in the epilepsy group. Maximal mouth opening, laterotrusion, and the ratio of restricted mouth opening did not differ significantly in the epilepsy group. Deflection occurred significantly more often in the epilepsy subgroups (mild and moderate groups; P<.001), and the extent of deflection was also significantly higher in all the epilepsy subgroups (P<.001) than in controls. Regarding the pressure pain threshold, significant difference was observed in the severe group at the left masseter muscle points M1 (P=.046) and M2 (P=.028) compared with controls.

CONCLUSIONS

All parameters typical of TMD could be found frequently in patients with epilepsy. Because of the seizures and the consequent joint overload, the TMJ involvement was more common or more serious in those diagnosed with epilepsy. Outcomes of this study support the assumption that epilepsy is a risk factor for the development of TMD.

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.

Oral health status and its associated factors among post-stroke inpatients: a cross-sectional study in Hungary

Background

Post-stroke inpatients are at risk of poor oral health for a number of reasons. The aim of this study was to assess the oral health status of post-stroke patients and also to explore the factors that may influence it.

Methods

This cross-sectional study was organised at National Institute for Medical Rehabilitation in Hungary. Altogether 410 post-stroke patients were enrolled in the survey. Personal medical history and functional assessment was obtained from the final medical reports of the patients. The clinical examination and data collection were conducted according to the World Health Organization (2013) criteria. Socio-demographic background and behaviours related to oral health were assessed using a questionnaire. The dental status was explained by the number of Decayed, Missing and Filled Teeth (DMFT). The association of socio-demographic factors, stroke and functional assessment with oral health status and behaviour was evaluated. Chi-square test, Fisher’s exact test, Welch test, Mann–Whitney U test, Kruskal–Wallis test, ANOVA model and correlation analysis were used to analyse our data. The level of significance was set at p < 0.05.

Results

Mean age of stroke patients was 59.21(Standard Deviation [SD] 14.74) years. Mean DMFT score was 20.13 (8.08), including 3.28 (4.24) decayed teeth, 15.02 (10.29) missing teeth and 1.83 (2.94) filled teeth score. Factors that influenced the oral health status were gender, age, occupational status, level of education, type and risk factors for stroke. Significant correlation was found between the Functional Independence Measure and oral health-related behaviours with patients brushing their teeth once a month showing the lowest value.

Conclusion

According to the results, low socio-demographic and economic status, low level of education and the Functional Independence Measure score, unemployment, the combination of risk factors for stroke and residual dysfunctions are associated with poor oral health status. The data indicate that a series of changes are needed, for special attention and care in oral health for patients who have had a stroke. Based on the findings of this research, a new model of prevention and care can be developed, with an interdisciplinary collaboration, to promote the quality of life of these individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02259-2.

Oral health care and service utilisation in individuals with Rett syndrome: an international cross-sectional study

BACKGROUND

There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care.

METHODS

Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors.

RESULTS

Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population.

CONCLUSIONS

Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.

Assessment of Oral Health Status in Epileptic Children and Healthy Children in Bengaluru City: A Comparative Study

Introduction

Objective

Material and methodology

Results

Conclusion

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Dental health in persons with disability

Systemic and structural barriers limit dental health for individuals with special healthcare needs (SHCN), who have poorer dental hygiene, higher rates of dental disorders, and less access to oral care. We aimed to understand these barriers directly from the patient and caregiver population as well as review the literature on oral health of individuals with SHCN. We reviewed the literature on individuals and caregivers of those with SHCN to identify barriers to dental healthcare faced by these individuals. We focused on clinical and educational interventions to support clinicians treating this population. For the literature review, PubMed, Google, and Google Scholar were searched. We also relied upon the knowledge gained during the course of routine clinical care and patient advocacy activities. Published manuscripts were searched for the following Medical Subject Heading (MeSH) term: "Dental Care for Disabled" and the following subheading: pharmacology, adverse effects, ethics, methods, standards, and therapy. Relatively few dentists have formal training on caring for those with SHCN. Barriers faced by these individuals include accessibility, comorbidities, communication challenges, and barriers to home oral hygiene. Strong care coordination and communication between dentists, caregivers, and other providers is essential for positive outcomes. Our current dental healthcare system has failed to meet the needs of those with SHCN. The comfort and dignity of the patient are of paramount importance.

The effect of simulation-based education on childhood epileptic seizure management knowledge, skills, and attitudes of nursing students

BACKGROUND

Lack of knowledge about epileptic seizure management and negative attitudes toward children with epilepsy among nursing students may negatively affect the quality of healthcare services they deliver.

AIM

This study aimed to examine the effect of training given to nursing students using simulation and standard child mannequins on their childhood epileptic seizure management knowledge, skills, and attitudes.

METHODS

Participants (n = 72) were recruited from a Nursing Faculty in Izmir, Turkey. Students were randomly assigned to the intervention and control groups (n = 36 in each). The intervention group received simulation-based training on epilepsy while the control group received standard child mannequin training on epilepsy. One week after the training, the students were asked to demonstrate their epileptic seizure management knowledge and skills on a simulation model or a standard child mannequin. During this process, they were observed and assessed by two independent observers on the basis of a list of epileptic seizure management skills. All participants completed the personal information form, the Epilepsy and Epileptic Seizure Management Knowledge Test, and the Epilepsy Knowledge and Attitude Scale before, and after the training, McNemar's test, repeated measure ANOVA (intravenous), dependent t-test, chi-square test, Fisher's exact test, independent t-test, Pearson's correlation analysis, and Pearson's chi-square test were used to compare the groups. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between observers.

RESULTS

The epilepsy knowledge scale mean scores of both groups significantly increased after their respective trainings (p < 0.001), but the difference between the groups was not statistically significant (p = 0.829). There was no statistically significant difference between the pre- and posttraining epilepsy attitude scale mean scores of the control group (p = 0.630), however, a statistically significant increase was observed in the epilepsy attitude scale mean score of the intervention group (p = 0.008). In addition, both groups' self-confidence in epileptic seizure management significantly increased after the training (p = 0.000).

CONCLUSIONS

Simulation-based training was beneficial for students insofar as it helped them to develop positive attitudes toward epilepsy.

How to Manage Impacted Third Molars: Germectomy or Delayed Removal? A Systematic Literature Review

Objectives: The aim of this systematic review is to evaluate and compare the risks and benefits of germectomy and delayed removal of third molars and develop a patient management algorithm for second molar eruption in syndrome/incompliant patients. Materials and Methods: A literature search was performed in the following databases; the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, and Web of Science. Last search was done on July 2nd, 2018 including articles published from the last 18 years. The search aimed to identify all relevant studies written in English language. Gray literature was excluded. Risk of bias was evaluated with specific predetermined criteria. This systematic literature review was reported according to the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: 104261. Results: Literature search war performed on July 2018 and updated on February 2019. A total of 1610 articles were screened. After abstract screening and discarding duplicates, 86 full-text articles were obtained and subjected to additional evaluation. Four articles were included in the review. Three studies were considered as having a medium risk of bias and one was assessed as at high risk. Due to the heterogeneity of presenting results and a very low number of included studies a quantitative analysis was not possible. Only qualitative analysis was made. Considering the limited number of studies included and the level of risk of bias there is no sufficient evidence to state the benefits of preventive removal of impacted third molars, especially in patients with poor oral hygiene due to intellectual disability. Early germectomy represents an elective approach of pathologic alteration of tooth germ; orthodontic issues meet appropriate indication for a delayed removal. Conclusions: Given the best evidence-based information regarding patients’ medical condition, we highlight the need to provide an ethical-based comprehensive approach in the diagnostic workflow and the assessment of treatment outcome.

Oral health and dental status in people with epilepsy in rural China

PURPOSE

We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China.

METHODS

A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed "Oral health and Dental status Questionnaire". Univariate and multivariate analyses were used to explore the relationships between seizure frequency and oral health and dental status.

RESULTS

A total of 875 people participated. Almost two thirds (65.8%) reported brushing their teeth at least once a day but 634 (73.0%) brushed their teeth for less than 3 min each time. Only 80 (9.1%) had visited a dental clinic in the previous year. Multivariate logistic regression analysis showed that having 1-4 seizures/month (OR 0.60, 95%CI 0.40-0.90) or >4 seizures/month (OR 0.38, 95%CI 0.22-0.66) was associated with decreased odds of brushing teeth at least once a day, and higher seizure frequency was associated with increased odds of dental injury due to seizures (OR 2.07, 95%CI 1.22-3.50 for <1 seizure/month; OR 2.12, 95%CI 1.25-3.58 for 1-4 seizures/month; OR 3.09, 95%CI 1.57-6.07 for >4 seizures/month).

CONCLUSION

Seizure frequency was significantly associated with seizure-related dental injury, and with the lack of good oral health practice. Improvement in the oral health of people with epilepsy in resource-poor areas should be encouraged.

Assessment of oral health status of children with epilepsy: A retrospective cohort study

BACKGROUND

Epileptic children are liable to experience oral health problems either due to the disease itself or medications administered to control the condition.

AIM

We aimed to investigate caries experience, gingival health and oro-facial traumatic injuries in a sample of epileptic Egyptian children.

DESIGN

A retrospective cohort study was conducted from September 2016 to April 2017 using data from medical records in Children Hospital at Ain Shams University. Dental examination was performed for 100 epileptic children and 80 healthy subjects who matched in age, gender, and socio-economic status. Caries experience was measured using the decayed, missing and filled teeth (DMFT or dmft) index and gingival index (GI) of Loe and Sillness was used to determine gingival health status. Oro-facial injuries were assessed using the WHO classification of trauma. Quantitative data were presented as mean, SD, and 95% CI values. Qualitative data were presented as frequencies and percentages and the significance level was set at P ≤ 0.05.

RESULTS

The mean ± SD GI for epileptic children was significantly higher (1.16 ± 0.42) than that of healthy children. (1.01 ± 0.11) Healthy subjects had significantly lower mean dmf index scores 2.2 ± 2.6 compared to epileptic subjects where mean dmf scores were 4.1 ± 2.1. No significant difference, however, was detected between the two groups regarding caries experience in permanent dentition or incidence of oro-facial injuries.

CONCLUSIONS

Epileptic children are highly burdened with gingival problems and liable to develop dental caries especially in primary dentition. Oral traumatic injuries, however, are not common complications if seizure attacks are well controlled.

The prevalence of orodental trauma during epileptic seizures in terms of dental treatment - Survey study

INTRODUCTION

Epilepsy is one of the most common neurological disorders. Seizures that occur during attacks may lead to head injuries. It is crucial to establish proper prophylactic management against trauma occurrence, as nowadays prevention is not sufficient.

AIM

Assessment of the frequency of head and intraoral trauma during epileptic seizures and to evaluate factors that may predispose to injuries.

MATERIAL AND METHODS

The questionnaire was carried out among 106 patients with epilepsy. Survey conducted questions regarding development of the disease and occurrence of orodental and head trauma. Results were statistically analyzed with the chi-square test (p<0.05).

RESULTS

52.4% of subjects admitted the occurrence of oral trauma during epileptic seizures. The most common were lips, tongue or cheeks injuries. 18% patients suffered from tooth crack and 17% from tooth fracture. 50% of respondents suffered from head trauma during seizures: 41% patients reported bruises, 39% burns, 37% wounds, 10% nose fractures, 7% eye socket trauma and 3% skull crack. 14.1% of respondents experienced dentist refusal to undertake treatment, while 4% of patients had epileptic attack during dental procedures.

CONCLUSIONS

Dental trauma is common result of epileptic seizures. It is necessary to implement prophylactic management to prevent hard and soft tissues injuries, for example by using custom-made mouthguards. Moreover, specially designed dental programs for this group of patients should be provided.

Dental care in patients with epilepsy: a survey of 82 patients and their attending dentists and neurologists in southern Germany

INTRODUCTION

The current study assessed the knowledge and attitudes of dentists and neurologists, and of their patients with epilepsy, in the catchment area of an outpatient clinic for epilepsy in southern Germany.

METHODS

One-hundred patients with epilepsy were asked to complete questionnaires about their dental treatment. Attitudes of their attending dentists and neurologists were also assessed.

RESULTS

Patients with epilepsy: The questionnaires were returned by 82% of patients. Of these, 84% regularly (once or twice a year) sought out a dentist, 79% reported their epilepsy to the dentist, 6% were refused treatment by a dentist because of their epilepsy, 10% had already experienced a seizure while at a dental office and 52% wished for more detailed information pretreatment. Dentists: Although 97% treated patients with epilepsy, 21% believed that their equipment was inappropriate for treating a patient experiencing seizures. The majority were not familiar with interactions between antibiotics/analgetics and anti-epileptic drugs. Short-term general anaesthesia was preferred for critical patients by 70% of dentists, 70% recommended dental ceramic for prosthetic reconstruction of anterior teeth and 64% would not recommend use of a removable denture. Neurologists: Sixty-two per cent were asked for advice by their patients, 71% knew about particular risks and interactions between antibiotics/analgetics and anti-epileptic drugs, 8% would stop valproic acid before extensive dental intervention and 92% recommended general anaesthesia in critical patients (uncooperative patients, patients with learning difficulties, and patients with frequent generalised tonic-clonic or complex partial seizures).

DISCUSSION

In general, patients were satisfied with their dental treatment. Regarding the clinician's role, however, dentists need to know more with respect to treating patients with seizures. Beyond that, it would be desirable for neurologists to take more time to answer their patients' questions regarding dental care.

Dental service use among patients with specific disabilities: A nationwide population-based study

BACKGROUND/PURPOSE

The Taiwan National Health Insurance program has allocated a specific fund for dental services to patients with specific disabilities (PSDs); however, the trends and the quality are unknown. In this study, we conducted quantity analyses and quality assessments of dental service use among PSDs using a nationwide population-based database.

METHODS

PSDs were identified according to the codes of diagnosis fee. Quantity analyses included the number of patients receiving dental services, the number of visits, and the percentages of categories of dental service use. Quality assessments included refilling rates for operative dental treatments and unfinished rates for endodontic therapies.

RESULTS

For quantity analyses, dental services were accessible to 3-4% of patients with disabilities and were mostly provided to younger PSDs. The general population received more operative and endodontic therapies, and PSDs received more periodontal therapies. For quality assessments, the teeth of PSDs had a 9.74-15.07% refilling rate, which was higher than that of the general population (1.39-6.37%). Furthermore, the teeth of PSDs had a 32.03% unfinished endodontic rate, which was higher than that of the general population (21.42%).

CONCLUSION

During 2010-2012, only 3-4% of patients with disabilities had access to dental services, mostly provided to younger PSDs. Teeth of PSDs had higher refilling rates and unfinished endodontic sessions than the general population. We suggest that a more comprehensive dental care system is necessary to improve the quantity and quality of dental services, especially in middle-aged and older PSDs.

Dental students' knowledge and attitudes toward patients with epilepsy

BACKGROUND

Inadequate knowledge and negative attitudes toward epilepsy can affect the provision of health services for patients with epilepsy.

AIM

The aim of the present study was to assess the knowledge and attitudes toward epilepsy among clinical dental students in Jordan.

METHOD

The study was conducted using a 21-item questionnaire to assess professional experience with epilepsy, knowledge about epilepsy, social tolerance, and willingness to care for patients with epilepsy among dental students at the University of Jordan.

RESULTS

More than one-third of dental students believed that epilepsy is due to insanity or mental illness. Only 45% were able to identify convulsion or shaking as a sign of epilepsy, and more than one-third did not know how to act in case of an epileptic seizure in the dental clinic. Disappointingly, 43.4% of the respondents were of the opinion that people with epilepsy should not have children, and only 38.6% thought that people with epilepsy should be employed at the same jobs as other people. About 50% indicated that their families would be concerned about them treating patients with epilepsy, and 30% believed that knowing that patients with epilepsy were treated in their clinic might make other patients reluctant to continue their treatment there.

CONCLUSION

The results revealed an inadequate level of knowledge and negative attitudes toward epilepsy among dental students at the University of Jordan. There is an urgent need to educate dental students about epilepsy.

Electrophysiological evidence on epileptiform activity enhanced by electrical stimulation of teeth in rats

The aim of this study was to evaluate the possible effects of electrical stimulation (ES) of tooth on penicillin-induced epileptiform activity in rats. Experiment was realized on 24 adult male Sprague Dawley rats. Rats were assigned three groups [stimulation group (SG), penicillin group (PG), and penicillin+stimulation group (PSG)]. In SG, ES was only applied. Ten pulses of electrical current were delivered to the teeth for a duration of 2 milliseconds at 1-second intervals from a stimulator. Currents were applied in the range of 40-240 μA with 40 μA steps. Electrocorticography (ECoG) recordings were taken before and after ES. In PG, ECoG recordings were taken before and during the injection of penicillin. In PSG, after epileptiform activity was induced, ES was applied and ECoG recordings were taken as in SG. All the data were analyzed with Student's t test. Applied currents did not cause any epileptiform activity in SG. When the PSG was compared with the PG it was seen that the spike frequency of epileptiform activity increased in a statistically significant way after application of 240 μA (P < 0·05). On the other hand current application caused an increase in the spike amplitude of the PSG compared with the amplitude of the PG, but it was not statistically significant. We concluded that ES of tooth with high current can trigger epileptiform activity in rats. For this reason, further research is required to evaluate the effects of ES of tooth for pulp testing on epileptic human subjects and antiepileptic drug users.

The association between periodontal disease and seizure severity in refractory epilepsy patients

PURPOSE

Periodontal diseases are common in most populations and affect people at all socioeconomic levels. Evidence suggests that patients with epilepsy actually have higher risks of dental disease and increased oral health needs, but the frequency and consequences of poor controlled seizures on dental and periodontal health have not been reported before. We aimed to assess the impact of seizure frequency on periodontal status and oral hygiene in a sample of epilepsy patients.

METHODS

One hundred and nine consecutive patients treated for epilepsy at the outpatient clinic of our University Hospital were invited to take part in an oral examination to determine their periodontal disease status, together with a control group. In addition, seizure frequency and use of medication were documented.

RESULTS

In logistic regression model, patients were significantly more susceptible to bad oral hygiene, gingivitis and periodontitis that controls (p<0.001); seizure frequency was significantly related to bad oral hygiene (p=0.010), gingivitis (p<0.001) and periodontitis (p<0.001). Tooth brushing habits and presence of caries were associated with oral health in patients group.

CONCLUSION

Our study found a significant positive correlation between periodontal disease and seizure severity. Epilepsy patients need to focus more on their oral health and quality of oral hygiene.

Oral health-care utilization in adults with disabilities in Belgium

Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.

Oral health care utilization in children with disabilities

OBJECTIVES

The objectives of this report were to survey the utilization of oral health care in children and adolescents with disabilities over a 7-year period and to compare these data with the utilization pattern of their peers without disabilities. For most countries, these data have not been published in the international literature so far.

MATERIAL AND METHODS

The cohort used was the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents. The database comprised prospective data on oral and general health care utilization and sociodemographic variables collected from 2002 up to 2008.

RESULTS

Data were available from 326 children and adolescents with and 53,589 without disabilities. Dental attendance rates were low in both subgroups: only 50 % had a dental visit in four or more of the seven observation years. Emergency oral and medical care was recorded significantly more often in children with disabilities whereas radiographs, restorations, and orthodontic assessments and treatments more frequently in children without disabilities.

CONCLUSION

The present study demonstrated that dental attendance rates in both subgroups were low and that in those who attended, preventive oral health care was only infrequently attested. Further research is needed to elucidate whether the lower number of radiographs and restorations and the higher number of emergency visits observed in the subgroup with disabilities reflect unmet oral treatment needs.

CLINICAL RELEVANCE

Objective data on health care utilization are essential to enable governments and stakeholders to devise appropriate care and to optimize access to care for persons with disabilities.

Epilepsy is associated with unmet health care needs compared to the general population despite higher health resource utilization--a Canadian population-based study

PURPOSE

(1) To determine whether health resource utilization (HRU) and unmet health care needs differ for individuals with epilepsy compared to the general population or to those with another chronic condition (asthma, diabetes, migraine); and (2) to assess the association among epilepsy status, sociodemographic variables and HRU.

METHODS

Data on HRU were assessed using the 2001-2005 Canadian Community Health Surveys, a nationally representative population-based survey. Weighted estimates of association were produced as adjusted odds ratio with 95% confidence intervals, and logistic regression was used to explore the association between sociodemographic variables and HRU in those with epilepsy. All data on disease status, HRU, and unmet health care needs were self-reported.

KEY FINDINGS

Individuals with epilepsy had the highest rate of hospitalizations and the highest mean number of consultations with physicians. Despite higher rates of consultation with psychologists and social workers compared to the general population, those with epilepsy were significantly more likely to say they had unmet mental health care needs. People with epilepsy were also less likely to use dental services compared to the general population. Epilepsy was a significant predictor of HRU in logistic regression models.

SIGNIFICANCE

Given the prevalence of psychiatric comorbidities in those with epilepsy, it is concerning that this group perceives unmet mental health care needs. It is also troublesome that there was decreased utilization of dental health care resources in those with epilepsy considering that these patients are more likely to have poor oral health. Although individuals with epilepsy use more health care services than the general population, this increase appears to be insufficient to address their health care needs.

Oral health status in epileptic children

BACKGROUND

The aim of the present study was to evaluate the oral hygiene status and dental treatment requirements in children with epilepsy.

METHODS

The treatment group consisted of 211 children with epilepsy (120 boys and 91 girls, 4-15 years old, mean age 7.85 + or - 2.98 years). The control group consisted of healthy children, matched by age and gender. Clinical features of the patients were obtained from hospital records. Clinical examinations were conducted, under standard light, using a plane buccal mirror, a dental probe and air drying to evaluate caries experience and to record the periodontal health of each child. Statistical analysis was performed using chi(2) test, Fisher exact test and anova.

RESULTS

The number of decayed and missing teeth, the degree of abrasion and periodontal indexes were significantly worse in patients with epilepsy, compared to the control group (P < 0.001). Gingival enlargement was documented in 42% of patients on valproate monotherapy compared to only in 16% of patients on phenobarbital. Dental caries and halitosis were the most common oral disorders. Generalized tonic-clonic seizures often cause minor oral injuries and traumatized anterior teeth.

CONCLUSIONS

Epileptic children are at an increased risk of developing caries and gingivitis compared with healthy subjects.

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.

Management of dental patients with seizure disorders

Dental practitioners from time to time must treat patients with epilepsy or similar seizure disorders. This article describes the various classification for epilepsy, explains how such disorders are evaluated and diagnosed, discusses management methods, and addresses related issues for special populations, such as pregnant women and elderly. In addition, the article offers information about what special steps dentists should take in treating such epileptic patients and others vulnerable to seizures and in preparing offices and staff for the possibility that a patient will have a seizure in the office. In general, a patient with severe, poorly controlled epilepsy should be treated in a hospital. Otherwise, a well-controlled patient should easily be treated in the office.

Prosthodontic status and recommended care of patients with epilepsy

STATEMENT OF PROBLEM

Epilepsy is a chronic disease that can affect oral health and prosthodontic status in different ways. However, epilepsy is a condition of various etiologies and seizure types, and different patients may have differing needs in prosthodontic care.

PURPOSE

The purpose of this study was to examine the prosthodontic status of patients with epilepsy to determine if the disease has any effect on prosthodontic treatment and to obtain information regarding the level of prosthodontic care. This information was used to provide recommendations for the prosthodontic treatment of patients with epilepsy.

MATERIAL AND METHODS

One hundred one epileptic patients were examined, interviewed, and compared with 101 age-matched control (nonepileptic) subjects of the general population. Epileptic patients were recruited at an epilepsy outpatient clinic. The only exclusion criterion was a mental handicap severe enough to exclude cooperation of the patient during a dental examination. Control subjects were recruited at a community radiographic chest-screening clinic. Epileptic patients were first grouped according to dental risk factors and dental manageability. Dental classification of patients with epilepsy considered the frequency and type of seizures, as seizures may damage the teeth and dental prostheses. The number of missing teeth, the ratio of missing and replaced teeth, and the number of fixed and removable partial dentures and complete dentures, and the characteristics (material, degree of abrasion, and age) of the dentures was determined by dental examination. Finally, the state of oral mucosa and the number of seizure-related injuries was noted. Statistical comparison of the patient and the control group was performed, using the 2-tailed t -test for continuous variables and the chi-squared test or Fisher's exact test for categorical variables (alpha=.05).

RESULTS

The number of missing teeth was significantly higher in the epilepsy group than in the control group (P =.021). The ratio of replaced and missing teeth was lower in the epileptic group (P <.01), indicating inadequate prosthodontic care. There was also a significant difference in the age of the fixed prostheses (P =.0016), being lower in the epilepsy group, and in the material of fixed prostheses (P =.033), metal-ceramic being more common in the control group. More epileptic patients were edentulous than control subjects (8 versus 3) and the average age at the time of examination was younger (48 versus 57 years). Seizure-related injuries were reported by 11% of patients, all belonging to the subgroup of patients with frequent generalized tonic-clonic seizures.

CONCLUSION

Patients with epilepsy have an increased risk for loosing teeth and, furthermore, the prosthodontic status of epilepsy patients was not as optimal as compared with the control group. Seizure-related injuries to prostheses are also an issue, but only in those suffering from frequent generalized tonic-clonic seizures. Therefore, the large majority of patients can and should receive prosthodontic treatment without restrictions. For a smaller group of patients, however, certain restrictions apply, to prevent potentially dangerous seizure-related complications.

Prevalence of epilepsy and health status of adults with epilepsy in Georgia and Tennessee: Behavioral Risk Factor Surveillance System, 2002

Behavioral risk factors associated with comorbidity in people with epilepsy are largely unknown. We studied a population-based sample of 8057 adults through the 2002 Behavioral Risk Factor Surveillance System, in Georgia and Tennessee, ascertaining a lifetime epilepsy prevalence of 2.1% in this population. This structured interview revealed that those with epilepsy had significantly worse self-reported fair or poor health status (39% vs 17% in adults without epilepsy), significantly greater cigarette smoking (38.8% vs 24.9% in other adults), and high rates of obesity (34.1% vs 23.7% in adults without epilepsy). Large percentages of adults with epilepsy reported currently symptomatic asthma and recent joint pain. Adults with epilepsy had lower educational attainment and lower household incomes, but a higher rate of medical insurance coverage, than did other adults. This type of population-based survey can serve to identify health disparities, behavioral risk factors for other chronic diseases, and unmet health care needs in individuals with epilepsy, and to track changes in these measures over time.