Seizure disorder (epilepsy)

Oral health effects

• Dental trauma from tonic-clonic seizures

  Involuntary jaw clenching during a generalized seizure commonly fractures or avulses teeth and can lacerate the tongue, cheeks, or lips.

  Clinical management: Assess for existing dental trauma; consider a custom mouthguard for patients with poorly controlled seizures.

• Increased tooth wear (attrition/bruxism)

  Bruxism during or between seizures contributes to greater dental wear than seen in the general population.

  Clinical management: Monitor wear; consider a nightguard if clinically indicated.

• Status epilepticus as an in-chair emergency risk

  Though uncommon, a seizure during treatment is a high-severity chairside emergency, particularly if seizure control is poor or a dose was missed.

  Clinical management: Confirm seizure frequency/control and last-dose timing before starting; keep the chair clear of loose instruments and have an emergency protocol ready.

• Gum overgrowth from seizure medicines (phenytoin gingival overgrowth)

  Long-term phenytoin causes gingival overgrowth in a large share of users (16-94% across studies); valproate, carbamazepine and phenobarbital have also been implicated.

  Clinical management: Record anticonvulsant history; emphasize meticulous plaque control and short recalls; debride thoroughly; refer for gingivectomy or suggest the patient discuss alternative drugs with their neurologist if severe.