6. Neurologic Disease

Question 1

What are considerations for epilepsy, in relation to?

• Seizure history
• Anxiety
• Appointment time
• What do you do if seizure
• Medication

Answer 1

1. Type, frequency, last, trigger
2. Manage stress well
3. Well rested, shorter appointments, early morning
4. Passive restraint, aspiration awareness, EMS as needed
5. Phenytoin (dilantin) - gingival hyperplasia

Question 2

What are 5 etiologies of epilepsy?

Answer 2

1. Genetic
2. Metabolic disorders
3. Mitochondrial disease
4. Prenatal brain injury
5. Head injury (wounded ill/injured population)

Question 3

Dental considerations for parkinsons

Answer 3

1. Many meds cause xerostomia or orthostatic hypotension

2. COMT inhibitors - Epi might increase BP, so limit to 2 carpules

Question 4

Dental considerations for oromandibular dystonia

Answer 4

1. Clinical awareness (it isn’t just TMD)
2. Neurology referral to rule out secondary cause
3. No cure (very hard to manage)
4. Muscle relaxants, anti-spasmodics / convulsants
5. Botox

Question 5

Dental considerations for MS

Answer 5

1. Maintain index of suspicion/awareness such as numbness, paresthesias, pain
2. Visual disturbances
3. Refer for eval
4. Treat during remission periods
5. Fatigue, heat intolerance

Question 6

S/Sx for Cerebrovascular Accident

Answer 6

Sudden onset of numbness, weakness, confusion, change in vision and movement-balance coordination

Question 7

Dental considerations for CVA

- What about bleeding?

Answer 7

1. Situational awareness
2. For post-stroke, check BP, appt timing, good pain control
3. Know INR value if on anticoagulants, avoid NSAIDS, local hemostatic measures

Question 8

Considerations for Alzheimer’s?

Answer 8

1. Appropriate medical management (cholinesterase inhibitors, antidepressants, anxiety, psychotics)
2. Xerostomia
3. Appt timing
4. Procedure selection