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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2019  |  Volume : 16  |  Issue : 4  |  Page : 144-147

Oral characteristics of children with seizure disorders in a tertiary health institution


1 Department of Child Dental Health, Faculty of Dental Sciences, University of Lagos, Lagos, Nigeria
2 Department of Child Dental Health, Lagos University Teaching Hospital, Lagos, Nigeria
3 Department of Paediatrics, Faculty of Clinical Sciences, University of Lagos, Lagos, Nigeria

Date of Web Publication22-Oct-2019

Correspondence Address:
Dr. Aderonke O Oluwo
Department of Child Dental Health, Lagos University Teaching Hospital, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_42_19

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  Abstract 

Background: Children with seizure disorders are faced with different oral conditions from lack of personal care, side effects of medications, and injuries from poor neuromuscular controls. Aims: This study aims to assess the oral health characteristics of children diagnosed with seizure disorders. Settings and Design: A cross-sectional survey was carried out among children aged 0–16 years who attended the outpatient neurology clinic of the Department of Paediatrics, Lagos University Teaching Hospital and an age- and gender-matched control group. Materials and Methods: Data were collected through interviewer-administered questionnaires to their parents/caregivers and oral examinations of the children. Statistical Analysis Used: Data entry was done using Statistical Package for Social Sciences version 20, and statistical analysis was performed using Chi-square test, and the level of significance was set at P < 0.05. Results: Two groups of 101 children each with seizure disorders and without seizure disorders aged between10 months and 16 years participated in the study. Majority of the participants with seizures –92 (91.1%) had never visited the dentist. The Decayed, Missing, Filled Teeth for participants with seizure disorders and control were 0.56 + 1.89 and 0.15 + 0.50, respectively. With regard to gingival hyperplasia, anterior open bite, proclined teeth, and fractures of teeth, patients with seizures showed significantly worse conditions compared with the control group. Conclusions: Result from this study showed that children who have seizures had poorer oral health and dental visit behavior than those without seizures. There is therefore a need for oral health care to be incorporated into recommended health care of these groups of patients to improve their quality of life.

Keywords: Dental visits, oral health characteristics, seizure disorders


How to cite this article:
Nzomiwu CL, Oluwo AO, Oredugba FA, Lesi FE. Oral characteristics of children with seizure disorders in a tertiary health institution. J Clin Sci 2019;16:144-7

How to cite this URL:
Nzomiwu CL, Oluwo AO, Oredugba FA, Lesi FE. Oral characteristics of children with seizure disorders in a tertiary health institution. J Clin Sci [serial online] 2019 [cited 2019 Nov 13];16:144-7. Available from: http://www.jcsjournal.org/text.asp?2019/16/4/144/269720


  Introduction Top


Seizure disorder is the most common childhood neurologic condition and a major public health concern.[1],[2] In infants, birth injuries and congenital defects are the major causes of epilepsy whereas in children and adolescents, birth injuries, genetic factors, infections, and trauma are the major contributing factors. However, its incidence is highest in the first decade of life, a period during which children begin and complete a critical part of their social and educational development.[3],[4]

It affects approximately 50 million people worldwide, of whom 80% reside in developing countries including Nigeria.[5] In a study [6] conducted in a neurology clinic in Nigeria, the highest proportion (44.3%) of the children seen within the period of study had seizures. Children diagnosed with seizure disorders face considerable challenges. Seizures, when poorly controlled, may be disabling and interfere with the child's ability to learn, whereas secondary influences such as stigma and lack of knowledge about the condition can negatively affect social and psychological function.[7],[8],[9]

Studies have shown that children with active seizure disorders are likely to have increased risk of developing dental disease when compared with healthy controls.[3] Károlyházy et al.[10] reported that patients with seizure disorders showed worse conditions in all aspects of oral health than those without the condition. Children with seizure disorders are found to be faced with higher incidence of dental conditions such as traumatic dental injuries, dental caries,[4] gingival hyperplasia, and gingival bleeding (as a result of the medications used for treatment).[3],[4],[10] These conditions would pose great risk to their daily activities thereby affecting their quality of life.

It is therefore necessary for parents/caregivers to understand the need for dental visits and the importance of good oral health while managing the child's seizure disorder. This will go a long way in taking care of the child's dental health, thus improving his/her quality of life.

Few reports have been published on the oral hygiene and dental treatment requirements of adults and children with epilepsy.[3] Furthermore, the medical literature has more information on the oral health of adult patients affected by seizure disorders but contains little information on the influence of such conditions on the oral health of children. Thus, the aim of this study is to assess the oral health characteristics of children diagnosed with seizure disorders and provide baseline data for future studies.


  Methods Top


The study design was cross-sectional among children aged 0–16 years who attended the outpatient neurology clinic of the Department of Paediatrics, Lagos University Teaching Hospital and an age- and gender-matched control group from a nearby school.

Ethical approval was obtained from the Institutional Review Committee of Lagos University Teaching Hospital. Data collection was through interviewer-administered questionnaires to their parents/caregivers, followed by oral examinations of the children. The questionnaires sought for information on demographics (age, sex, ethnic group, religion, parent's or guardian's level of education), onset and duration of seizure, type and duration of medications, previous dental visit, and dental treatment. Oral examination was performed using sterile dental mirror and periodontal probe under natural light while patients sat on consultation chair either alone or on the laps of their parent/guardian depending on the age of the child.[11] All diagnoses were made without the use of a radiograph. Data analysis was done using IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp). Statistical analysis was performed using Chi-square and Fisher's exact test, and differences were considered significant at P ≤ 0.05.


  Results Top


Two groups of 101 children with seizure disorders and without seizure disorders aged between 0 month and 16 years with a mean age of 6.98 ± 4.02 years participated in the study. There were 48 males and 53 females who have had seizure for between 12 months and 15 years and had also been on medication between 6 months and 15 years. Children who have had seizures for a duration of <5 years –95 (83.3%) attended more frequently than those who have had seizure for more than 5 years –19 (16.6%). Among the participants with seizure disorders, a higher proportion of their parents had tertiary education: fathers –66 (57.9) and mothers –63 (61.2).

Majority – 92 (91.1%) of the participants with seizures and 66 (65.3%) of the participants without seizures had never visited the dentist. Among those (8.9%) who had visited the dentist, 5.4% of them visited due to pain.

The Decayed, Missing, Filled Teeth/teeth (DMFT/DMFt) indices for participants with seizure disorders and those without seizure disorders were 1.25 ± 0.46/2.00 ± 1.00 and 2.25 ± 1.49/4.75 ± 4.27, respectively, but the difference was not statistically significant.

Compared with the participants without seizure, more participants with seizure had poorer oral hygiene, and this difference was statistically significant (P = 0.001) [Figure 1].
Figure 1: Oral hygiene status of the participants

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Seven (6.93%) participants with seizure disorders presented with gingival enlargement, with a higher proportion (43%) of them on carbamazepine medication. However, there was no statistically significant relationship between gingival enlargement and the different medications used by these patients [Table 1].
Table 1: Relationship between numbers of study participants with seizure disorder that presented with gingival enlargement and medications used

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With regard to oral health conditions such as gingival hyperplasia, anterior open bite, and proclined teeth, patients with seizure disorders showed significantly worse conditions compared with the control group, P < 0.05 [Table 2].
Table 2: Some of the presenting oral health conditions among the participants

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  Discussion Top


Oral health status of epileptic patients has been described by several authors.[3],[4],[6],[12] Antiseizure medications among several options for the treatment of epileptic seizures have been implicated in oral health diseases. The choice of medication is related to the type of seizure. Individuals that experience frequent seizures often have worse oral health status than the general population.[12] Dentists with thorough knowledge of seizure disorders and the medications used to treat them can provide necessary dental and oral health care to these patients.

In this study, majority of the participants were treated with sodium valproate alone or in combination with other drugs while carbamazepine was the second most used drug. Many studies have shown that sodium valproate (Epilim) remains the drug of choice for different forms of seizures.[1],[7],[9],[13] In this study, however, drug combinations used by participants included sodium valproate and carbamazepine, sodium valproate and pyridoxine, carbamazepine, and pyridoxine. The results of the current study demonstrate that oral hygiene and dental status in epileptic children showed a significant difference when compared with that of the healthy control group. Interestingly, majority of the seizure participants had never visited the dentist, yet they had various oral conditions that required the attention of a dentist. Frequent long-term consumption of sweetened medications increases the risk of impaired oral health in addition to the challenge of maintaining proper oral hygiene in these patients. It is therefore of utmost importance to educate their parents on good oral hygiene and plan adequate dental treatment for children diagnosed with seizure disorder.

Our findings revealed that in most of the oral conditions identified, children with seizure disorder had more oral problems compared with the control group. These maybe consequences of a combined effect of neglected oral hygiene, oral cavity injuries, and increased exertion on the teeth. Although their DMFT was slightly higher showing that they had more dental caries than the control, this difference was not statistically significant. In a study by Denloye et al.,[6] it was shown that patients with seizure disorders had poorer oral health than those without. These observations are probably due to factors such as socioeconomic status and access to dental care. A poor socioeconomic background and restricted access to dental care are usually associated with poor oral health. Tooth fracture may have resulted from falls during an episode of seizure, and the proclined teeth may have been as a result of concurrent adenoid hypertrophy. Listed among the oral health conditions and prevalent among seizure participants is gingival enlargement.[6],[12],[14],[15] This is the most commonly reported periodontal problem among individuals with seizure disorders. In most of the literature, phenytoin is reported to be the most commonly incriminated drug for this oral condition.[4],[10],[16] In this study, however, it was not used by any of the participants. Carbamazepine as a monotherapy or in combination was associated with gingival enlargement in this study. This shows that drugs other than phenytoin can cause gingival hyperplasia. Some researchers have reported that sodium valproate was the most associated medication [3],[17],[18] followed by phenytoin.[17],[18] With regard to the oral hygiene of the individuals with gingival hyperplasia, there were no clinically and statistically significant difference between them and those without gingival enlargement. Some studies have shown significant differences between oral hygiene and the presence of gingival hyperplasia,[4],[17],[19] while some did not report any association.[6] Generally, in Nigeria, children as well as adults have poor dental visit behavior. This was clearly shown in a hospital-based study where the children had poor dental visit behavior. Adults take responsibility for the health of children and are needed to take these children to obtain dental care; but, if these adults are not knowledgeable and do not understand the importance of dental checkup, then they are not likely to present their children for dental visit except when there is pain or the need for an emergency treatment arises. Second, parents are usually overwhelmed by hospital visitations for their child concerning chronic disorders like seizures that they hardly make out time for other visits except emergencies.


  Conclusions Top


Children who have seizures had poorer oral health and dental visit behavior than those without seizures. There is therefore a need for oral health care to be incorporated into recommended health care of this group of patients to improve their quality of life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jones JE, Austin JK, Caplan R, Dunn D, Plioplys S, Salpekar JA. Psychiatric disorders in children and adolescents who have epilepsy. Pediatr Rev 2008;29:e9-14.  Back to cited text no. 1
    
2.
Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2012;129:256-64.  Back to cited text no. 2
    
3.
Gurbuz T, Tan H. Oral health status in epileptic children. Pediatr Int 2010;52:279-83.  Back to cited text no. 3
    
4.
Gurbuz T. Chapter 9. In: Foyaca-Sibat H, editor. Epilepsy and Oral Health, Novel Aspects on Epilepsy. InTech; 2011. Available from: http://www.intechopen.com/books/novel-aspects-onepilepsy/epilepsy-and-oral-health. [Last accessed on 2018 Dec 20].  Back to cited text no. 4
    
5.
World Health Organization. Epilepsy Fact Sheet N 999. World Health Organization; 2012. Available from: http://www.who.int/mediacentre/factsheets/fs999/en/index.html. [Last accessed on 2018 Jun 18].  Back to cited text no. 5
    
6.
Denloye O, Ajayi D, Lagunju I. Oral health status of children seen at a paediatric neurology clinic in a tertiary hospital in Nigeria. Pediatr Dent J 2012;22:16-21  Back to cited text no. 6
    
7.
Raspall-Chaure M, Neville BG, Scott RC. The medical management of the epilepsies in children: Conceptual and practical considerations. Lancet Neurol 2008;7:57-69.  Back to cited text no. 7
    
8.
Baker GA, Hargis E, Hsih MM, Mounfield H, Arzimanoglou A, Glauser T, et al. Perceived impact of epilepsy in teenagers and young adults: An international survey. Epilepsy Behav 2008;12:395-401.  Back to cited text no. 8
    
9.
Wu KN, Lieber E, Siddarth P, Smith K, Sankar R, Caplan R. Dealing with epilepsy: Parents speak up. Epilepsy Behav 2008;13:131-8.  Back to cited text no. 9
    
10.
Károlyházy K, Kovács E, Kivovics P, Fejérdy P, Arányi Z. Dental status and oral health of patients with epilepsy: An epidemiologic study. Epilepsia 2003;44:1103-8.  Back to cited text no. 10
    
11.
World Health Organization. Oral Health Surveys: Basic Methods. 5th ed. Geneva. World Health Organization; 2013.  Back to cited text no. 11
    
12.
Joshi NH, Deshpande AN, Deshpande NC, Rathore AS. Comparative evaluation of oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs. J Indian Soc Periodontol 2017;21:125-9.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Russ SA, Larson K, Halfon N. A national profile of childhood epilepsy and seizure disorder. Pediatrics 2012;129:256-64.  Back to cited text no. 13
    
14.
Morgan HI, Abou El Fadl RK, Kabil NS, Elagouza I. Assessment of oral health status of children with epilepsy: A retrospective cohort study. Int J Paediatr Dent 2019;29:79-85.  Back to cited text no. 14
    
15.
Cornacchio AL, Burneo JG, Aragon CE. The effects of antiepileptic drugs on oral health. J Can Dent Assoc 2011;77:b140.  Back to cited text no. 15
    
16.
Marakoglu I, Gursoy UK, Cakmak H, Marakoglu K. Phenytoin-induced gingival overgrowth in un-cooperated epilepsy patients. Yonsei Med J 2004;45:337-40.  Back to cited text no. 16
    
17.
Zaib-Un-Nissa, Iqbal MA, Almani SA, Rajput AH, Muneeb M, Memon HN, Jehangir SS, Shaikh S. Casual comparative analysis of gingival index score among epileptic patients using carbamazepine, sodium valproate and phenytoin. Indo Am J Pharm Sci 2017;4:4622-6.  Back to cited text no. 17
    
18.
Aragon CE, Burneo JG. Understanding the patient with epilepsy and seizures in the dental practice. J Can Dent Assoc 2007;73:71-6.  Back to cited text no. 18
    
19.
Percival T, Aylett SE, Pool F, Bloch-Zupan A, Roberts GJ, Lucas VS. Oral health of children with intractable epilepsy attending the UK national centre for young people with epilepsy. Eur Arch Paediatr Dent 2009;10:19-24.  Back to cited text no. 19
    


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    Tables

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