Many people suffer from epilepsy, as well as the whole set of problems, in this case oral, resulting from this disease, by the pharmacological therapies used to combat it.
This condition means that patients with epilepsy are patients with special conditions that require treatment and a specific dental approach. It depends on the knowledge and management of the professional, who must be well trained to avoid complications during clinical sessions.
Epilepsy is the most frequent neurological pathology affecting around 50 million people worldwide, predominating in childhood and old age.
The cause of this illness can be idiopathic, (unknown), it is not known why it happens, but it is highly linked to the inheritance. Secondary causes may occur, either due to genetic causes or developmental problems. These usually appear during childhood frequently. Also other causes can be traumatisms, severe organic problems, malformations, metabolic abnormalities, tumors …
We can define Epilepsy, as an excessive neuronal discharge of a set of neurons, whose activity becomes frenetic, with seizures being the main clinical sign.
Three status or types of epilepsy are determined:
Partial or focal crisis. Are those that affect a specific area of the brain, whose clinical course is sweating, nausea, skin redness Also contraction of a part of the body muscles, dilation of pupils with or without loss of consciousness.
Total crises. They are neuronal discharges that involve everything or almost the entire brain. They go through loss of consciousness, generalized muscle contraction, followed by a state of relaxation and drowsiness.
Absences, sudden loss of conscious activity, which can last from instants becoming imperceptible until minutes.
The success of the management and dental treatment lies in the knowledge of the type of epilepsy that the patient presents, as well as the knowledge of all those stimuli that can trigger the epileptic crisis. These factors that trigger crises can be very varied, some of them being:
- Suppression of antiepileptic treatment.
- Stress, fear or anxiety for dental treatment.
- Sleep deprivation.
- Metabolic alterations.
- Noises
- Dehydration
- Application of drugs.
- Presence of stimuli such as noise or flashing or very powerful lights.
- Infectious processes
- Menstrual cycle.
That is why you should pay attention to the clinical history, collect the information well, make an appointment with a neurologist if necessary. In addition, clinical sessions should be postponed to periods of stability, far from epileptic crises.
The main oral problems resulting from epilepsy are gingival hyperplasia (excessive growth of the gums) and xerostomia (decreased salivary flow considered normal).
Hypertrophy or gingival growth is the main problem of epileptic people. Especially those who take phenytoin, which accounts for 50% of epileptic patients. The expression of hyperplasia occurs with an enlarged gum, invading this part or the entire clinical crown of the tooth which generates multiple disorders. It can occur:
The appearance of caries due to deficiency in normal hygiene since they can not be cleaned under the gum.
- Infections of all kinds.
- Periodontal and dental.
- Swallowing problems
- Phone problems.
- Halitosis…
In these cases the solution goes through referral to the neurologist or physician who has placed the treatment of hydantoins. This shows whether it is possible to adjust the pharmacological treatment for another. In these cases in which this option is viable, gingival hypertrophy often disappears. It is thus left uncovered sequelae such as caries, or plaque, as well as tartar that have to be treated. There are some cases in which pharmacological replacement is not enough or is not possible. In these patients the treatment is surgical as it goes through the performance of gingivectomies or gingivoplasties, (hypertrophic gum cutting). Also the subsequent scaling and root planing along with hygiene and treatment of coexisting problems.
In the case of xerostomia, the treatment goes through the interconsultation with the doctor to see if it can be corrected and adjust medication that corrects the salivary deficit. In addition as a prevention technique are:
- The increase in the intake of water or liquids.
- Use of lubricating gels
- Use of drugs that act on glandular parenchyma promoting increased salivary flow.
- The sequelae resulting from xerostomia should be corrected, such as the appearance of candida infections or gingival infections.
The best dental management in these cases is prevention and this goes through increasing visits to the dentist. In addition you should increase the hygiene and the number of dental brushes. From SJD Dentist we invite you to visit us to help you correct the oral problems of this illness, so if you know someone or yourself, in this situation, go ahead and visit us.