DH201 CLINICAL SCIENCES III Lisa Mayo RDH, BSDH What lies
behind us and what lies before us are tiny matters compared to what
lies within us Ralph Waldo Emerson CNS Disorders CH 58
Spinal Cord Injury Spinal cord caries both motor and sensory
nerves that branch to send messages between the brain and specific
areas of the body Injury to the spinal cord which causes paralysis
and loss of sensation in nerve cells 450,000 people in USA spinal
cord injury (SCI) 100,000 new cases each year 16-30yrs of age most
common
Slide 5
Spinal Cord Injuries Etiology 50% motorcycle/automobile
accidents 25% occupational accidents 20% sports related 5% falls or
violence
Spinal Cord Injury Sensor motor effects 1. Complete lesion: no
sensation or motor function below the level of the lesion 2.
Incomplete lesion: Partial injury to the spinal cord. Leaves some
evidence of sensation or motor function below the level of the
lesion Some function may return within a few hours after injury Max
return = 6-18 months Most severe = lesion levels above C6
Slide 9
Spinal Cord Injuries Characteristics Paraplegia: damage to
thoracic, lumbar or sacral vertebrae Quadriplegia: cervical
vertebrae involved Oral Considerations Loss of function will affect
daily oral hygiene Paralysis of face will affect mastication
Wheelchair transfers will be necessary in dental office Shunt =
premed Muscle spasms Meds w/ oral side effects Short morning appts
recommended Home Fl, antimicrobial mouthwash
Slide 10
Slide 11
Spinal Cord Injuries Secondary Complications (Wilkins p.889)
Tendency for pressure sores (decubitus ulcer) Muscle-reflex
spasticity Vulnerability to infection Cardiovascular instability
Bladder and bowel complications
Slide 12
Slide 13
Slide 14
3. Spinal Cord Injuries InjuryFunctional Level C-1,2,3None need
ventilator. Loss of diaphragm function C-4,5,6,7Partial shoulders,
arms, hands ALL CERVICAL INJURIES Quadriplegia All need personal
care, Wheelchair transfers Unable to regulate body temp at times
Unable to elicit a function cough respiratory issues Horners
syndrome: drooping eyelids, constrict pupils, sweating 1 side of
face
Slide 15
3. Spinal Cord Injuries InjuryEffects T1-T4Paralysis of legs,
trunk. Loss sensation below nipples Normal movement of
shoulders/elbows T5-T11Paraplegic L1-S2Various patterns of leg
weakness and numbness Depending on level of injury, no feeling to
sexual organs S3-S5Numbness in the pelvis & legs Some cases
sexual organs are not harmed but many times are affected Any level
spinal cord injury can cause loss of bladder & bowel
control!!
Slide 16
Spinal Cord Injuries Special Patient Dental Tx Considerations
Thorough med hx Restraints as needed for involuntary muscle control
Short morning appts Diet counseling OHI: pt and caregiver
Wheelchair adaptations Pt positioning for stabilization and easy
access (mouth props) Consider special aids for daily care and for
dental tx Caring, sincere attitude by clinician showing concern for
pt
Slide 17
Question Which of the following patients is most likely to
require a 2- man transfer technique from wheelchair to dental
chair? A. 10-yr old with cerebral palsy B. 25-yr old man with
spinal cord injury at C6 C. 30-yr old man with mild multiple
sclerosis D. 65-yr old man with arthritis in his hands
Slide 18
Answer B. 25-yr old man with spinal cord injury at C6
Slide 19
Definition: life-threatening emergency condition in which the
blood pressure increases sharply (Ex: 300/160mmHg) Reflex action:
pulse rate will drop Symptoms: pounding headache, flushing, chills,
perspiration, stuffy nose Prevention Avoid abrupt changes in body
position Semi-supine Emergency care: position chair upright
gradually, do NOT recline the chair, Monitor BP & call EMS if
BP does not drop within 2-3min Spinal Cord Injury Autonomic
Dysreflexia
Slide 20
NB Question A client with a spinal cord injury at the level of
C- 6 would be a quadriplegic. Power scaling devices are
CONTRAINDICATED for clients with paralysis. a. The first statement
is TRUE; the second is FALSE b. The first statement is FALSE; the
second is TRUE c. Both statements are TRUE d. Both statements are
FALSE
Slide 21
NB Answer A client with a spinal cord injury at the level of C-
6 would be a quadriplegic. Power scaling devices are
CONTRAINDICATED for clients with paralysis. a. The first statement
is TRUE; the second is FALSE b. The first statement is FALSE; the
second is TRUE c. Both statements are TRUE d. Both statements are
FALSE
Slide 22
2. CVA (Stroke)
Slide 23
Cerebrovascular Accident (CVA)/Stroke Sudden loss of brain
function Clinical manifestation of cerebrovascular disease Patient
has changes in motor function, communication, perception Hemiplegia
or hemiparesis common Death can occur within minutes
Slide 24
Etiologic Factors for Stroke 1. Thrombosis Clot within a blood
vessel of the brain or neck Clot closes the vessel and shuts off
the oxygen supply Results in cerebral infarction Cerebral
thrombosis is the most common cause of stroke (NBQ) 2.
Intracerebral embolism Blood vessel is blocked by a clot
Atherosclerotic plaque buildup can become an embolism and risk of
stroke Dental panoramic film Calcifications in the carotid artery
may be observable Indicate an risk of stroke Contd next slide
Slide 25
Etiologic Factors for Stroke 3. Ischemia Blood flow to an area
of the brain 4. Cerebral hemorrhage May rupture and bleed into
brain 5. Predisposing factors Atherosclerosis & Hypertension:
greatest risk factor that leads to stroke Hypercholesterolemia,
hypertriglyceridemia Tobacco, drug abuse Cardiovascular disease
Diabetes mellitus Use of oral contraceptives (enhanced by
hypertension, tobacco use, age over 35, and high estrogen levels)
Contd next slide
Slide 26
Transient ischemic attack (TIA) Mini-stroke or Little stroke
Last few min to an hour May leave no permanent damage Risk factor
for a full stroke CVA S&S
Slide 27
Lungs Breathing labored, deep, slow Vertigo, chills Paralysis 1
side body Speech defects Loss of consciousnessWilkins p.1077
Slide 28
CVA S&S Effects depend on the location of the damage to the
brain Side of body affected is opposite that of the brain injury
Ex: Left CVA = RT hemiplegia and vice versa RT hemiplegia:
difficult verbal communication and are more apt to be cautious,
anxious, and disorganized LF hemiplegia: difficulty with action
requiring physical coordination and may respond impulsively with
overconfidence 2/3 who survive= some degree of permanent
disability
Slide 29
Slide 30
CVA Assessment Considerations Unilateral/bilateral loss of
function HBP, diabetes, coronary disease increase risk Difficulty
in communication Wilkins p.892, box 58-3 for common meds Poor oral
hygiene & challenged with home care Increased caries, perio Do
NOT tx for 6mo following stroke
Slide 31
NB Question Elective dental treatment should be postponed until
___ months after a stroke. a. 1 b. 2 c. 4 d. 6
Slide 32
NB Answer Elective dental treatment should be postponed until
___ months after a stroke. a. 1 b. 2 c. 4 d. 6
Slide 33
NB Question A sudden loss of brain functioning resulting from
an interference of blood supply to the brain best describes: a.
Alzheimers disease b. Stroke c. Myocardial infarction d.
Ventricular septal defect
Slide 34
NB Answer A sudden loss of brain functioning resulting from an
interference of blood supply to the brain best describes: a.
Alzheimers disease b. Stroke c. Myocardial infarction d.
Ventricular septal defect
Slide 35
NB Question A client presents with the following
characteristics: paralysis on the left side of the body,
personality change to a more abrupt manner, vocabulary problems,
and a decrease in auditory memory. What is the most likely cause of
these symptoms? a. Myasthenia gravis b. Multiple sclerosis c. Right
cerebrovascular accident d. Parkinsons disease
Slide 36
NB Answer A client presents with the following characteristics:
paralysis on the left side of the body, personality change to a
more abrupt manner, vocabulary problems, and a decrease in auditory
memory. What is the most likely cause of these symptoms? a.
Myasthenia gravis b. Multiple sclerosis c. Right cerebrovascular
accident d. Parkinsons disease
Slide 37
3. Bells Palsy
Slide 38
Bells Palsy Idiopathic, unilateral facial muscle paralysis
Etiology unknown May be assoc w/viral infections or damage to the
nerve oHerpes simplex, herpes zoster, cytomegalovirus oDamage to
nerve or parotid gland surgery Affects 7 th cranial nerve (Facial)
Unilateral Eyelids will not close, pre-disoposes to eye infections
Recovery: 3 weeks-6mo or not at all Tx: no cure Seen positive
results with use corticosteroids + antivirals given w/in first 72
hours Surgery to repair damage
Slide 39
Bell s Palsy Characteristics Abrupt weakness or paralysis of
facial muscles, usually w/out pain Mouth: corner droops =
salivation, drooling is uncontrollable Eyelids may not close Speech
and mastication may be impaired
Slide 40
Bells Palsy Tx plan modifications Lack of eye closure Need eye
and airway protection Excessive salivation/drooling Emphasize
personal home care on afflicted side
Slide 41
Review Bell s palsy is paralysis of which cranial nerve? A)
Fourth B) Fifth C) Sixth D) Seventh E) Eighth
Slide 42
Answer D) Seventh is the correct answer. Bell s palsy is
paralysis of the facial muscles innervated by the seventh, or
facial, cranial nerve.
Slide 43
NB Question Each of the following conditions is associated with
paralysis EXCEPT one. Which one is the EXCEPTION? a. Bells palsy b.
Graves disease c. Stroke d. Spinal cord compression
Slide 44
NB Answer Each of the following conditions is associated with
paralysis EXCEPT one. Which one is the EXCEPTION? a. Bells palsy b.
Graves disease c. Stroke d. Spinal cord compression
Slide 45
4. MS
Slide 46
Multiple Sclerosis (MS) Chronic degenerative disease of the
myelin sheath within the white matter of the CNS and becomes
sclerotic Myelin is the fatty tissue around the nerve fibers
Results in interference with the transmission of nerve impulses and
frequent involvement of the spinal cord and optic nerves Women more
than men Caucasians more common Average onset is 30 Normal life
span 80% have functional limitations after 15 years Periods of
remission
Slide 47
Slide 48
Multiple Sclerosis Characteristics Unilateral facial numbness
or pain Paralysis in 1+ extremities Balance abnormalities
Disruptions in thinking/behavior & speech (dysarthria)
Nystagmus: involuntary eye motions & diplopia Susceptibility to
infections Oral Characteristics Swallowing problems (dysphagia)
Facial muscle weakness Increased susceptibility to dental
disease
Slide 49
Slide 50
MS Diagnosis/Treatment Early tx w/in 6mo of onset is crucial to
deter neurologic damage TX Goal= prevent relapses & worsening
symptoms Palliative tx to manage symptoms, improve function, and
safety Psychological support Meds: Wilkins p.894, Box 58-4
Slide 51
MS Dental Treatment General hygiene care Adequate nutrition
Avoidance of strain & stress Prevention of infections &
injury Medication side effects Wheelchair & catheters common
towards end of life
Slide 52
NBQ: Which of the following disorders is characterized by
periods of active symptoms, then remission when toxins that damage
nerve fibers and replace the myelin sheath with sclerotic tissues?
a. Muscular dystrophy b. Multiple sclerosis c. Myasthenia gravis d.
Parkinsons disease
Slide 53
Which of the following disorders is characterized by periods of
active symptoms, then remission when toxins that damage nerve
fibers and replace the myelin sheath with sclerotic tissues? a.
Muscular dystrophy b. Multiple sclerosis c. Myasthenia gravis d.
Parkinsons disease A: muscle disease B: when myelin sheath of
nerves is destroyed and replaced by sclerotic tissue C: weakness of
voluntary muscles such as facial expression, chewing, swallowing D:
chronic neurological disorder that affects substania nigra neurons
of the brain
Slide 54
NB Question MS patients have the following symptoms except: A.
Vision problems B. Enamel hypoplasia c. Balance abnormalities D.
Urinary tract problems
Slide 55
Answer B. Enamel hypoplasia
Slide 56
NB Question A genetically linked, chronic, demyelinating
disease of the central nervous system best describes: a. Multiple
sclerosis b. Cerebral palsy c. Graves disease d. Epilepsy
Slide 57
NB Answer A genetically linked, chronic, demyelinating disease
of the central nervous system best describes: a. Multiple sclerosis
b. Cerebral palsy c. Graves disease d. Epilepsy
Slide 58
We make a living by what we get; we make a life by what we
give. Sir Winston Churchill
Slide 59
5. ALS (Amyotrophic Lateral Sclerosis)
Slide 60
Stephen Hawking http://www.youtube.com/watch?v=pjYrkI_mL4E
http://www.youtube.com/watch?v=7mc5z4LIsqE
http://www.youtube.com/watch?v=pjYrkI_mL4E
Slide 61
Amyotrophic Lateral Sclerosis Also called Lou Gehrigs Disease
Progressive neurodegenerative disorder characterized by loss of
motor neurons Men more than women Caucasians more common Onset:
middle age or later 5% of cases prior to age 30 Average life
expectancy is 35 years, but range is broad and some live much
longer Respiratory failure most common cause of death
Slide 62
Amyotrophic Lateral Sclerosis Diagnosis No diagnostic tests for
ALS Diagnosis is usually made after ruling out other disorders with
similar symptoms Clinically diagnosed with both upper and lower
neuron dysfunction w/no periods of remission Etiology unknown 5-10%
genetic (autosomal dominant)
Slide 63
ALS Symptoms Cramps and spasticity Weakness in extremities
Muscle wasting Increasing respiratory difficulty Difficulty
swallowing (dysphagia) and chewing Facial weakness
Spasticity/wasting of tongue Sialorrhea (excessive saliva)
Slide 64
ALS Treatment Only FDA-approved treatment: Rilusole Only
extends life by 2mo Palliative tx Sialorrhea managed with
medications (Atropine) Later stages Radiation Botox injections
every 3mo
Parkinsons Slow progressive degeneration of certain neurons in
the substantia nigra of the basal ganglion - leads to lack of
dopamine (hormone that helps control nerve transmissions) Results
in loss of control of voluntary muscles, loss of postural
stability, slowness of spontaneous movement, resting tremor, and
muscular rigidity After age 50, more men then women (2:1) Etiology:
not known
Slide 67
Slide 68
Parkinsons Characteristics Muscle rigidity, stiffness Akinesia:
impairment of motor function Slow involuntary tremors Festinating
gait: bradykinesia Slurred speech Stooped posture & postural
instability Fingers may be involved in a pill-rolling motion
Systemic: variations in blood pressure, cardiac dysrhythmias,
excessive sweating, bowl and bladder dysfunction, and sleep
disorder Intellect is seldom affected except in the advanced stages
= dementia Oral Characteristics Excessive salivation, drooling
w/difficulty swallowing Face blank, staring, expressionless &
unblinking eyes Tremors of facials muscles
Slide 69
Parkinsons Dental Tx Modifications Modified home care
instructions and aids Directly face the patient when communicating
Appt 2-3 hours after taking meds Antimicrobial mouth rinse &
home fluoride
Slide 70
Parkinson s Treatment Diet Physical therapy Drugs to replenish
dopamine shortage (Levodopa) Surgery: brain
Slide 71
NB Question Which of the clients conditions is a degenerative
disorder of the central nervous system that often impairs motor
skills, speech, and postural stability? a. Gastroesophageal reflux
disease (GERD) b. Hyperlipidemia c. Parkinsons disease d.
Hypertension
Slide 72
NB Answer Which of the clients conditions is a degenerative
disorder of the central nervous system that often impairs motor
skills, speech, and postural stability? a. Gastroesophageal reflux
disease (GERD) b. Hyperlipidemia c. Parkinsons disease d.
Hypertension
Slide 73
7. Myasthenia Gravis
Slide 74
Myasthenia Gravis Autoimmune neuromuscular disease Weakness,
fatigability of symmetric voluntary muscles Causes defect in nerve
transmission at neuromuscular junctions # ACH (acetylcholine)
receptors in each junction is reduced Women more than men
Slide 75
Slide 76
Myasthenia Gravis Characteristics Lack of facial expression
(distress difficult to see) Eyes Diplopia: double vision Ptosis:
drooping eyelids Eye muscle weakness Dysphagia Weakened voice
Patient may support the chin with one hand to help during talking
Muscles of respiration involved = breathing crisis
Myasthenia Gravis & Types of Crisis Myasthenic crisis
Results from under medication or increased severity of the disease
Deficiency of ACH leads to the crisis symptoms & can be
alleviated by anticholinesterase med Inability to maintain an
airway Emergency care 1. Suction 2. Provide a patent airway 3.
Transport to ER
Slide 79
Myasthenia Gravis & Crisis Cholinergic crisis Caused by
overmedication with ACH Muscle weakness w/in 30-60min after meds
taken Tx 1. Stop meds 2. EMS immediately 3. Respiratory symptoms
develop = ventilation urgent
Slide 80
Myasthenia Gravis: Tx 2 purposes 1. Influence the course of the
disease 2. Induce remission Meds Anticholinesterase agents
Corticosteroids Azathioprine (immunosuppressive) Cyclosporine
(immunosuppressive)
Slide 81
8. Cerebral Palsy
Slide 82
Cerebral Palsy (CP) Disorder of movement and posture resulting
from a non- progressive defect of the immature brain Not contagious
4 types Etiology: injury to the brain NBQ Prenatal: anoxia, uterine
bleeding, infections (rubella), blood type incompatibility, lack
nutrition, gestational diabetes Postnatal: carbon monoxide
poisoning, lead poisoning, trauma from accidents or battering,
cerebral hemorrhages, infections (encephalitis, meningitis)
Slide 83
Cerebral Palsy Classifications 1. Spastic palsy 2. Dyskinetic
or athetoid palsy 3. Ataxic palsy 4. Combined palsy: combo of the 3
SEE WILKINS P.898 KNOW DIFFERENCES BETWEEN THE TYPES
Slide 84
Cerebral Palsy Characteristics Motor disability Exaggerated
contractions, inability to use arms/leg (Oral hygiene an issue)
Deafness common Intellect affects in 50% of patients Seizures
common Oral Characteristics Impaired speech (dysarthria), chewing,
swallowing Muscles of mastication abnormal functioning Mouth
breathing, tongue thrust = Open bite, protruded ant teeth Bruxism =
attrition GERD = erosion Caries, perio Poor head control
Slide 85
Slide 86
Slide 87
Which of the following infectious diseases is a common
postnatal cause of cerebral palsy? a. Rubella b. Mumps c.
Encephalitis d. Herpes zoster NB Question
Slide 88
Which of the following infectious diseases is a common
postnatal cause of cerebral palsy? a. Rubella b. Mumps c.
Encephalitis d. Herpes zoster NB Answer
Slide 89
Cerebral Palsy Treatment Surgical, orthopedic, speech, physical
therapy Bracing to support the lower limbs and the use of cane,
crutches, walker, or wheelchair Meds: seizure control meds can
cause gingival hyperplasia NO CURE
Slide 90
NB Question Which of the following is a common oral finding in
persons with cerebral palsy? a. High incidence of bruxism b. Class
1 occlusion c. Decreased gag reflex d. Low incidence of
periodontitis
Slide 91
NB Question Which of the following is a common oral finding in
persons with cerebral palsy? a. High incidence of bruxism b. Class
1 occlusion c. Decreased gag reflex d. Low incidence of
periodontitis
Slide 92
NB Question Which disease is a non-progressive disorder of
posture and movement resulting from a lesion on the brain? A.
Multiple Sclerosis B. Downs Syndrome C. Cerebral Palsy D.
Myasthenia Gravis
Slide 93
NB Answer Which disease is a non-progressive disorder of
posture and movement resulting from a lesion on the brain? A.
Multiple Sclerosis B. Downs Syndrome C. Cerebral Palsy D.
Myasthenia Gravis
Slide 94
NB Question All of the following oral conditions are common in
clients with cerebral palsy EXCEPT one. Which one is this
EXCEPTION? a. Open bite b. Facial asymmetry c. Nerve paralysis d.
Swallowing problems
Slide 95
NB Answer All of the following oral conditions are common in
clients with cerebral palsy EXCEPT one. Which one is this
EXCEPTION? a. Open bite b. Facial asymmetry c. Nerve paralysis d.
Swallowing problems
Slide 96
9. Spina Bifida
Slide 97
Spina Bifida (Myelomeningocele) Congenital defect or opening in
the spinal column When spinal cord protrudes through spina bifida =
myelomeningocele Folic acid prior to pregnancy can help prevent
Patients risk for latex allergy
Slide 98
Slide 99
Spina Bifida Embryo Neural tube forms during 1 st mo of
pregnancy Neural tube = brain, brainstem, spinal cord arise When a
place in the spinal column fails to close, the result is an open
defect in the spinal canal (spina bifida)
Slide 100
Spina Bifida Types 1. Myelomeningocele Protrusion or
outpouching of the spinal cord and its covering (meninges) through
an opening in the bony spinal column Paralysis of legs, trunk 2.
Meningocele Protrusion of the meninges through a defect in the
skull or spinal column Paralysis is uncommon 3. Spina bifida
Occulta Congenital cleft in the bony encasement of the spinal cord
when no out-pouching of the meninges or spinal cord exists
Asymptomatic
Slide 101
Slide 102
Slide 103
Review A protrusion of the meninges through a defect in the
skull or spinal column is called: A) meningocele B) spina bifida C)
myelomeningocele D) occulta
Slide 104
Review A protrusion of the meninges through a defect in the
skull or spinal column is called: A) meningocele B) spina bifida C)
myelomeningocele D) occulta
Slide 105
Spina Bifida Characteristics Bony deformities Club foot Spinal
curvatures: humpback (kyphosis), curvature (scoliosis), or swayback
(lordosis) Loss of sensation to pain, temp Bladder, bowel paralysis
Hydrocephalus: excessive accumulation of fluid in the brain which
dilates ventricles & compresses brain tissues Seizures
common
Spina Bifida & Dental Care Impaired motor ability Need for
body stabilization and support May need premed Increased risk for
latex allergy
Slide 109
10. Seizure Wilkins CH62
Slide 110
Seizures Sudden paroxysmal electrical discharge of neurons in
the brain Results from a transient, uncontrolled alteration in
brain function Unprovoked, unpredictable, involuntary Abrupt onset
May or may not cause loss of consciousness Also called convulsion
fit spell ictus Seizure
Slide 111
Seizures Epileptic syndromes are complex Diagnosis based on:
Clinical S&S, Hx, EEG, Functional neuroimaging Classification
1. Age-related onset 2. Symptoms 3. Anatomic localization in the
brain (temporal, frontal, parietal, occipital lobes) Epileptic
Syndrome
Slide 112
Seizure Types 1. Generalized: affects the entire brain at the
same time 1) Absence (petite mal) seizure 2) Tonic-clonic (grand
mal) seizure 2. Partial: A seizure of focal origin that involves
only a part of the brain is called a partial seizure 1) Simple 2)
Complex
Slide 113
The Seizure 1. Generalized 1) Absence (petite mal) seizure Loss
of consciousness Lasts 5-30 seconds Most common in children Patient
has blank stare, usually does not fall, posture becomes fixed, may
drop whatever is being held Patient quickly returns to full
awareness, resumes activities, unaware of what occurred 2)
Tonic-clonic (grand mal) seizure (next slide) Seizure Types
Slide 114
The Seizure 1. Generalized 2) Tonic-clonic (grand mal) seizure
Muscles of the chest and pharynx contract at the same time, forcing
air out and a sound known as the epileptic cry Loss of
consciousness is sudden and complete Patient becomes stiff and
falls or may slide out of the dental chair Musculature contraction
oTonic phase: tension with rigidity oClonic phase: movements follow
w/intermittent muscular contraction & relaxation Tongue may be
bitten Lasts 1-3 minutes then respiration returns Saliva: may
become mixed w/ air & appear as foam Patient begins to recover,
may be confused, tired, complain of muscle soreness or injury;
falls into a deep sleep Phases of seizure may be called preictal,
ictal, and postictal Seizure Types
Slide 115
Seizure
Slide 116
The Seizure 2. Partial: (more common in adults) 1) Simple
Staring spell Dizziness Jerking of muscles around the mouth No loss
of consciousness 2) Complex Trance-like state with confusion Lasts
few min to hours Does not remember the attack Seizure Types
(contd)
Slide 117
You Tube Seizure
http://www.youtube.com/watch?v=Nds2U4CzvC4
Slide 118
Seizure Types Status epilepticus (SE) One or more seizures
lasting longer than 30min Brain injury may occur Life-threatening
MEDICAL EMERGENCY Seizure lasting more than 5min = seizure unlikely
to self- terminate & considered to progress to SE
Slide 119
Etiology Etiology: divided into primary & secondary 1.
Primary (idiopathic): genetics, neurologic abnormalities 2.
Secondary (symptomatic) oMaternal infection (rubella) oPerinatal
injuries oBrain tumor, stroke, head injury oInfections: meningitis,
encephalitis, opportunistic infections of AIDS oMetabolic &
toxic disorders (alcohol, drugs) Seizure
Slide 120
NB Question The type of seizure where consciousness begins and
ends abruptly in 5 to 30 seconds followed by a quick resuming of
activities describes: a. Simple seizure b. Tonic clonic (grand mal)
seizure c. Absence (petite mal) seizure d. Complex-focal
seizure
Slide 121
NB Answer The type of seizure where consciousness begins and
ends abruptly in 5 to 30 seconds followed by a quick resuming of
activities describes: a. Simple seizure b. Tonic clonic (grand mal)
seizure c. Absence (petite mal) seizure d. Complex-focal
seizure
Slide 122
Clinical Manifestations Can be induced by flashing lights
(dental light), odors (dentistry) Aura (warning) May be a sensation
of numbness, tingling, twitching or stiffness of certain muscles
Some do NOT have Ask patient about Seizure
Slide 123
Treatment Medications (Antiepileptic drugs) Table 62-1, p.944
(meds to know are on next slide) Many side effects: gingival
enlargement Phenytoin (Dilantin) most common Causes fibroblasts and
osteoblasts to deposit excessive extracellular matrix Ant gingiva
& maxillary teeth most affected More facial & interprox
than lingual Effects: biofilm control problem, affect mastication,
alter tooth eruption, interfere with speech, esthetic concerns
Advanced lesion: tissue covers a large portion of the anatomic
crown Tx 1. Nonsurgical tx with 1-3mo RC 2. Cessation of drug 3.
Surgery Seizure
Slide 124
Wilkins p.944, Table 62-1 Drugs most commonly used for both Gen
& Partial Seizures 1) phenytoin (Dilantin) 2) carbamazepine
(Tegretol, Carbatrol) 3) valproic acid (Depakene) 4) levetiracetam
(Keppra) 5) topiramate (Topomax) Drugs most commonly use for
Partial Seizures 1) gabapentin (Neurontin) 2) lamotrigine
(Lamictal) Drugs most commonly use for Status Epilepticus 1)
lorazepam(Ativan) 2) phenytoin (Dilantin) First name = Generic name
(official name of the drug) Second name = Trade name (mult
companies may manufacturer the drug and will call it different
names)
Slide 125
(Source: Reprinted with permission from Langlais RP, Miller CS.
Color atlas of common oral diseases. 3 rd ed. Philadelphia:
Lippincott Williams & Wilkins; 2003. Section 5, Intraoral
findings by color changes; 81 p.)
Slide 126
Surgical Tx of the brain Vagus nerve stimulation:
pacemaker-like device is implanted in the upper left chest and
delivers an intermittent signal to the vagus nerve (dental
considerations) Ketogenic diet: to induce fat metabolism and
maintain ketosis, used primarily in kids Seizure TX
Slide 127
Slide 128
Review What type of diet may be recommended for patients with
epilepsy? A) Ketogenic B) Low calorie C) Vegetarian D)
Macrobiotic
Slide 129
Review What type of diet may be recommended for patients with
epilepsy? A) Ketogenic B) Low calorie C) Vegetarian D)
Macrobiotic
Slide 130
Seizure Dental Considerations Effects of accidents during
seizures: Scars of lips, tongue, oral cavity may note in EIOE exam,
Fractured teeth Patient positioning: supine in chair Do not place
tongue blade between teeth Watch for warning signs of AURA BLS
Postictal phase Document incident Reassure patient Check oral
cavity Contact family emergency contact
Slide 131
Seizure Dental Considerations MD Consult Questions Has seizure
activity increased or changed Does dental treatment impact epilepsy
condition A well-controlled patient with epilepsy may still have a
seizure When seizure-prone, a person is advised to wear the Medical
Alert jewelry Information to obtain from patients MD name, #,
emergency contact person Age of onset of seizures Precipitating
factors Frequency of seizures Date of last seizure & type Date
of last medical examination Recent illness, stress, alcohol,
menstrual cycle, fatigue, pain Tx: meds, surgery, diet, herbs
Slide 132
Review The emergency medical system should be activated if the
seizure is still occurring or has reoccurred within: a. 5 minutes
b. 30 minutes c. 1 hour d. Emergency medical systems should be
activated immediately for all seizures
Slide 133
Review The emergency medical system should be activated if the
seizure is still occurring or has reoccurred within: a. 5 minutes
b. 30 minutes c. 1 hour d. Emergency medical systems should be
activated immediately for all seizures
Slide 134
Board Question When taking a medical history about a seizure
disorder, all the following are critical questions EXCEPT one.
Which is the exception? a. What medications are you taking and did
you take them today? b. Did you bring your medications to this
appointment? c. What behaviors do you exhibit during a seizure? d.
How long do the seizures last? e. Do you know when youre going to
have a seizure, ie: aura or sensations?
Slide 135
Board Answer When taking a medical history about a seizure
disorder, all the following are critical questions EXCEPT one.
Which is the exception? a. What medications are you taking and did
you take them today? b. Did you bring your medications to this
appointment? c. What behaviors do you exhibit during a seizure? d.
How long do the seizures last? e. Do you know when youre going to
have a seizure, ie: aura or sensations?