Epilepsy and Oral Health: An Important Relationship
Epilepsy is a neurological condition characterised by recurrent, unprovoked seizures. It affects approximately 5–7 per 1,000 people in India and is usually managed with antiepileptic medications (AEDs). For dental patients with epilepsy, there are several important considerations: the direct oral effects of antiepileptic drugs, the risk of a seizure during a dental procedure, drug interactions, and the general principle of minimising patient stress and anxiety.
Always inform your dentist of your epilepsy diagnosis, the medications you take (name, dose, and frequency), how well controlled your seizures are, and when you last had a seizure.
Phenytoin and Gum Overgrowth
Phenytoin (Dilantin, Eptoin) is one of the oldest and most widely used antiepileptic drugs. One of its most significant oral side effects is gingival overgrowth (gingival hyperplasia) — a diffuse, fibrous enlargement of the gum tissue that can eventually cover the teeth entirely if untreated. This condition affects approximately 50% of patients on phenytoin and is most pronounced in adolescents and young adults.
The overgrowth typically begins in the interdental papillae (the gum tissue between the teeth) and gradually extends to cover the visible tooth surfaces. It is not a tumour or cancer — it is an overgrowth of normal fibrous connective tissue stimulated by the drug.
- Excellent oral hygiene significantly reduces the severity of gingival overgrowth — professional cleaning every 3–4 months is recommended for all patients on phenytoin
- If overgrowth is severe, surgical removal (gingivectomy) can restore normal gum contours
- After surgery, overgrowth will return if phenytoin is continued — discuss with your neurologist whether an alternative AED can be used
- Alternative AEDs with less gum overgrowth risk include sodium valproate, levetiracetam, and lamotrigine
Other AEDs and Oral Health
Different antiepileptic drugs have different oral side effects:
- Sodium valproate (Valparin, Depakote): Can impair platelet function and prolong bleeding time — inform your dentist before any extraction or surgery
- Carbamazepine (Tegretol): Can cause dry mouth (xerostomia), increasing cavity risk; rarely causes ulcers
- Phenobarbitone: Can interact with drugs metabolised by the liver — including some antibiotics (erythromycin, metronidazole) and antifungals (fluconazole), which can raise phenobarbitone levels dangerously
- Levetiracetam (Keppra): Generally few dental interactions; considered one of the safer AEDs for dental patients
- Lamotrigine: Rarely causes Stevens-Johnson syndrome — a severe skin and mucosal reaction; alert your dentist if you develop mouth ulcers or a rash while on lamotrigine
Seizure Precautions in the Dental Chair
The dental environment — bright lights, anxiety, unfamiliar sounds and sensations — can in theory lower the seizure threshold in susceptible patients. Practical precautions at The Tooth Stop for patients with epilepsy include:
- Taking a full seizure history: frequency, type, and last date of seizure
- Scheduling appointments when the patient is well-rested and well-medicated
- Keeping instruments and instruments trays away from airway in case of seizure
- Having suction and oxygen immediately accessible
- Not restraining the patient if a seizure occurs — protect the airway and allow the seizure to run its course
- Timing the seizure: if it lasts more than 5 minutes (status epilepticus), call emergency services immediately
Dental Treatment Under Sedation
For epileptic patients with severe dental anxiety or those who are unable to cooperate due to learning disabilities or developmental challenges, dental treatment under sedation or general anaesthesia may be considered. This requires referral to a hospital dental setting with full anaesthetic monitoring.
Some antiepileptic drugs interact with benzodiazepines and anaesthetic agents — a specialist anaesthetic assessment is essential before any sedation procedure.