Quality Resource Guide l Guidelines for Consultation With and/or Referral to a Physician 2nd Edition 13 www.metdental.com Medical Condition Implications for Dental Care When to Consult/Refer What to ask for and how to use information received NEUROLOGIC DISORDERS Epilepsy: Characterized by seizures, due to excessive neuronal activity - Risk of a seizure in the dental chair - Gingival overgrowth due to epilepsy medications - Unclear history of seizures, history of seizures that are recent or poorly managed - Diagnosis, type of seizures, cause if known, and any known precipitating factors: Seizures can be partial or generalized, with the latter being more severe. Epilepsy is often idiopathic but can be secondary to other condi- tions such as cancer and head trauma. In some patients, light and sound stimuli can lead to seizures. - Level of control: Poorly controlled patients may require special precau- tions for seizure prevention, including sedation or other stress reduction measures. The dental team should be prepared to manage a seizure if it occurs. Dental treatment planning should take seizures into account (e.g. fixed prostheses may be preferable). - How treated: Gingival overgrowth is a side-effect of phenytoin (Dilantin). Risk is increased with local irritants (such as calculus) and concomitant use of other medications that can cause gingival overgrowth (calcium channel blockers, cyclosporine) 24 . Parkinson Disease: Characterized by degeneration of neurons that produce dopamine, leading to tremors and possibly mood disorders and dementia - Tremors can impede professional dental care and home oral hygiene measures - Side effects of medications - Unclear history of Parkinson Disease or its man- agement, tremors without a known diagnosis - Diagnosis and level of control: Poorly controlled patients may have signifi- cant involuntary movements and stress and may need a modified toothbrush and frequent recall visits. - How managed: Dopamine precursors/agonists and COMT inhibitors can cause orthostatic hypotension and dry mouth. Alzheimer Disease: Characterized by deposition of amyloid plaques and inflammation in the brain, leading to reduced levels of neu- rotransmitters, manifesting as cogni- tive deficits and memory loss - Patients may have difficulty understanding questions or remembering instructions - Patients with severe dementia may have a legal guardian for healthcare issues. - Side effects of medications - Unclear history of Alzheimer Disease or its management, or late-stage of dementia. - Diagnosis and stage of dementia: Middle and late-stage patients may be uncooperative and need treatment planning modifications, (e.g. sedation, written instructions, frequent recall). - How managed: Patients on antipsychotics and antidepressants may have dry mouth.