8/6/2019 49773280 Dental Protocol of an Epileptic Patient

1/19

FAHAD QIAM

562FINAL YEAR BDS

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

2/19

Symptom of a braindisorder

Involves paraoxysmalneuronal dischargesufficient to cause effectssuch as recurrent seizureswith disturbances ofconsciousness

Detected as abnormalactivity byelectroencephalograpy

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

3/19

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

4/19

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

5/19

Effects over 1% of general population

More prevalent in young and in the mentally orphysically impaired

Prevalence increases with age

Higher in racial minorities compared toCaucasians

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

6/19

Idiopathic

Symptomatic or secondary

(i) Intracranial

(ii) Systemic

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

7/19

INTRACRANIALINTRACRANIAL

CAUSESCAUSES

Space occupying lesions Trauma

Vascular defects

Infections

Cerebral palsy

Rubella syndrome

AIDS

Meningitis

SYSTEMICSYSTEMIC

CAUSESCAUSES

Hypoxia Hypoglycemia

Inborn errors ofmetabolism

Drug overdose

Drug withdrawal

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

8/19

GeneralizedGeneralized

- Tonic-clonic

- Absences

PartialPartial

- Simple

- Complex

OthersOthers

- Myoclonic

- Atonic

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

9/19

Blood dyscrasias:- BM suppression- Leukopenia- Thrombocytopenia

- Secondary platelet dysfunction

Increased microbial infection

Delayed healing

Gingival & post-operative bleeding

Gingival overgrowth

Xerostomia

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

10/19

Clinician must assess

1- Type of seizures

2- Etiology of seizures

3- Frequency of seizures

4- History of injuries related to

seizure activity

5- Presence of aura to seizureactivity

6- Known seizure triggers

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

11/19

Withdrawal of anti-convulsant medication

Epileptogenic drugs (alcohol, ketamine, lidocaine,metronidazole, TCAs)

Fatigue, starvation or stress

Infection

Menstruation

Flickering lights (television, strobe lights)

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

12/19

For a poorly or uncontrolled seizure disorders consult

with the patients physician and a neurologist

Such patients should be referred to a hospital setting,

not suitable for private dental offices

Complete blood count with differential count

Serum levels of anticonvulsant drug

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

13/19

Avoid known triggers

Give appointments at that time of day when seizuresare less likely to occur

Use of sedative medications before treatment

Light should not be focused on their eyes

Use of dental floss secured-mouth props

Placement of fixed metal prosthesis

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

14/19

1. Clear all instruments away from the patient.

2. Place the dental chair in a supported, supineposition as near to the floor as possible.

3. Place the patient on his or her side (todecrease the chance of aspiration ofsecretions or dental materials in thepatients mouth).

4. Do not restrain the patient.

5. Do not put your fingers in his or her mouth(you might be bitten).

6. Time the seizure (the duration of the event

may seem longer than it actually is).

7. Call 911 if the seizure lasts longer than 3minutes.

8. Call 911 if the patient becomes cyanoticfrom the onset.

9. Administer oxygen at a rate of 68L/minute.

10. If the seizure lasts longer than 1 minuteor for repeated seizures, administer a 10-

mg dose of diazepam intramuscularly(IM) or intravenously (IV), or 2 mg ofativan, IV or IM, or 5 mg of mid-azolam,IM or IV.

11. Be aware of the possibility ofcompromised airway or uncontrollable

seizure

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

15/19

1. Do not undertake further dental treatment that day.

2. Try to talk to the patient to evaluate the level of consciousness duringthe post-ictal phase.

3. Do not attempt to restrain the patient, as he or she might be confused.

4. Do not allow the patient to leave the office if his or her level ofawareness is not fully restored.

5. Contact the patients family, if he or she is alone.

6. Do a brief oral examination for sustained injuries.

7. Depending on post-ictal state, discharge the patient home with aresponsible person, to his or her family physician or to an emergency

room for further assessment.

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

16/19

Avoid aspirin & NSAIDS in patients on Valproic acidtherapy

Frequent professional cleanings

Use of an electric toothbrush

Chlorhexidine M/W & folic acid

Topical fluoride

Antifungal agents

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

17/19

DRUGS THAT INCREASEDRUGS THAT INCREASE

ANTICONVULSANTANTICONVULSANT

ACTIVITYACTIVITY

Aspirin

Azole antifungals

Metronidazole

Propoxyphene

DRUG ACTIVITY ALTEREDDRUG ACTIVITY ALTERED

BY ANTICONVULSANTSBY ANTICONVULSANTS

Acetaminophen

Doxycycline

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

18/19

Clinical Periodontology Caranza

Medical Problems in Dentistry Scully &Cawson

Understanding the Patient with Epilepsy andSeizures in the Dental Practice: Cecilia E. Aragon,DDS, MS; Jorge G. Burneo, MD, MSPH

8/6/2019 49773280 Dental Protocol of an Epileptic Patient

19/19