Seizures Induced by Dental Fear

How do seizure disorders intersect with sedation dentistry? When a patient presents with fear-induced seizures, can a clinician still treat the patient? DOCS Education faculty weigh in.

A DOCS Education member inquires:

We treated a 46-year-old male patient who had a grand mal seizure in the office last week during his hygiene visit (without sedation). During the seizure, he stopped breathing for several second and his O2 saturation went to 83 for the duration of the seizure, which was less than a minute. He claims no diagnosis of epilepsy, but has had previous seizures at dental visits, but no other times. Due to seizures he was dismissed from his former dental practice. His sister informs us that his diagnosis was "white coat syndrome." He is taking no medications.

To follow up after this episode, the patient was evaluated by his physician who did not prescribe any medication nor recommend any treatment. He wants to return for treatment with sedation.
Is this an appropriate sedation case? Are there specific medical tests that should be done? Is there a sedation protocol that would provide greatest safety in terms of preventing a seizure?

Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

If I'm reading your post correctly, the patient has a seizure disorder caused by dental anxiety. If the patient is otherwise healthy, then sedation can prevent a seizure and make dental care possible. I would not treat him without sedation. Any DOCS Education sedation protocol is appropriate as long as the sedation creates the level of CNS depression needed to eliminate his anxiety. This may be moderate sedation, which is best achieved by incremental dosing to effect at appropriate doses administered at appropriate intervals.

Dr. Jerome Wellbrock, DOCS Education faculty member, adds:

I agree with Dr. Feck that sedation for dental appointments would be very beneficial and would most likely prevent seizure if they truly are caused by anxiety. However I think the diagnosis of "seizure brought on by anxiety" sounds rare. I would highly recommend this patient have a work-up with a neurologist. An evaluation by his primary care provider giving no medications or recommendations is not helpful at all in dealing with this situation.

The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.