**4.1 General situation**

The medical literature contains little information on the influence of epilepsy in dental care. Most existing studies focus on phenytoin-induced gingival hyperplasia. These individuals often have worse oral health status than the general population. They tend to have a higher incidence of dental caries and difficulty in accessing dental care (Chikte et al., 1991). The main reason for higher prevalence of dental caries in disabled individuals is the inadequate plaque removal. Visually impaired cannot visualize the plaque on the teeth surfaces so even

changes captured by video and the focal epileptiform abnormalities in the EEG are the most

**Drug Type of seizure Most common oral side effects and** 

Phenytoin GTCS, partial Gingival hyperplasia, delayed healing,

Carbamazepine GTCS, partial Agranulocytosis, aplastic anemia,

Valproic acid Absence, any type Excessive bleeding, decreased platelet

Phenobarbital Any type Drowsiness, drug interactions, xerostomia,

Ethosuximide Absence Leukopenia, Stevens-Johnson syndrome,

Primidone Partial (psychomotor) Ataxia, vertigo, stomatitis, osteoporosis Gabapentin Partial Xerostomia, stomatitis, gingivitis, glossitis,

Temporal lobectomy is perhaps the most common type of surgery for epilepsy. In the only randomized controlled trial of surgery versus medical treatment, the success rate was 64%. However, patients can experience a significant decline in verbal memory (McKhann et al., 2002). Which can be partly predicted through a detailed neuropsychologic evaluation

The medical literature contains little information on the influence of epilepsy in dental care. Most existing studies focus on phenytoin-induced gingival hyperplasia. These individuals often have worse oral health status than the general population. They tend to have a higher incidence of dental caries and difficulty in accessing dental care (Chikte et al., 1991). The main reason for higher prevalence of dental caries in disabled individuals is the inadequate plaque removal. Visually impaired cannot visualize the plaque on the teeth surfaces so even

Table 1. Adverse effects of antiepileptic drugs commonly used in children.

**4. Treating dental patients with epilepsy** 

(Loring, 1997).

**4.1 General situation** 

gingival

**dental considerations** 

bleeding, osteoporosis

xerostomia, delayed healing, gingival bleeding (thrombocytopenia),

delayed healing, osteoporosis, xerostomia, stomatitis, gingivitis, drug interactions

and nonsteroidal anti-inflammatory drugs

osteoporosis

aggregation,

with aspirin

stomatitis, osteoporosis

orofacial

orofacial

edema, dysgeusia

edema, dysgeusia

important pieces of information in the presurgical evaluation.

Fig. 1. Severe gingival enlargement in a child with epilepsy.

understanding the importance of oral hygiene is difficult for them, which results in the progression of dental caries as well as inflammatory disease of the periodontium (Mann et al., 1984). Patients living with epilepsy have special needs during dental treatment. In almost all aspects of oral health and dental status, the condition of patients with epilepsy is significantly worse than age-matched groups in the general (nonepileptic) population (Karolyhazy et al., 2003). Furthermore, patients who have poorly controlled epilepsy and experience frequent generalized tonic–clonic seizures exhibit worse oral health in comparison with patients who are better controlled or only have seizures that do not involve the masticatory apparatus (Karolyhazy, et al., 2003).

The number of decayed and missing teeth, the degree of abrasion and periodontal indexes are significantly worse in patients with epilepsy. Those with epilepsy also have significantly fewer restored and replaced teeth than the general population (Karolyhazy et al., 2005).
