Managing seizures in dental practice

Seizures can be caused by epilepsy, syncope, hypoglycaemia, stroke and cerebral hypoxia from other causes. In young children, fever can cause seizures.

Seizures can involve a sudden spasm of muscles (producing rigidity such that the patient falls), jerky movements of the head, arms and legs, and loss of consciousness. Seizures may affect all or part of the body. The patient may have warning symptoms before the seizure (aura).

Status epilepticus refers to continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. Status epilepticus is a medical emergency—call 000 for immediate transfer to hospital.

In dental practice, follow the advice in Management of seizures in dental practice for first-aid management of patients with seizures.

Figure 1. Management of seizures in dental practice

If a seizure occurs:

  • Stop dental treatment.
  • Ensure the patient is not in danger in the dental chair—protect the patient from falling from the chair, or lift them onto the floor.
  • If possible, turn the patient on their side to reduce the risk of aspiration.
  • Avoid restraining the patient during the seizure, unless it is essential to avoid injury.
  • Wait until the seizure stops.
  • Assess consciousness by talking to the patient.
  • Maintain airway.
  • If there is vomit in the mouth or pharynx, remove it with high-volume suction once the seizure has stopped. Do not place anything in the patient’s mouth during the seizure.

See further management advice for seizures known to be caused by syncope, hypoglycaemia or stroke. For seizures of unknown cause or in patients with known epilepsy, if the patient recovers completely, keep under observation for at least a further 30 minutes. Do not allow the patient to drive home. Advise the patient to seek urgent medical review and provide a written summary of events of the seizure directly to the medical practitioner.

If the seizure or loss of consciousness lasts for more than a few minutes, or if repeated seizures occur without recovery of consciousness between attacks (ie status epilepticus):

  • Call 000.
  • Maintain airway.
  • Monitor the patient until assistance arrives.