Adverse effects of antileptic drugs

The oral adverse effects of antiepileptic drugs are listed in Table 1. The principal concern of dentists is the persistent gingival hyperplasia which may occur with phenytoin therapy.

Factors which may occur in the dental surgery which could precipitate epileptic fits in susceptible persons include:

• use of sympathomimetic amines
• infection
• stress
• flickering lights
• cerebral hypoxia.

Emergency treatment of a seizure is directed principally at preventing the patient from damaging themselves. Place the patient on their side with the face rotated downwards to minimise the risk of compromising the airway should vomiting occur. The placement of a prop of some sort between the teeth serves no purpose and the procedure may be dangerous for the dentist.

A prolonged seizure may require oxygen and, if status epilepticus does develop, give diazepam or clonazepam by slow intravenous injection in appropriate doses.