Week 11 - Psychoses and Epilepsy Wrap Up

Question 1

What are dental implications of schizophrenia

Answer 1

• xerostomia (due to hyposalivation)
• hypersalivation in patients taking clozapine (cholinergic agonist)
• bruxism - due to medication or anxiety
• can act as CNS depressants - risk of orthostatic hypotension, sedatives and anesthesia to be used with caution

Question 2

What are oral manifestations of epilepsy

Answer 2

• Patients with epilepsy have increased risk of:
  o Dental caries (due to poor oral hygiene or dry mouth)
  o Oral trauma, especially from seizures
  o Lacerations, particularly of the tongue
  o Ulcerations and glossitis (linked to B12 deficiency from medication)
  o TMJ injuries and tooth avulsions
  o Gingival hyperplasia, bleeding gums, and delayed healing (medication-induced)

Question 3

what are adverse effects of antiepileptic drug phenytoin

Answer 3

• gingival hyperplasia
• xerostomia

Question 4

What are adverse effects of antiepileptic drug carbamazepine

Answer 4

• xerostomia
• stomatitis
• glossitis
• ulceration
• dysgeusia
• bleeding (with NSAIDS)
• bone marrow suppression

Question 5

What is gingival hyperplasia

Answer 5

condition where the gum tissue becomes excessively enlarged or overgrown.
- most common side effect of phenytoin

Question 6

what can cause gingival hyperplasia

Answer 6

• phenytoin
• calcium channel blockers (e.g., nifedipine)
  o Immunosuppressants (e.g., cyclosporine A)
• Caused by altered fibroblast function → excess extracellular matrix in gingival tissue.

Question 7

what is treatment for gingival hyperplasia

Answer 7

• good oral hygiene
• surgical intervention if severe

Question 8

what are antiseizure drugs/function

Answer 8

CNS depressants (either inhibit excitation or potentiate inhibition) —suppress abnormal electrical activity in the brain.

Question 9

what are dental implications of antiseizure drugs

Answer 9

o Caution with sedatives like benzodiazepines or barbiturates since it is a CNS depressant

o Possible interactions with:
- antibiotics and analgesics
- NSAIDS and antimicrobials

o Most local anesthetics are safe.

Question 10

what is the teratogenic risk (any substance that can cause birth defects in a developing fetus) of antiseizure medication

Answer 10

Phenytoin use in pregnancy can cause craniofacial defects like cleft lip.

Question 11

what is the interaction between antibiotics and antiseizure drugs

Answer 11

increase rate of breakdown of some antibiotics and analgesics

Question 12

what is the interaction between NSAIDs and antimicrobials and antiseizure drugs

Answer 12

may affect absorption or metabolism of anticonvulsants negatively

Question 13

What are dental considerations for epileptic patients

Answer 13

• Ensure medication adherence before appointment to reduce seizure risk.
• Schedule appointments at times when seizures are less likely.
• Minimize triggers:
  o Reduce stress aby explaining procedure before starting
  o Use dark glasses to avoid light triggers.- keep bright light out of the patients eyes
  o Keep the environment quiet. – avoid extreme noise

Question 14

What to do if a seizure occurs during treatment

Answer 14

o Remove instruments from the mouth.
o Clear area around the chair.
o Turn patient to the side.
o Monitor airway and breathing.
o Time the seizure; if >3 minutes, call emergency services (risk of status epilepticus).