Dental Care of Epileptics

Westphal, Peter

doi:10.1111/j.1528-1157.1972.tb04573.x

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…It is a general impression that patients with epilepsy tend to have poorer oral health and receive less adequate dental treatment in comparison with the general (nonepilepsy) population (1–4). We have set out to take a survey of oral health and dental status of patients with epilepsy in comparison with the nonepilepsy population.…”

Section: Classification Of Epilepsy Patients According To Dental Riskmentioning

confidence: 99%

Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study

et al. 2003

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Summary: Purpose: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients. Methods: We first set up four “dental” subgroups of epilepsy patients, based on the types of seizures, seizure frequency, and mental state. One hundred one patients underwent a survey concerning their dental, medical, and epilepsy histories, followed by a dental examination. Indexes quantifying oral hygiene, the number and condition of the remaining teeth, periodontium, and the degree of prosthetic treatment were measured. An age‐matched control group of general (nonepilepsy) population underwent an identical dental examination. Statistical comparison was performed between the patient and the control groups and between subgroups of epilepsy patients. Results: In almost all aspects of oral health and dental status, patients with epilepsy showed a significantly worse condition compared with the control group. Comparison of the subgroups of epilepsy patients revealed that the most severe findings concern patients who have poorly controlled epilepsy, especially those who have frequent generalized tonic–clonic seizures. Conclusions: The observed difference probably results from a combination of factors such as the effect of the seizures themselves, socioeconomic conditions, and the negative attitude of dentists. We recommend that the planning of dental treatment of such patients should start with the assessment of their disease and determination of the “dental” subgroup to which they belong. For each subgroup, specific recommendations for interventions are given.

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Section: Classification Of Epilepsy Patients According To Dental Riskmentioning

confidence: 99%

Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study

et al. 2003

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“…We have compared cultured normal and responder human gingival fibroblasts but did not include gingival fibroblasts taken from a region not demonstrating clinical overgrowth in responder patients. The gingival overgrowth enhances the accumulation of more irritants (plaque), with an accompanying increase of pocket depth and gingival inflammation which often complicates gingival enlargement caused by phenytoin in vivo (Westphal 1972). Furthermore, the gingival overgrowth may be due to a multiplicity of interactions in vivo.…”

Section: Discussionmentioning

confidence: 99%

The effects of phenytoin (5, 5‐diphenylhydantoin) on human gingival fibroblasts in culture

Vernillo

Schwartz

1987

J of Periodontal Research

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Macromolecular biosynthesis in monolayer cultures of normal and responder human gingival fibroblasts derived from tissue explants was evaluated in the presence or absence of phenytoin (5μg/ml) from the 5th to the 8th day after plating and a labeling period with 14C‐proline (0.2 μCi/ml) for the last 48 hours. Collagenase digestion and hydroxyproline determinations indicated an increase in collagen product. At least part of the increase may have been due to a drug‐modulated decrease in collagen degradation. Phenytoin (PHT) also stimulated synthesis of glycosaminoglycan as indicated by an approximately 2‐fold increase in sulfate‐labeled product. Ultrastructural examination revealed a pronounced change in the protein synthetic apparatus of PHT‐treated cells. Tritiated phenytoin bound to fibroblasts and appeared to undergo internalization as indicated by trypsin treatment.

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“…Also, there is evidence to support plaque control program as a palliative measure (17,46). However, gingival overgrowth itself distorts the gingival contour that impedes plaque removal and exacerbates inflammation creating a vicious cycle (47). When starting PHT therapy, instructions should include intra-sulcular method of brushing and inter-dental cleansing (17,47).…”

Section: Plaque Controlmentioning

confidence: 99%

“…However, gingival overgrowth itself distorts the gingival contour that impedes plaque removal and exacerbates inflammation creating a vicious cycle (47). When starting PHT therapy, instructions should include intra-sulcular method of brushing and inter-dental cleansing (17,47). Chlorhexidine mouth rinse was found to have some value in preventing PIGO in post-operative patients (48), however, a chlorhexidine toothpaste was not useful for therapeutic purpose (49).…”

Section: Plaque Controlmentioning

confidence: 99%

Phenytoin-induced gingival overgrowth

Arya

Gulati

2011

Acta Neurologica Scandinavica

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Gingival overgrowth is a common adverse effect of therapy with Phenytoin, having important medical and cosmetic implications. Poor periodontal hygiene is an important risk factor for severity of Phenytoin-induced gingival overgrowth (PIGO), which is a time-dependent process. There is complex interplay of altered fibroblast biology, connective tissue turnover, inflammatory processes, and growth factors on a background of genetic susceptibility to produce increase in various components of interstitial matrix in PIGO tissue. Treatment options have included change of PHT to another anti-seizure drug, measures to improve periodontal hygiene and gingivectomy. There is conclusive evidence that folic acid supplementation significantly decreases the incidence of PIGO.

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Dental Care of Epileptics

Cited by 8 publications

References 4 publications

Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study

Dental Status and Oral Health of Patients with Epilepsy: An Epidemiologic Study

The effects of phenytoin (5, 5‐diphenylhydantoin) on human gingival fibroblasts in culture

Phenytoin-induced gingival overgrowth

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