DT News - MEA - Researchers publish guide to support dentists in treating patients with epilepsy

Anisha Hall Hoppe, Dental Tribune International

Thu. 29 June 2023

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MECCA, Saudi Arabia: Affecting over 70 million people globally, epilepsy is a disorder that may give dental professionals pause, as the treatment of patients with epilepsy can be complex and many clinicians may not feel qualified to provide sufficient care. Researchers at Umm Al-Qura University in Saudi Arabia have developed a practical reference guide for dentists who seek to be more confident in providing care to patients with epilepsy of varying severity.

Taking a multidisciplinary approach

In addition to providing suggestions for consulting with the patient’s neurologist, the guide outlines the importance of dental professionals being able to identify risk and trigger factors for their epileptic patients. In patients with poorly controlled epilepsy, trigger factors are valuable in determining what could potentially cause a seizure during dental treatment. Understanding basic epileptic treatments and being able to differentiate between different types of seizures are useful for dental treatment, particularly when attempting to estimate length of an episode that occurs during dental care and whether or not the patient requires further medical intervention.

The guide provides a handy reference for essential evaluation of the seizure type, typical symptoms reported prior to onset and descriptions of bodily events during an episode. For patients well versed in their condition, they may be able to indicate to their treatment provider that they are experiencing symptoms signalling the onset of an epileptic attack, allowing clinicians to prepare. Practitioners can also verify with patients with diagnosed epilepsy whether they have been consistently taking their medications, have been experiencing more seizures lately, need special care to prevent triggers and are eating regularly—blood glucose level being a key component in preventing seizures for some patients.

Medication awareness

Being educated in epileptic care is also critical to differentiating between seizures and other potential medical issues, such as migraines or strokes. The guide provides an overview of essential antiepileptic medications which are key for being able to treat a patient who may suffer from side effects or require medication for dental treatment that could conflict with their antiepileptic medication regimen.

Some antiepileptic medications specifically affect the oral cavity, such as gingival enlargement, ulceration, xerostomia, glossitis and stomatitis. Establishing a point of communication with the patient’s neurologist can therefore help the dental clinician feel more comfortable with carrying out treatment and planning for dental procedures.

Citing the common antiepileptic drug sodium valproate as an example, the researchers note in the guide that it is vital to assess whether a patient is taking it, as it increases bleeding risk. They also advise consulting the patient’s neurologist when planning prescriptions for treatment of oral conditions, as some non-steroidal anti-inflammatory drugs, antibiotics, anti-fungal agents and other drugs common in dental practice can interfere with some antiepileptic medications.

Patient communication

Collaborating with the patient with epilepsy to establish a long-term dental care plan is a valuable way of making dental care easier and ensuring that the patient is less hesitant to receive dental treatment regardless of epilepsy status. Planning adjustments to standard dental treatments in light of the patient’s condition and explaining the rationale to the patient are also critical. For example, the researchers recommend fixed prostheses over removable ones for safety in the event of a seizure, as they are not as likely to fracture or potentially obstruct an airway.

The use of a mouth prop during treatment ensures that any instruments used will be clear of the oral cavity should a seizure begin during treatment. Explaining specific treatment decisions makes dental care collaborative and further increases the likelihood of treatment compliance, such as providing patients with a mouth guard that they can use prior to a seizure to help prevent bruxism and tooth attrition.

Proper anaesthetic protocol and management of dental anxiety

Regarding the clinical application of anaesthetic drugs, the researchers note that clinicians should be aware of the difference between seizures due to lidocaine overdose and those due to epilepsy and that traditional lidocaine with adrenaline is generally safe for most patients. However, when utilising medications to ease dental anxiety, such as methods for conscious sedation, the clinician should consult with the patient’s neurologist to avoid inadvertently reversing the anti-seizure effect of the patient’s medication when reversing sedation. Overdose is a real possibility in epileptic patients being treated with benzodiazepines, as they have a far higher tolerance for sedatives used in dentistry, such as midazolam, supporting the establishing of a care plan prior to treatment. Non-pharmacological techniques for dental anxiety are recommended in some cases, and the use of the modified dental anxiety scale can be useful for clinicians in assessing anxiety and creating an anxiety management plan.

Management of seizures and seeking assistance

The guide also includes useful tables detailing care management in the event of a seizure, such as how to clear the dental treatment area of trays or machines, recording details of the seizure, assessing vital signs and knowing when further medical treatment may be necessary. Being able to evaluate the severity of a seizure is key in knowing when a patient just needs to recover in the clinical room before being escorted home or whether an emergency care team should be summoned. The guide provides points of caution in care, detailed procedures and emergency medication administration.

Creating a plan for and with each patient will go a long way to helping both the clinician and the patient feel more confident with treatment. An individual care plan, which may involve pursuing useful alternatives to traditional treatment protocols, increases the likelihood of improved long-term oral health, which the majority of epileptic patients struggle to maintain.

The guide, titled, “Special care dentistry and epilepsy”, was published online on 10 June 2023 in King Khalid University Journal of Health Sciences.