Chapter 63- pt w/ seizure disorders Flashcards
A paroxysmal (sudden) event that results from abnormal brain activity. May involve a loss of consciousness with or without convulsive movements or spasms
Seizure
Effects of gingival overgrowth
Poses dental biofilm control problem May affect mastication May alter tooth eruption May interfere with speech May cause serious esthetic concerns
Early clinical features of gingival overgrowth
Appears as a painless enlargement of interdental papilla with signs of inflammation. Tissue eventually becomes fibrotic, pink, and stippled, with a mulberry or cauliflower look
Advanced lesion of gingival overgrowth
Tissue increases in size and extends into the marginal gingiva and covers a large portion of the crown. Often cleft-like grooves between the lobules
Severe lesion gingival overgrowth
Large, bulbous gingiva May cover the enamel, tend to wedge the teeth apart and interfere with mastication
Microscopic appearance of gingival overgrowth
During therapy, phenytoin is found in the saliva, blood, sulcular fluid, and biofilm. Fibroblasts and collagen increase in number in the connective tissue. The stratified squamous epithelium is thick with longe rete ridges. Inflammatory cells are in greatest abundance near the base of the pockets
What appears to be the most important determinant of the severity of phenytoin induced gingival enlargement?
Biofilm
Contributing factors to gingival enlargement
Mouthbreathing
Overhanging restorations
Large carious lesions
Calculus and other biofilm retaining factors encourage gingival overgrowth
Treatments of gingival overgrowth
Change prescription
Nonsurgical treatment (scaling and biofilm control)
Surgical removal
Different diagnosis of medications causing gingival enlargement
The majority of patients with epilepsy or a history of seizure should receive the same level of dental care as the general population
True
Patient approach for someone with seizures
Provide a calm and reassuring atmosphere and treat the patient with patience and empathy
Encourage self expression
Recognize possible impairment of memory
Help pt develop an interest in caring for their mouth
Care plan prior to the start of phenytoin therapy
A rigorous biofilm control program and complete scaling are introduced
Initial appointment series for pt treated with phenytoin with slight or mild gingival overgrowth
Nonsurgical treatment including frequent scaling, can help tissue reduction. Frequent maintenance appointment can be important
Initial appointment series for pt treated with phenytoin with moderate gingival overgrowth
After the weekly biofilm instruction and scaling, re-evaluation of the tissue can determine if further procedures are needed.
Initial appointment series for pt treated with phenytoin with severe fibrotic overgrowth
Initial scaling and biofilm control are carried out to prepare the mouth for surgical pocket removal. Plans for changing the drug should be discussed with pts physician
Continuing care for someone with gingival overgrowth
Frequent appointments on a 1, 2, or 3 month recall depending on the severity of the gingival enlargement and the pts motivation to maintain their oral health
What has a vital part in the care of a pt with a seizure disorder?
Daily biofilm removal
Fluoride therapy
Sealants
Dietary control
Emergency care objectives for a pt with seizures
Prevent body injury and accidents related to the oral cavity like.. Tongue bite Broken or dislocated teeth Dislocated or fractured jaw Broken dentures
Differential diagnosis of a seizure
Syncope Migraine headache Transient ischemic attack Stroke Sleep disorder Movement disorders Overdose of local anesthetic Hypoglycemia or insulin overdose Hyperventilation
Preparing for an appointment for a pt with seizures
Place emergency materials in a convenient location
Have pt remove dentures
Provide calm and reassuring atmosphere
Have other dental personnel ready in case of emergency
Emergency procedures for a pt with seizures
No attempt should be made to restrain pt or stop convulsions
Terminate procedure and call for assistance
Protect pt from injury
(Don’t let them near anything sharp, don’t let them fall, monitor vitals, don’t put shit in their mouth, a bunch of obvious bullshit)
When a seizure is still occurring or has recurred in 5 minutes activate emergency medical system
YES
Emergency care in the postictal stage
Complete the record or emergency Allow pt to rest Talk to pt in low voice Check oral cavity for trauma Contact pts family/friend
Status epilepticus
One or more seizures that lasts more than 30 minutes. Brain injury can occur and result in long term morbidity or death.
A term used to describe a group of functional disorders of the brain that are characterized by recurrent seizures
Epilepsy
How is the diagnosis of seizures made
Clinical signs and symptoms History EEG Neuroimaging Age-related onset Symptoms Location in the brain
3 basic types of seizures
Generalized: Affects the entire brain at the same time
Focal: Involves only one part of the brain (partial)
Unknown: These include epileptic spasms
Causes of seizures can be
Genetic, structural/metabolic, or unknown
Prognosis for seizures
Good. 75% become seizure free
Precipitating factors
Stress, apprehension, fatigue; sensory stimuli, like flashing lights, noises, peculiar odors, and use or withdrawal of alcohol or drugs
Aura
Warning sign of seizure
Primary prevention of seizures
involves avoiding brain injury with protective devices
Secondary prevention of seizures
involves early detections and compliance with recommended treatment
Tertiary prevention of seizures
involves interventions that decrease triggering factors that may cause seizures
These drugs are used to control seizures
antiepileptic
What medication is most common associated with gingival enlargement
Phenytoin
How can herbal supplements affect dental treatment
increased bleeding
Surgeries for epilepsy
Gamme-knife radiosurgery
Vagus nerver stimulation
Epilepsy in itself produces no oral changes. Specific changes relate to the side effects of medications
TRUE
Effects of accidents during seizures
Scars of lips and tongue
Fractured teeth
How often does gingival overgrowth occur in pts on phenytoin
25% to 50%
Mechanism of phenytoin and gingival overgrowth
Phenytoin may cause fibroblasts and osteoblasts to deposit excessive extracellular matrix, causing gingival overgrowth
Biofilm makes response worse
Gingival overgrowth is greater in
Younger patients
