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Prosthetic Treatment for an Unusual Epileptic Problem: Report of Case
Prosthetic treatment for an unusual epileptic problem: report of case
Edgar N. Starcke, Jr., DDS, Birmingham
A fter injuries to his tongue caused during grand mal seizures, a patient was treated successfully by means of an upper removable partial denture.
almost always deviates to the left and is bitten. On occasion, as a result of the biting, the tongue has been severely injured to the extent of trau matic laceration.
Examination
A 3 8-year-old male epileptic was first examined by the dental clinic staff of the Amarillo VA Hos pital after referral from the regional outpatient clinic, VA Hospital, Lubbock, Texas. The veter an’s mood was one of extreme apprehension and concern as he explained that when each grand mal seizure occurred he sustained an injury at times severe to his tongue.
On clinical and radiographic examinations, all gingival tissues, alveolar bone, and natural teeth were found to be in an acceptable state of health. However, an examination of the tongue revealed deep scarring on the left dorsal and lateral sur faces as a result of the injury caused by biting (Fig 1). The patient was wearing a removable partial upper denture that replaced the upper right canine through the upper left lateral incisor.
Case history The epilepsy began in 1947 when the patient was injured in a jeep accident during his term of service with the Navy. Since that time, he has frequently suffered grand mal seizures. From time to time, variable regimens of medications, in cluding diphenylhydantoin (Dilantin), phéno barbital, and primidone (Mysoline), have been prescribed. The patient said that the medications have reduced neither the frequency nor the severi ty of the seizures; on the contrary, they have been growing worse. Peculiar to this patient, the grand mal seizures occur without warning only when the patient is asleep, at which time the tongue 878
Fig 1 ■ Note injury on dorsal and lateral surfaces of tongue.
Fig 2 ■ Partial denture restoration at time of wax try-in.
The partial denture was found to be unservice able. During the initial examination as he expressed concern about the biting of his tongue, the patient said that he had, on two occasions, found it neces sary to have his tongue sutured and that the tongue had some numbness on the left side. He was also concerned about the prospect of having all of his teeth removed and having complete den tures. However, he thought that he would have to have complete dentures because during the previous consultations, this treatment was recom mended.
the tongue. Consideration was also given to the patient’s concern over having all of his teeth ex tracted. Therefore, as a suitable alternate treat ment, it was decided that only the upper left canine through the second left molar be extracted to determine whether the space provided would reduce or eliminate any further traum a to the tongue. To insure maximum medical control, the pa tient was admitted to the hospital for all surgical procedures. After the teeth were extracted, he was discharged and received post hospital care (PHC). He was instructed to return to the hospi tal after a three-month interval. On his return, he reported that he had had two subsequent seizures but had experienced no further injury to his tongue. It was decided that because of his favor able report, no further teeth would be removed. The patient was treated by means of a removable partial upper denture and was instructed to re move it each night before he retired (Fig 2).
Conclusion A satisfactory remedy for this patient was accom plished with the removal of a minimum number of teeth and with the construction of a removable partial denture. The partial denture is im portant to prevent oral injury and has a satisfactory func tion and appearance.
Treatment An immediate interceptive treatment was obvi ously necessary to prevent any further traum a tQ
Doctor Starcke is a career resident in prosthodontics, Veterans Administration Hospital, Birmingham 35233; he was formerly a staff dentist, Veterans Administration Hos pital, Amarillo, Texas.
Starcke: PROSTHETIC TREATMENT FOR EPILEPTIC ■ 879
Edgar N. Starcke, Jr., DDS, Birmingham
A fter injuries to his tongue caused during grand mal seizures, a patient was treated successfully by means of an upper removable partial denture.
almost always deviates to the left and is bitten. On occasion, as a result of the biting, the tongue has been severely injured to the extent of trau matic laceration.
Examination
A 3 8-year-old male epileptic was first examined by the dental clinic staff of the Amarillo VA Hos pital after referral from the regional outpatient clinic, VA Hospital, Lubbock, Texas. The veter an’s mood was one of extreme apprehension and concern as he explained that when each grand mal seizure occurred he sustained an injury at times severe to his tongue.
On clinical and radiographic examinations, all gingival tissues, alveolar bone, and natural teeth were found to be in an acceptable state of health. However, an examination of the tongue revealed deep scarring on the left dorsal and lateral sur faces as a result of the injury caused by biting (Fig 1). The patient was wearing a removable partial upper denture that replaced the upper right canine through the upper left lateral incisor.
Case history The epilepsy began in 1947 when the patient was injured in a jeep accident during his term of service with the Navy. Since that time, he has frequently suffered grand mal seizures. From time to time, variable regimens of medications, in cluding diphenylhydantoin (Dilantin), phéno barbital, and primidone (Mysoline), have been prescribed. The patient said that the medications have reduced neither the frequency nor the severi ty of the seizures; on the contrary, they have been growing worse. Peculiar to this patient, the grand mal seizures occur without warning only when the patient is asleep, at which time the tongue 878
Fig 1 ■ Note injury on dorsal and lateral surfaces of tongue.
Fig 2 ■ Partial denture restoration at time of wax try-in.
The partial denture was found to be unservice able. During the initial examination as he expressed concern about the biting of his tongue, the patient said that he had, on two occasions, found it neces sary to have his tongue sutured and that the tongue had some numbness on the left side. He was also concerned about the prospect of having all of his teeth removed and having complete den tures. However, he thought that he would have to have complete dentures because during the previous consultations, this treatment was recom mended.
the tongue. Consideration was also given to the patient’s concern over having all of his teeth ex tracted. Therefore, as a suitable alternate treat ment, it was decided that only the upper left canine through the second left molar be extracted to determine whether the space provided would reduce or eliminate any further traum a to the tongue. To insure maximum medical control, the pa tient was admitted to the hospital for all surgical procedures. After the teeth were extracted, he was discharged and received post hospital care (PHC). He was instructed to return to the hospi tal after a three-month interval. On his return, he reported that he had had two subsequent seizures but had experienced no further injury to his tongue. It was decided that because of his favor able report, no further teeth would be removed. The patient was treated by means of a removable partial upper denture and was instructed to re move it each night before he retired (Fig 2).
Conclusion A satisfactory remedy for this patient was accom plished with the removal of a minimum number of teeth and with the construction of a removable partial denture. The partial denture is im portant to prevent oral injury and has a satisfactory func tion and appearance.
Treatment An immediate interceptive treatment was obvi ously necessary to prevent any further traum a tQ
Doctor Starcke is a career resident in prosthodontics, Veterans Administration Hospital, Birmingham 35233; he was formerly a staff dentist, Veterans Administration Hos pital, Amarillo, Texas.
Starcke: PROSTHETIC TREATMENT FOR EPILEPTIC ■ 879