Gingival Enlargement and Seizure-related Oro- dental Injuries in Patients with Epilepsy

Abstract

Background: Patients living with epilepsy suffer from the adverse effects of antiepileptic medication such as gingival enlargement and traumatic injuries of the oral cavity related to the epileptic seizures. This study aimed to assess the prevalence of gingival enlargement and seizure-related oro-dental injuries among patients with epilepsy. Materials and Methods: This descriptive cross-sectional study included 500 consecutive patients with epilepsy attending the Outpatient Department of Neurology at a tertiary care hospital in Bengaluru, India. Patients were categorized into four groups according to the dental risk factors and manageability. Results: Gingival enlargement was observed in 59% of patients on phenytoin (PHT) therapy. Among them, 33% of patients were on PHT monotherapy and 67% were on PHT polytherapy. Of the 120 subjects with gingival enlargement, 49% had moderate enlargement while 10% had a severe enlargement. Oro-mucosal injuries were significantly more in the study population as compared to injuries of the teeth and jaws. This comparison across the groups was statistically significant (P < 0.03). Trauma to the tongue, cheek biting, lip injury, fracture and loss of teeth, and jaw fractures were seen only in patients with generalized tonic-clonic seizures (Groups II, III, and IV). Lip injury, cheek biting, trauma to tongue, loss of teeth, and jaw fracture were all significantly associated (P < 0.05) with seizures occurring more than once a year. Conclusions: The prevalence of gingival enlargement and seizure-related hard and soft tissue injuries of the oral cavity in patients with epilepsy supported the need for an interdisciplinary approach and targeted oral health promotion to ameliorate the oral health of these patients with epilepsy