November is National Epilepsy Awareness Month. This neurological disorder, characterized by recurrent seizures, not only affects one’s daily life, but also creates distinct challenges when seeking essential dental care. As we inspect the intricate interplay between epilepsy and oral health, let’s examine these challenges through the lens of two supporting quotes.
Communication and Awareness “When caring for patients with epilepsy it is important to inquire about their medical history”, says Dr. Aubrey Hedrick. “A thorough history will help the dentist and dental team evaluate the severity, frequency, and usual presentation of a patient’s epilepsy. This allows us an opportunity to communicate with other doctors caring for the patient, such as their neurologist. We can determine what medications the patient takes, manage their drug regimen for the dental appointment, and make plans to evaluate the patient’s medication concentration in their blood when indicated. While interpreting this medical information, we can discover environmental triggers that may activate a patient’s seizure activity and discuss the proposed treatment in detail with the patient. After this detailed discussion, when possible, triggers related to the operation may be modified or eliminated. Once it has been decided that treatment may proceed in the clinic and preparations have been made to lower the risk of seizure, it is important to be prepared for a seizure to occur. For example, my office stocks Midazolam, a benzodiazepine, which is used to terminate seizure activity that does not stop spontaneously.”
Understanding and Managing a Seizure “Patients that present with seizures may or may not have epilepsy” explains Dr. JohnHansford. “An understanding of the patient’s medical history is important because it helps establish the patient’s baseline and helps the healthcare team develop a differential diagnosis. For example, a history of epilepsy can help us identify an epileptic seizure from a febrile seizure, local anesthesia overdose seizure, or hypoxic seizure etc. Once a seizure has been observed, it is important to determine and treat the underlying cause. In terms of the seizure itself, most are self-limiting and will terminate spontaneously within two to five minutes of onset. If the seizure lasts beyond five minutes, it is very unlikely to self-limit. After 15-20 minutes brain damage usually occurs. Midazolam is the first-line treatment for protracted seizures aka status epilepticus in children, and it works best when given sooner to the time when the seizure duration crosses the 5–minute threshold rather than later. After seizures have stopped, there is a key factor that must be evaluated: respiration. In the post-ictal time period, after seizure activity has ceased, patients may lose their spontaneous respiratory drive. Additionally, the midazolam may contribute to impaired respiration.
Dentists and members of the healthcare team should be prepared to monitor respiration. This can be done through physical observation, capnography, pulse oximetry, and indirectly through ecg impedance and heart rate monitoring. Dentists and members of the healthcare team must also be prepared to manage the patient’s airway. This can be done through chin lifts, jaw thrusts, bag-valve-mask ventilation, intubation, and supplemental oxygen administration. It is important for parents to inquire about provider experience, credentials, and BLS, PALS, and ACLS training.
Dr. JohnHansford is a double-board certified specialist in pediatric dentistry and dental anesthesiology. Opinions expressed are those of the writer.