Table 3.57.

Key considerations for dental management in epilepsy (see text)

	Management modifications*	Comments/possible complications
Risk assessment	2	Risk of epileptic attack
Appropriate dental care	2/4	Better in ‘good phases'; avoid precipitating factors; behaviour control; use a mouth prop; management of status epilepticus
Pain and anxiety control
– Local anaesthesia	1	Limit lidocaine dose; avoid electronic dental analgesia
– Conscious sedation	3/4	Avoid midazolam and nitrous oxide
– General anaesthesia	3/4	May enhance the toxic effects of anticonvulsants
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	Determine when seizures usually occur
– Patient positioning	0
Treatment modification
– Preventive dentistry	1	Frequent plaque removal and chlorhexidine are recommended
– Oral surgery	1/4
– Implantology	1/4/5
– Conservative/Endodontics	1/4/5
– Fixed prosthetics	1/4	Increase metal structure
– Removable prosthetics	1/4/5	Risk of fracture; acrylic better than porcelain
– Non-surgical periodontology	1/4
– Surgical periodontology	1/4
Hazardous and contraindicated drugs	2	Avoid aspirin, acetaminophen and metronidazole (see Box 3.9)

^*0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.