Epilepsy is the most common serious neurological condition in the UK. Around one person in every 100 people has epilepsy (more than half a million people in the UK). People with epilepsy may be well known to individual dental practices as seizures often result in recurrent dental injuries, while some anti-epileptic drugs (AEDs) have oral side effects, necessitating more frequent appointments. Dentists need to be aware of the issues surrounding seizures and teeth to ensure good dental healthcare of epilepsy patients.
The unpredictable nature of seizures combined with side effects from some medications can add to the long-term impact of epilepsy. Issues range from experiences in the dental chair to gum disease, broken or lost teeth and the stigma associated with dental injuries.
Research has shown epileptic seizures to be the most common medical incident in the dental surgery – stress and hypoglycaemia are often triggers for seizures. Dental injuries rate as the third most common non-fatal seizure related injury after head injuries and burns and scalds, and people with epilepsy (unless on means-tested benefits) can pay a heavy price for having the condition, needing repeated dental treatments for seizure related teeth and gum damage.
In a study of 1,673 people with epilepsy in Gloucestershire, researchers found that dental injury occurs in approximately one per cent of people with epilepsy and for those with junior myoclonic epilepsy (JME), this figure rises to around 10 per cent.
Lead researcher Dr Rhys Thomas from Wales Epilepsy Research Network (WERN) at Swansea University said the significant increase in dental injury in people with JME was probably due to the sudden onset of a seizure without an aura, giving the person no time to take any safety precautions.
He said; “A build-up of myoclonic jerks prior to a generalised seizure should act as a warning, but because it also promotes falling forwards it results in more injuries to the front teeth in those with JME.
“There may be other factors too that account for the increase. For example in JME, seizures are more likely to occur first thing in the morning in the bathroom, providing more hard surfaces for the person to fall against than in other settings during the day.”
Other oral problems frequently experienced include broken teeth, lacerations to the wall of the mouth and tongue caused by involuntary biting during a seizure. Biting the tongue or the inside of the mouth during a seizure can result in painful ulcers.
Dr Guy Hollis, the Epilepsy Society’s dental expert, recommends that patients see their dentist if ulcers last longer than 14 days. If brushing becomes too uncomfortable, mouths can be rinsed with Corsodyl or medication such as Iglu applied until the swelling subsides, sucking ice cubes and taking painkillers may also help.
If a patient falls during a seizure and damages their teeth, an emergency appointment should be arranged as soon as possible and if an injury affects appearance or self confidence, the possibility of cosmetic treatment could be discussed.
It’s also helpful if patients know what to do if a tooth is knocked out. Many people with epilepsy are unaware that the tooth should be handled carefully by the crown, not the root. They need to know that if the tooth is clean it should be replanted in its socket immediately and the patient should bite down on a clean handkerchief to keep the tooth in position until a dentist is seen.
If the tooth is dirty, people need to know that it can be rinsed in milk or under cold water, but not scrubbed. If the patient is unable to replant their tooth or are not confident in doing so, the tooth can be stored in milk or placed in saliva, in the person’s mouth next to the cheek. It is essential that people know to seek medical advice as quickly as possible in these circumstances.