Dravet syndrome can have some surprising effects on many parts of the body — including the teeth and gums. This rare, lifelong form of epilepsy starts early in infancy and may involve long-lasting seizures, treatment side effects, and eating difficulties. All of this can take a toll on dental health.

If you feel like you or your child with Dravet syndrome has more dental problems than most people, you’re probably right. In this article, we’ll cover six ways Dravet syndrome can affect the teeth.

1. Delayed Tooth Development

Seizures from Dravet syndrome usually begin in the first year of life — between 4 and 7 months of age, around the time most babies start teething. Babies with Dravet syndrome, however, might get their teeth later. When the teeth finally come in, they’re sometimes smaller or shaped differently than normal.

2. Tooth Wear and Breakage

Many people with Dravet syndrome grind or gnash their teeth — a condition called bruxism. Grinding can wear down the tooth enamel (outer layer) and cause you to bite your tongue or inner cheeks. Seizures can cause the jaw to clench tightly, which sometimes leads to dental injuries like broken or missing teeth or a fractured jawbone.

For several reasons, kids with Dravet syndrome are at a higher risk of dental cavities.

Some older seizure medications called anticonvulsants can make nighttime grinding worse. This side effect has been reported by several people on MyEpilepsyTeam:

• “I grind so badly that my teeth are flat with no enamel left from vomiting.”
• “If it’s not grinding teeth, it’s the biting on the tongue.”
• “I grind my teeth, and my dentist recommended a mouth guard.”
• “The dentist eventually tracked really strange wear that my teeth were getting that indicate grinding.”

If you or your child grinds their teeth, talk to a dentist. They can help find ways to protect the teeth.

3. Cavities

Kids with epilepsy are likely to take at least one drug that can have oral side effects, increasing the risks of tooth decay and gum disease. These drugs, along with nutrition challenges that are common in Dravet syndrome, can raise the risk of caries (cavities) — small holes left by tooth decay. Cavities develop when bacteria in the mouth feed on sugars left behind by foods or drinks. The bacteria produce acid, which slowly eats away at the tooth surface.

Some liquid oral (taken by mouth) medications that treat Dravet syndrome contain sucrose, a type of sugar, to make them taste better. One study compared 84 children with epilepsy who took liquid oral medications for more than three months with 106 kids receiving other forms of medication. Over 76 percent of kids taking the liquid drugs had cavities, compared with 55.6 percent of the other group.

Kids with Dravet syndrome may also have a hard time brushing their teeth. Motor skills and coordination challenges may make it difficult to clean teeth thoroughly, setting the stage for oral hygiene issues and eventually cavities.

Read more about treatments for Dravet syndrome.

4. Dry Mouth

Saliva helps keep your mouth clean and moist. Most people experience occasional dry mouth, or a lack of saliva, when they’re dehydrated. However, chronic (long-term) dry mouth can cause or worsen oral health problems like cavities, mouth sores, and gum disease.

Dry mouth is a common side effect of some medications that treat Dravet syndrome. For example, divalproex sodium (Depakote), an anticonvulsant often prescribed to help manage seizures, can reduce the amount of saliva your body makes. Other anticonvulsants may also cause dry mouth.

5. Gum Problems

Dental health involves not just your teeth but also your gums, the pink tissue that supports teeth. Dravet syndrome and some of its treatments can affect gum health in a couple of major ways.

Gingivitis

Gingivitis (early-stage gum disease) develops when plaque (a sticky layer of bacteria) builds up on your teeth. This infection can cause red, tender, swollen gums and bad breath.

If you or your child has Dravet syndrome, it’s important to find a dentist who understands your needs.

Dry mouth, a common side effect of seizure medications, also can lead to gum disease. Some anti-seizure medications — including levetiracetam (Keppra), which is sometimes prescribed for Dravet syndrome — cause gingivitis as a side effect.

Gum Overgrowth

Some people with epilepsy develop gum enlargement or overgrowth of gum tissue — a condition called gingival hyperplasia. The gums become puffy and may bleed easily. Gingival hyperplasia can make teeth appear smaller than they are. Overgrown gums also make it harder to brush and floss, which can contribute to cavities and gum disease.

This problem can be a side effect of medications for Dravet syndrome and other types of epilepsy. The anticonvulsant phenytoin (Dilantin, Phenytek) causes gingival hyperplasia in up to half of people taking it for one to two years. Divalproex sodium can also cause gingival hyperplasia.

6. Need for Root Canals

People with Dravet syndrome might need a root canal after injuring a tooth during a seizure. This dental treatment removes inflamed or infected pulp (soft tissue) inside a tooth. A root canal may be needed because of tooth trauma even if the tooth itself doesn’t break.

Signs that indicate the need for a root canal include:

• A chipped or cracked tooth
• Darkening of the gums
• Small bumps (like pimples) on the gums
• Severe tooth pain, especially while chewing
• Swelling or tenderness in the gums
• Sensitivity to hot or cold foods and drinks

A root canal can relieve pain in the long run, but the treatment itself can cause short-term pain or soreness. People with Dravet syndrome and other types of epilepsy might find root canal treatment challenging, especially if sensory issues or medical anxiety are present. Dentists can work with you to help make the treatment more manageable.

Getting Informed Dental Care for Dravet Syndrome

If you or your child has Dravet syndrome, it’s important to find a dentist who understands your needs. Make sure your dental team knows how to respond if a seizure occurs during a visit. Let them know when the most recent seizure occurred and which medications are being taken to manage Dravet syndrome.

Dental tools often include bright lights, which can sometimes trigger seizures in people with Dravet syndrome. You may want to wear dark glasses or ask the dentist to adjust the lighting during treatment.

Good dental care is essential for everyone but especially for people with Dravet syndrome. Regular dental checkups and cleanings can help catch problems early — and keep teeth and gums as healthy as possible.

Talk With Others Who Understand

MyEpilepsyTeam is the social network for people with epilepsy and their loved ones. On MyEpilepsyTeam, members come together to ask questions, give advice, and share their stories with others who understand life with epilepsy.

Do you experience frequent dental problems with Dravet syndrome? What steps have you taken to protect your oral health? Share your experience in the comments below, or start a conversation by posting on your Activities page.