Airway compromise and aspiration (inhalation of foreign material) are possible. Supplemental oxygen should be administered. Parenteral benzodiazepines such as diazepam or midazolam are the first-line medications for this emergency. Administered intravenously, these drugs are minor tranquilizers (sedatives) that prevent or stop seizures by slowing down the central nervous system, thereby making abnormal electrical activity less likely (Trinka & Leitinger, 2022).
at an abnormally rapid rate), and the blood pressure can significantly rise. The clonic phase occurs next and is a rhythmic jerking, lasting a minute or longer. The patient may lose bladder or bowel control. The postictal phase follows and is characterized by severe fatigue for several hours or longer. The most severe type of seizure is called status epilepticus . A person experiencing status epilepticus has a seizure lasting 5 minutes or longer or fails to regain consciousness between seizures. Status epilepticus is a serious emergency. Dental treatment implications The dental management of the patient with seizure disorder begins with an understanding of the type, severity, and history of the patient’s seizure activity. It is important to know how frequently the patient experiences a seizure, the patient’s typical seizure triggers (such as bright lights), how the patient feels after a seizure, and if there are any prodromal indications that a seizure is imminent. As a precaution, patients should be scheduled at least one hour after seizure medications have been taken. Oral health providers should be aware of the many types of antiseizure medications and their possible adverse side effects. (See Table 7.) Several actions need to be considered if a seizure occurs in the dental chair. First, cease all treatment activity and remove sharp instruments from the mouth. Remove the rubber dam if it has been placed. Lower the dental chair as close as possible to the floor. Roll the patient to one side to prevent aspiration. Though it seems counterintuitive, do not place a bite block in the patient’s mouth. During the postictal phase, the patient may be unarousable for a considerable amount of time. The clinical protocol is to: ● Administer oxygen. ● Suction to manage secretions. ● Call caregivers to assist in patient management. Patients with seizure disorder have many rehabilitative dental options. Removable appliances offer minimal chance of airway obstruction. Partial denture design can incorporate additional retentive elements. The key to successfully treating the patient with seizure disorder is to understand the type of seizure they typically have, prepare dental staff for a potential seizure episode, and be ready to contact emergency services if needed.
Table 7: Seizure Medication or Treatment and their Effects Generic Name Trade Name Adverse Effects Phenytoin Dilantin • Gingival hyperplasia
• Hypotension • Bradycardia
Valproic acid
Depakene Depakote
• Periodontal abscess • Dysgeusia • Thrombocytopenia • Agranulocytosis • Aplastic anemia • Xerostomia • Delayed healing • Thrombocytopenia
Carbamazepine Tegretol Epitol
Clonazepam
Klonopin • Drowsiness • Ataxia
Ethosuximide
Zarontin
• Leukopenia • Stevens-Johnson syndrome • Orofacial edema • Dysgeusia • Aplastic anemia • Xerostomia • Stomatitis • Orofacial edema • Xerostomia • Stomatitis • Gingivitis • Orofacial edema • Dysgeusia • Problems associated with surgery • Voice change; hoarseness; cough; difficulty swallowing
Felbamate
Felbatol
Gabapentin
Neurontin Gralise
Vagus nerve stimulator (approved by the FDA in 1977; similar in size, shape, and location to a pacemaker; connects to left vagus nerve; preset electrical intervals; effectiveness rate: 50%)
(Epilepsy Foundation, 2023) Note . Adapted from Jeske, A. H. (2018). Mosby’s dental drug reference (12th ed.). Elsevier.
AUTISM SPECTRUM DISORDERS
social isolation. Since then, the taxonomy of autism has developed into the umbrella term autism spectrum disorder , which describes a range of signs and symptoms. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) grouped the previously distinct diagnoses of autism, Asperger’s syndrome, childhood disintegrative disorder, and pervasive developmental disorder into this
Although the term autism had been used since before World War I, its employment for the constellation of symptoms by which we define the disorder today dates back to a 1943 paper written by Leo Kanner of Johns Hopkins University (Feinstein, 2021). Dr. Kanner recognized several common features in his patients, including slowly developed learning skills, speech difficulties, lack of eye contact, and
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