things to ask and consider about the neurological section of medical history that we take on dental chair

1. Neurological
History
By Ayesha Zaheer
3rd year
Department of Oral
Diagnosis

2. ROLE OF
MEDICAL
HISTORY IN
DENTISTRY
• It increases dentist’s
awareness of disease and
medication which might
interfere with the pt. dental
treatment
• Could be vital if a medical
emergency occurs
• It may be related to
diagnosis
• Pre cautionary measures
are sometimes indicated

3. Dizziness
and
Fainting
▫ Dizziness is a
feeling of light
headedness or
fainting
▫ Dizziness is not a
disease but
rather a symptom
of various
disorder
▫ It can be pre
syncope
▫ Fainting usually
turns out to be
due to syncope,
commonly due to
vasovagal
syncope
▫ Which is usually
because of lack
of oxygen in the
brain
▫ And it should be
treated as
medical
emergency

4. Epilepsy or
seizures
Epilepsy is a disorder in
which brain activity becomes
abnormal, causing seizures or
periods of unusual behavior,
sensations, and sometimes
loss of awareness.

5. Epilepsy
Questions to be asked
▫ How long have you had
epilepsy?
▫ How frequently do your
seizure occur?
▫ What type of seizure do
you have?
▫ Can you talk/respond
appropriately during a
seizure?
▫ How do your seizure
begin?
▫ When was your last
seizure?
▫ What medications do you
take for your seizures?

6. Oral
manifestation
of epileptic
patients
▫ Increased risk for
• dental caries
• oral trauma laceration, including bite
injuries to tongue
• ulcerations and glossitis as a result of
medication-induced B-12 deficiency
• trauma-induced TMJ disc dislocation
requiring reduction
• • Medication-induced gingival
hyperplasia, bleeding gums, and
delayed healing

7. Medication
s of
epileptic
drugs
Like phenytoin, that usually
have side effects
e.g. gingival hyperplasia
Other drugs like
carbamazepine have side
effects of xerostomia and
stomatitis have been
reported and therefore helps
in diagnosis of many dental
conditions

8. Neuralgia
▫ Neuralgia is a stabbing,
burning, and often severe
pain due to an irritated or
damaged nerve.
▫ Trigeminal neuralgia
▫ The pain can be in the
teeth, lower jaw, upper
jaw, cheek and, less
commonly, in the forehead
or the eye

9. Trigeminal
neuralgia
or
toothache
▫ But dental pain
is way more
common than
neuralgia, so
before jumping to
the diagnosis of
neuralgia you
should examine
the patient
properly clinically
and by
radiographs to
exclude any
inflammatory
problem in the
teeth or
peridontium
▫ Features that
makes TN
peculiar
▫ 1. Pain occurs
along the course
of the nerve
▫ 2. Pain occurs
spontaneously
without obvious
cause.
▫ 3. Presence of
trigger zone is
characteristic of
the disease

10. Strokes or
TIA
▫ Stroke - (cerebrovascular
accident) is a serious and
often fatal neurologic event
characterized by the rapid
appearance (usually over
minutes) of a focal deficit
of brain function.
▫ TIA - The transient
ischemic attack (TIA), a
“mini” stroke. Symptoms
last less than 24 hours

11. Identify a
stroke pt
▫ Identify risk factors
• Hypertension
• CHF
• DM
• TIA or previous stroke
• Increasing age ≥75 years
• Elevated blood cholesterol or lipid level
• Cigarette smoking

12. DENTAL
CONSIDERAT-
IONS
• Schedule short, stress-free mid-
morning appointments.
• Use caution, as a fair number of
patients may be on Coumadin or
warfarin
• Encourage control of risk factors
(referral to physician, if appropriate)
• Note date of event, current status,
medical therapy, and any residual
disabilities.
• Provide only urgent dental care
during first 6 months after a stroke or
TIA

13. Strokes or
TIA
▫ Dental therapy
management of the patient
with a medical record of
ischemic stroke is
particularly important,
because of the real risk of
recurrence. In this respect,
the dentist should be
trained to prevent the
occurrence of a new
vascular attack
▫ and of any possible
complication

14. Dental office and dental medical team
shall have the necessary
means and knowledge in order to
perform effectively
in case of need.