Carbamazepine.
Dental management of epilepsy
If possible, any liquid anti-epileptic medication should be sugar-free (1107HFig. 16.8).
Sodium Valproate is not associated with gingival enlargement and like
Carbamazepine, Lamotrigine, and Oxcarbazepine is available as a sugar-free liquid.
Phenytoin results in gingival enlargement in about half of patients. The child with
good control of seizures needs a minimum of restrictions, although the possibility of
an attack occurring in the dental chair should be considered. A very high standard of
oral hygiene is required to minimize the development of gingival enlargement and
gingival surgery should never be contemplated unless the oral hygiene is good.
Trauma to anterior teeth is often encountered in people with epilepsy who may have
frequent, unpredictable falls. Reimplantation of avulsed teeth is usually
contraindicated in those with severe learning difficulties. If prostheses are required
then they should be well retained with clasps and unlikely to break or be inhaled
during subsequent attacks.
Key Points
Epilepsy:
- 0.5-1% of the population;
- gingival enlargement with phenytoin;
- check that any liquid medication is sugar-free.
1108H
Fig. 16.8 This 3-year-old child with epilepsy has rampant caries of the primary
dentition, with a somewhat unusual distribution of approximal lesions in both upper
and lower incisors as well as molars. The child had been on long-term, sucrose-based
medication but has now changed to the sugar-free sodium valproate liquid. (Courtesy
of Wolfe Publishing.)
16.6 METABOLIC AND ENDOCRINE DISORDERS
16.6.1 Diabetes mellitus
Diabetes is the most common endocrine/metabolic disorder of childhood and is due to
the deficiency of insulin and abnormal metabolism of carbohydrate, protein, and fat.
Type I diabetes mellitus is insulin-dependent (IDDM) and usually of juvenile onset. It
is age-related with peaks of presentation between 5 and 7 years and at puberty. The
prevalence of diabetes in school-age children is approximately 2 per 1000. Although