People with epilepsy may suffer from particular dental problems requiring special care. Some of these problems have been addressed.

EPILEPSY MEDICATIONS AND GUM PROBLEMS

The two most common gum problems are gingivitis and periodontitis. Gingivitis is inflammation of the gums. The gums may appear red and inflamed, you may notice bleeding when you brush or floss. Bleeding on brushing is not normal, healthy gums don’t bleed. Periodontitis involves loss of the supporting structures that hold the teeth in place. It is not a painful condition, in fact usually it is completely painless. Symptoms may include receding gums, bleeding gums, bad breath or a bad taste in your mouth or even loose teeth. Periodontitis is usually diagnosed by your family dentist, who should check for periodontal disease as part of a thorough routine dental examination. X-rays may also be needed to detect bone loss from around the teeth.

People who have difficulty cleaning their teeth, people who smoke, and diabetics are all at risk of developing periodontal disease, which may result in tooth loss.

One of the most common gum problems seen in patients with epilepsy is due to ‘Dilantin’ medication. Various medications can lead to an unsightly overgrowth of the gum tissue. The three major groups of drugs responsible are

1. Dilantin – an anti-convulsant

2. Calcium channel blocker – used to treat various heart conditions and hypertension

3. Cyclsporin – used following transplant surgery to prevent graft rejection.

Gingival overgrowth is most commonly seen around the front teeth but can be more widespread. It does not appear to be related to age, sex or race.

The relationship between dose and incidence or severity of gingival overgrowth is uncertain, but most studies do show a clear relationship between oral hygiene and the incidence and magnitude of Dilantin induced gingival overgrowth. Mouth breathing and other local factors such as crowding, will also relate to the occurrence of gingival overgrowth.

PREVENTION

Maintenance of dental health in people with epilepsy and an intellectual impairment is directly related to plaque control efficacy. Sometimes they are unable to achieve adequate levels of plaque control because of physical and mental limitations. Plaque removal is a skill that can be mastered only when an individual possesses the dexterity to manipulate a toothbrush (and floss) effectively.

DISCLOSING SOLUTIONS AND TABLETS.

These can be obtained from the pharmacy, and will stain plaque pink, so that it can be visualized and then removed. Depending on the patient’s ability to cooperate, disclosing solutions can be placed directly in the mouth and swished around the teeth, or painted on the teeth with a cotton bud. They can also be bought in a tablet form.

TOOTHBRUSHES

The best toothbrush is one that is small and soft. Electric toothbrushes can be particularly useful for patients with limited manual dexterity or understanding. They are also fun to use!! It is important to have an orderly routine that will reach every tooth and surface – and allow adequate time. Toothbrushing should be done at least once a day, preferably twice.

TOOTHPASTE

Toothpaste makes it easier to clean our teeth and makes it taste better! It also exposes the teeth to fluoride, which helps prevent against dental decay. However for some disabled people or their careers, toothpaste might make it more difficult to clean due to decreased visibility into the mouth. Toothpaste may also increase the gag reflex. If it is easier not to use toothpaste, a good result can be achieved by proper brushing alone, however a fluoride mouth rinse should be considered an addition.

MOUTH RINSES

Unfortunately many of the commercially available mouth rinses have minimal therapeutic effect. Although they are widely advertised and claim to ‘kill the bacteria’ that cause dental disease, this is not always the case. They leave your mouth felling clean and fresh but sometimes with little benefit. Mouth rinses containing Chlorhexidine may be prescribed by your dentist if indicated. Fluoride mouth rinses are also recommended for those at risk of dental decay.

Pit and fissure sealants

Topical fluoride

Communally fluoridated water

Dietary considerations

Periodic professional dental cleaning

Daily oral hygiene – performed by or monitored by full-time health care staff

A dry mouth can be uncomfortable and can affect eating and speech, it can also have disastrous dental effects. Many medications can lead to a dry mouth, one commonly used by people with epilepsy is Carbemazapine. Other medications that can result in a dry mouth include analgesics, anti-histamines, anti-hypersensitives, psychotropic agents (anti-anxiety and anti-depressants), anti-psychotic agents, anti-manic agents (lithium) and diuretics.

A dry mouth can result in very aggressive dental decay – the association between dietary sugar and dental caries is well recognized. Frequency of intake is most important.

What to do? Speak to your dentist if you suffer from a dry mouth, who may prescribe particular toothpastes or mouthrinses, such as a fluoride mouth rinse to protect the teeth from acid attack and decay. Frequent sips of water and a good diet can also be beneficial. Regular dental visits are crucial for people with a dry mouth.

Hyper salivation (excess saliva flow) is sometimes a problem in people with a physical or intellectual impairment, this may cause problems due to increased calculus formation.

Accidents do happen! Any accident where the teeth have received a bump requires immediate dental examination, however there are a few steps you can take to minimalise damage. Soft tissue trauma (to the lips, tongue and gums) will need to be assessed as well as the possibility of any bony fractures.

If the tooth is knocked out wash it in milk (keep UHT milk handy in case of emergency – this should be part of your first aid kit) then replace the tooth if possible, or take the tooth (stored in milk, not water) to your dentist for reimplantation. Do not delay – you will need immediate dental treatment, and perhaps antibiotics and tetanus shots.

If the tooth is loose, but not in its correct position it could be intruded or extruded. Immediate dental treatment is needed to reposition the tooth, this will need x-rays and the tooth may need to be splinted in position.

If the tooth is loose but in its correct position, the root of the tooth may have fractured. Dental treatment again is important.

A dental consultation is required even when there are no visible signs of tooth damage as root fractures can occur and teeth can lose their vitality. Early treatment and monitoring may help prevent future tooth loss.