Special Needs Research Paper: Epilepsy

Dental Hygiene III Summer 2018

Caitlin Berge
 Epilepsy is a disorder that affects the central nervous system and is characterized

by abnormal brain activity. Symptoms can vary depending on the type of epilepsy, and

can include convulsions or seizures, twitching, or even blank stares. Loss of

consciousness and awareness is also common. Often epilepsy can be attributed to

developmental disorders, infectious diseases, head trauma, tumors or strokes, and genetic

influence. In some people the cause may not be identified. It can be treated with various

therapies, surgery, or medications (Mayo Clinic, 2018).

Epilepsy is theorized to have been around since the beginning of human existence

and has appeared in texts dating back to 2000 B.C. from the Mesopotamian region. Later

examples appear in Egyptian medical texts around 1700 B.C. and in Babylonian texts

around 1050 B.C. Most of these references attribute the convulsions to “evil spirits” and

divine intervention rather than a neurological disorder. However, the first person to

recognize epilepsy as a medical disorder was in fact Hippocrates, the “father of

medicine”, around 300 B.C. He was also the first to recognize the condition as a

dysfunction of the brain (Diamantis, Magiorkinis, Sidiropoulou, 2010).

There are many different predisposing factors that can increase a person’s risk for

developing epilepsy including family history, age, head injuries, infections, vascular

diseases, stroke, dementia, or even high fevers in childhood. The disorder usually

manifests in children and the elderly but can arise at any age. Family history and genetic

influence can also influence risk due to certain genes that can make a person more

susceptible to environmental triggers (Wilkins, 2017). Environmental factors such as

head trauma, stroke, or infectious diseases can also factor into the occurrence of epilepsy.

The exact etiology in individuals is often not well understood. It can occur in both men
and women of any age or ethnicity—gender or race does not affect a person’s

susceptibility to developing epilepsy (Mayo Clinic, 2018).

Epilepsy affects the body physically in various ways. Some people have seizures

that only affect one area of the brain and they are referred to as focal seizures. With these

a person may or may not lose consciousness or awareness. Other individuals may

experience seizures that affect all areas of the brain, and these are referred to as

generalized seizures (Wilkins, 2017). Certain types of seizures may cause a person to

have stiffening or lose all muscle control, twitching or jerking, or a combination of the

three. Some individuals may only lose awareness or consciousness without

musculoskeletal symptoms and can be seen briefly staring into space. Loss of

consciousness and muscle control can make living a normal life difficult and even present

dangers to themselves and others. People with epilepsy are at risk for car accidents,

falling, drowning, as well as emotional and psychological distress (Mayo Clinic, 2018).

Epilepsy can be managed with medications such as phenytoin and carbamazepine,

but it is only successful in about half of patients. Often a combination of drugs is

necessary to control the onset of seizures. Additionally, patient compliance with taking

the medication as directed is not always optimal (“Treating Patients with Epilepsy”,

2007). This is often attributed to the potential side effects, which can include dizziness,

skin rashes, fatigue, memory loss or cognitive problems, or even more severe such as

depression or suicidal thoughts (Mayo Clinic, 2018). Epilepsy is often a lifelong

condition, but it can arise at any age, and it is possible for children especially to grow out

of the condition. Seizure disorders tend to be manageable and do not progress over time.

With medication, various therapies, and surgery, many people have managed to become
seizure-free. No one treatment has been proven to eliminate seizures in everyone,

however. Classifications of the disorder are ever changing and evolving, and this can

make it very difficult to treat successfully (Behr et al., 2016).

Epilepsy can have a physical effect on the oral cavity. With the loss of muscle

control as well as stiffening during a seizure episode, a person has the potential to bite his

or her tongue or other soft tissues in the mouth causing significant trauma. They are also

at risk of damaging hard tissues such as chipping teeth. Clinicians will often see scars

from past trauma in the oral cavity (Wilkins, 2017). The most common oral side effect

from seizure medication is gingival hyperplasia or gingival overgrowth. The gingival

tissue becomes enlarges, red, and inflamed. This can increase the risk for caries,

periodontal disease, delayed healing and infection, so control of dental biofilm is

important. Xerostomia is another potential side effect of certain medications, but it is rare

with anticonvulsants (“Treating Patients with Epilepsy” 2007).

Certain modifications of treatment may need to be implemented to successfully

and appropriately care for a patient with epilepsy. The need for a caretaker depends on

the age of the patient and severity of epilepsy. If there are intellectual or learning

disabilities associated with the conditions, then a caretaker may be appropriate.

Treatment for gingival hyperplasia can include a proactive treatment plan addressing

biofilm control, surgical removal such as a gingivectomy or periodontal flap procedure,

or even a change in medication to see if symptoms regress (Wilkins, 2017). With the

likelihood of gingival hyperplasia, proper home care instruction is critical to help reduce

inflammation. The gingiva may be extremely inflamed and sensitive, therefore a manual

toothbrush may decrease sensitivity, as it is less stimulating than an electric brush.

However, this is all dependent upon the patient. Any floss aid such as picks or irrigators

that might encourage a patient to comply with interproximal care may be helpful

(“Treating Patients with Epilepsy”, 2007).

Another consideration for epileptic patient of which the clinician must be aware

and prepared for is the potential for a seizure to occur in the dental chair during

treatment. A thorough documentation of health history is important to know the risks for

each patient. If this scenario does occur, it is important to clear any obstructions in the

room that could harm the patient such as chairs or sharp instruments. The patient should

be placed in a supine position in the dental chair and on his or her side if possible. The

clinician should refrain from restraining the patient but can offer gentle support so he or

she avoids injury, and should never place anything between the teeth. The seizure should

be timed, and emergency services should be activated if it lasts longer than five minutes

(Wilkins, 2017). If the seizure ends and emergency services are not needed, a brief oral

examination may be beneficial to check for intraoral injuries, and the appointment should

be rescheduled for another day. Depending on the state of the patient post-seizure, it may

be necessary to have them sit and rest for a period of time before they leave or even

contact a family member (“Treating Patients with Epilepsy”, 2007). With the proper

knowledge and preparedness, it is possible to effectively treat and provide excellent care

to patients suffering from epilepsy.

 References

Behr, C., Goltzene, M., Kosmalski, G., Hirsch, E., & Ryvlin, P. (2016). Epidemiology of

epilepsy. Revue Neurologique,172(1), 27-36.

Epilepsy. (2018, June 13). Retrieved from https://www.mayoclinic.org/diseases-

conditions/epilepsy/symptoms-causes/syc-20350093

Magiorkinis, E., Sidiropoulou, K., & Diamantis, A. (2010). Hallmarks in the history of

epilepsy: Epilepsy in antiquity. Epilepsy & Behavior,17(1), 103-108.

Treating patients with epilepsy. (2007). Dental Abstracts,52(5), 259-260.

Wilkins, E.M., Wyche, C. J., & Boyd, L.D. (2017). Clinical Practice of the Dental

Hygienist. Philadelphia: Wolters Kluwer.