**4.2.3 Prosthodontic problems**

Epilepsy is a chronic disease that can affect oral health and prosthodontic status in different ways. However, epilepsy is a condition of various etiologies and seizure types, and different patients may have differing needs in prosthodontic care (Karolyhazy, et al., 2005).

In a recent analysis of the prosthodontic status of patients with epilepsy, it was found out that compared with age-matched controls, patients with epilepsy have a tendency to become edentulous earlier. It was also found that prosthodontic treatment is suboptimal, as significantly fewer teeth are replaced, despite the fact that epileptic patients tend to have more missing teeth. Based on these findings, the authors suggested a classification for patients with epilepsy according to dental risk factors and dental manageability and provided recommendations for dental treatment (Aragon & Burneo, 2007).

Friedlander and Cummings (Friedlander & Cummings, 1989) mentioned that in patients with epilepsy replacement of missing teeth is important to prevent the tongue from being caught in the edentulous spaces during seizures.

Specific guidelines were also provided, such as discouragement of incisal restorations, use of fixed rather than removable prostheses and inclusion of additional abutments if fixed partial dentures are to be used (Karolyhazy, et al., 2005). In addition, the use of metal base for complete dentures and telescopic retention with denture bases made of metal or reinforced with metal for nearly edentulous patients was recommended for those with frequent partial seizures involving the masticatory apparatus, frequent generalized tonic– clonic seizures and other seizures associated with falls. Patients with epilepsy have an increased risk for loosing teeth, and the prosthodontic status of epilepsy patients is not optimal. This may unfavorably affect quality of life.

#### **4.2.4 Orthodontic problems**

Anti-epileptic drugs related to oral findings include recurrent aphthous-like ulcerations, gingival bleeding, hypercementosis, root shortening, anomalous tooth development, delayed eruption, and cervical lymphadenopathy (Johnstone et al., 1999).

Of particular interest to the orthodontist is a recent report of facial and body asymmetries affecting 41% of patients with partial seizures in the population studied; asymmetries included both hemihypertrophy and atrophy (Fong et al., 2003).

Gingival enlargement may cause delays in permanent teeth eruption and malocclusions in children with mixed dentition (Fig. 2). The hypertonicity of the oral musculature has caused the protrusion of the anterior teeth and the orthopaedic compression of the maxilla.
