Patient Information
Patient name
Date of appointment
Seizure type / diagnosis
Current AED medications
Last seizure (date)
Neurologist / contact
Agents with concerns — discuss before use
Epinephrine (adrenaline) in local anesthetic
Published side effects: rapid heartbeat, elevated blood pressure, trembling, anxiety, headache, sweating, palpitations. In patients with seizure disorders, epinephrine can lower seizure threshold and contribute to breakthrough events. Questions to raise: Is an epinephrine-free formulation available for this procedure?
Articaine as local anesthetic (where avoidable)
Published side effects: articaine has the highest reported rate of persistent paresthesia (prolonged numbness or tingling) among dental local anesthetics; also dizziness, ringing in the ears, and confusion at higher doses. Articaine enters the central nervous system more readily than lidocaine. Questions to raise: Can we use lidocaine without epinephrine, or mepivacaine plain, for this procedure?
Nitrous oxide sedation
Published side effects: nausea and vomiting (common), headache, dizziness. With repeated use or existing B12 deficiency: nerve damage, numbness, weakness, and neurological decline. Several AEDs affect folate metabolism — nitrous compounds this risk. If you choose to decline: ask your dentist to note this on your chart for future visits.
Topical fluoride treatment (varnish or gel)
Published side effects: nausea, vomiting, and stomach cramping from oral mucosal absorption; fluoride accumulates in the body with repeated applications. Questions to raise: What cavity-prevention alternatives are available that don't involve high-concentration fluoride?
Alternatives to discuss with your dentist
Mepivacaine 3% plain (Carbocaine) — no vasoconstrictor
Ask if mepivacaine plain is available for this procedure — no epinephrine, no vasoconstrictor.
Prilocaine 4% plain (Citanest) — if mepivacaine unavailable
Epinephrine-free alternative. Please review my full medication list before use.
Lidocaine 2% without epinephrine — if available
Ask if lidocaine without epinephrine is available — specifically without a vasoconstrictor additive.
Morning appointment scheduling
Cortisol is naturally highest in the morning (cortisol awakening response), which provides a degree of physiological seizure protection. Afternoon appointments carry a lower cortisol baseline.
Today's procedure — please note
Routine cleaning / exam — I'd like to discuss fluoride alternatives at this visit
Filling / restoration — I'd like to discuss epi-free anesthetic options
Extraction — I'd like to discuss epi-free anesthetic and nitrous alternatives
Amalgam removal — I'd like to discuss the SMART protocol before beginning
Unprotected amalgam drilling releases mercury vapor — the most bioavailable form of mercury, absorbed directly through the lungs and accumulated in the hippocampus and cerebellum. For a brain with a seizure disorder, this is a serious neurological event. SMART protocol requires: rubber dam, supplemental oxygen, amalgam separator, sectioning (not grinding), high-volume evacuation, protective barriers.
Other:
If sedation is needed
Published side effects of volatile inhalation anesthetics (sevoflurane, desflurane, isoflurane): post-operative nausea and vomiting, temporary confusion or agitation during recovery, malignant hyperthermia (rare but serious), and inorganic fluoride release during metabolism. Questions to raise: Given my seizure history, are IV propofol or regional anesthesia options for this procedure? Please ask that the anesthesiologist review your full history before the procedure.
Discuss: IV propofol or regional anesthesia as possible alternatives
Vasovagal awareness
Dental anxiety is common in patients with seizure disorders. A vasovagal response (rapid blood pressure drop from anxiety, needle, or reclined position) causes transient cerebral hypoperfusion that can trigger a seizure or syncopal event. If I appear pale, sweating, or become unresponsive: lower the chair, raise my legs, and do not restrain me. Call emergency services if a seizure lasts more than 5 minutes or I do not recover within 2–3 minutes.
If a seizure occurs in the chair
- — Remove all instruments from mouth immediately
- — Lower chair to flat or recovery position — do NOT restrain
- — Clear the area; protect from injury; do not put anything in mouth
- — Time the seizure
- — Most seizures end in 1–3 minutes without intervention
- — Call 911 if seizure exceeds 5 minutes, or if second seizure follows without recovery
- — My emergency contact:
- — My rescue medication (if prescribed): — follow the instructions my prescribing physician provided
My questions for this appointment
This document was prepared using research from theundoctored.com · Allie Johnson, DNM, DIM, PNM · Educational resource — not medical advice. For the full research basis of these recommendations, see: theundoctored.com/seizures.html and theundoctored.com/dental-toxins.html
Patient signature: _______________________________________ Date: _______________