Side effects

27 September 2013
Volume 29 · Issue 9

Angie King explores the problems sufferers of epilepsy can have with their oral health.

In the UK more than half a million people have epilepsy, this equates to one person in every hundred. Epilepsy tends to be a ‘hidden condition’ but people who suffer seizures, and even those who are on medication and seizure free, can experience issues with their oral health.

Epilepsy is the most common serious neurological condition in this country, it can affect anyone of any age at any time in their life.

An epileptic seizure is caused by an interruption to the brain’s electrical signals. There are many different types of seizure. Most epileptic seizures happen without warning, last a short time and stop by themselves. Injuries can occur, but most people do not come to any harm in a seizure and do not usually need to go to hospital or see a doctor.

Research has shown epileptic seizures to be the most common medical incident in the dental surgery – as stress is often a trigger for seizures; however the links between epilepsy and oral health can sometimes be overlooked.

Louise Bolotin, from Manchester, was delighted when she transferred to a new dentist. She said: “I had lived with 10 years of constant plaque which I had been trying to manage myself in between appointments. It was only when I saw my new dentist that he explained the plaque could be a side effect of my anti-epileptic drugs.”

Louise’s story is not unusual. Side effects from some medications can add to the long-term impact of epilepsy. At the University of Bonn, research has shown that the anti-epileptic drug (AED) phenytoin can cause gingival hyperplasia or gum overgrowth. Between 50-60 per cent of people who are prescribed it suffer inflamed gums which can threaten to engulf the tooth - causing sensitivity and bleeding.

Dr Guy Hollis, Epilepsy Society’s dental expert, says people with epilepsy who take phenytoin but worry about halitosis or gum disease should always seek the advice of both their dentist and GP if they want to discuss a change of medication. In the wider community of people with epilepsy the problems caused by phenytoin should be self-limiting, as though there are still many people taking it, the medication is no longer prescribed as a first choice of treatment. Guy comments: “However, many other problems persist such as dry mouth (xerostomia), broken teeth due to jaw clenching and trauma, plus sores on the tongue and inside of the mouth caused by biting during a seizure and sometimes as a reaction to medication.”

Some medication can cause dry mouth (xerostomia) which causes a patient constant thirst and difficulty when eating and speaking. Reduced saliva can encourage the growth of bacteria in the mouth and increase the risk of tooth decay, gum disease and disease in the lining of the mouth. To combat this, regular sips of water can be taken, gum can be chewed or the use of artificial saliva can be prescribed by dentists.

People with epilepsy often have concerns about their teeth and oral well-being. Injuries to the mouth, tongue and teeth are all too familiar to someone whose seizures are yet to be controlled and living with epilepsy often means living with recurrent dental injuries or oral side effects from medication. However for the average person with epilepsy, their oral hygiene is as good as in the general population.