Seizure Disorder

(Epilepsy)
By: Callan Meskimen
Dental Hygiene III
 In the dental hygiene field it is very common to see people that have some

sort of disability or disorder all throughout your career. It is important to have an

understanding of the disorders that you may see and be able to adjust your

treatment plan accordingly. Seizure disorders are a common disorder and over 3

million people in the United States have been diagnosed with approximately 65

million affected all throughout the world. This being said, at some point in a

dental hygienists career they will have a patient with a seizure disorder. To have

clear understanding of this disorder one must learn what the disability is, how it

affects the body, the effects in the oral cavity, and what must be done to adjust

the treatment plan.

A seizure disorder or more commonly known as epilepsy is a neurological

condition that provokes the electrical communication between brain cells

resulting in abnormal brain activity. The abnormal brain activity causes symptoms

such as a seizure which includes loss of consciousness, twitching or tremoring,

convulsing, sweating, loss of body function, inability or difficulty to talk or hear,

elevated heart rate and self harm such as tongue biting and falling. These

examples are commonly known stereotypes for seizures, but seizures come in

many different forms and each person may have slightly different symptoms.

Symptoms are determined by the type of seizures you have and the area in the

brain affected. There are two forms of a seizure: partial/focal and generalized.

Focal seizures are seizures that are localized to a certain area of the brain.

These seizures can range from simple seizures that cause dizziness and mouth

jerking to loss of consciousness and unintentional actions or movements. Since

focal seizures are localized in the brain symptoms of the seizure may depend on

the area being affected. For example, if the part of the brain that controls speech

is being affected by the seizure then the patient may have symptoms of

incoherent speech or the inability to speak. Generalized seizures affect both

sides of the brain. These seizures can range from short “petite” seizures with loss

of consciousness without convulsions to large seizures that may last several

minutes with stereotypical symptoms such as convulsions and crying out.

Typically, a patient will have a prodromal or an aura that will warn them that the

seizure is coming. If a patient tells you that they feel a seizure coming on

determine how they would prefer to be handled. Some people like to be laying on

the floor or some may want to be laying in a supine position and others prefer to

be sitting up depending on their symptoms. It is important to always discuss a

plan with the patient with epilepsy before treatment to ensure the safety of the

patient.

Seizures have been around since the beginning of time dating back to

1800 B.C. with the Babylonians. For hundreds of years seizures were

misunderstood and many considered people with seizures to be possessed by

demons. Epilepsy and symptoms of seizures is also mentioned in the new

testament in chapters Matthew, Mark and Luke describing them as being

possessed by a “spirit” or “demon”. It is thought that Hippocrates was the first to

believe that epilepsy was of the mind and not by demons. Today we know that

seizures are a neurological condition and can be idiopathic or symptomatic. For

some people their seizures have no reasoning or predisposing factor to why they
happen while other people develop a seizure disorder secondary to other

neurological issues. Some neurological conditions that may cause a seizure

disorder are: head trauma, stroke, alcohol/drug disorders, brain tumor,

congenital, infections such as meningitis and brain disease. Seizures affect all

ages both women, men and children of all shapes, sizes and races. Most people

will start having seizures at a young age and be diagnosed at a young age or

much later in life. Children more commonly suffer from generalized seizures and

adults more commonly suffer from partial seizures.

Seizures affect the body in many different ways. During a seizure many

patients have chest contractions and breathing may dissipate. Over time seizures

have the ability to increase the chances of heart disease and high blood

pressure. Patients also may suffer from bodily injuries from seizures. Cuts and

bruises are common after a seizure, but in some severe cases a patient could

break a bone, hit their head resulting in a concussion or brain bleed and have the

potential to choke. Patients may also have loss of memory and extreme

drowsiness after an episode. The prognosis for control over seizure episodes are

good and approximately 72% of people diagnosed are able to control their

seizures with medication. Antiepileptic medications are a drug therapy that helps

control the electricity in the brain cells by either inhibiting or stimulating the brain

cells activity. There are many antiepileptic drugs on the market, two popular

medications are Carbamazepine and Phenytoin. The main goal of this therapy is

to stop the seizures from happening without side effects. Although, with

medication comes side effects. Side effects for Carbamazepine include;

dizziness, drowsiness, nausea and vomiting and xerostomia. Side effects for

Phenytoininclude; bradycardia, cardiac arrhythmia, hypotension, gingival

hyperplasia and venous irritation and pain. With medication some people may

overcome their seizures or have control for the rest of their life while others may

not. Some people may have to try several different types of antiepileptic drugs to

find the drug that best fits them. Epilepsy cannot be cured, but can be managed

by getting enough sleep, destressing your life and keeping up with your

medication.

Along with affecting the body, seizure disorders affect the oral cavity.

When conducting the extra and intraoral exam a clinician may notice scars

around the mouth or head region from the patient haven fallen and hurting

themselves from previous episodes. The patient may also have cheek bites,

fractured teeth from uncontrolled bruxing or clenching, broken teeth from a hard

fall or convulsions and gingival hyperplasia from the antiepileptic medications.

The most common antiepileptic medication to cause gingival hyperplasia is

Phenytoin. Within a few weeks or months of taking Phenytoin and other

antiepileptic medications the gingiva will starts to enlarge, typically in the facial

and proximal areas of the anterior teeth. The gingival hyperplasia will harbor

bacteria and affect chewing thus increasing the changes of the patient

developing decay, eruption of deciduous teeth and periodontal disease. The

overgrowth may cause the patient to notice a change in their speech and be

displeased with the esthetics. Along with the gingival hyperplasia antiepileptic
medications can cause xerostomia. Xerostomia can also help contribute to dental

decay, bad breath, mouth sores, and difficulty in talking.

Adjusting your treatment plan may be necessary when having a patient

with a seizure disorder in your chair. As stated previously it is important to

discuss the protocol if the patient does have a seizure during the appointment as

well as an emergency contact number and the physician's name and number.

Make sure to do a thorough medical exam asking when their last seizure was,

what their symptoms are like during their episodes and the frequency of their

episodes. It is also important to know the medications the patient is on and the

side effects that come with them. Some patients may have a caretaker or

someone that drives them around depending on the patient and the severity and

frequency of their seizures. Be prepared and comfortable to have the caretaker in

the room per request of the patient. Due to the medications taken the patient may

have gingival overgrowth and depending on the severity may need debridement

of the tissue and scaling frequently to prevent decay and periodontal disease.

The patient’s oral hygiene is very important to keep the biofilm under control and

thorough oral hygiene instructions should be given to help patients understand

their part in taking care of their mouth. To help remove biofilm recommending an

electronic toothbrush may be beneficial to the patient. Stress the importance of

brushing the gums at a 45 degree angle to help remove the bacteria and remind

them that the medication they are on puts them at risk for decay and periodontal

disease. Also, a non alcoholic antimicrobial mouth rinse would help remove the

bacteria in the hyperplastic gum tissues without causing xerostomia. To help the
patients floss or stimulate their gums recommend soft picks or a rubber

stimulator to help clean under the hyperplastic gum tissue. If patients are taking

good care of their mouth they should be brought back every three months for

maintenance appointments for biofilm removal and debridement. If a patient is

having moderate to severe gingival overgrowth the treatment plan should be

changed to every month or every other month and discussion with the dentist

should be made for surgical removal if need be. Fluoride treatment may be

beneficial to help prevent decay and demineralization and upon Dentist’s

approval sealants on the posterior teeth may also help prevent decay.

If an emergency happens remember to stay calm and call for help. Put

the patient is in supine position, unless they tell you otherwise, and make sure

they don’t fall out of the chair. Evaluate for airway and monitor their vital signs.

Stay with the patient and when they come out of the seizure be soft and kind to

them because they may be dazed and confused. Make sure to check for trauma

and document the incident.

Epilepsy is a common disorder that dental hygienists should have a good

understanding of. Most patients will have a normal seizure free appointment, but

it is always important to be prepared and knowledgeable in case of an

emergency. Hygienists should know what a seizure disorder is, how it affects

their patients bodies, how it will affect the oral cavity and be able to adjust their

treatment plan accordingly.

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