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Restorative & Materials · patient case with 2 questions

Crown preparation in a patient with epilepsy and autism

Patient: Male, 27 years old

Chief Complaint: Accompanied by his mother, who requests a crown for a fractured upper front tooth.

Background: Autism spectrum disorder and generalised tonic-clonic epilepsy. Last seizure four months ago. Takes levetiracetam. Communicates in short phrases and repeats them; sensitive to bright light and loud sound.

Vital Signs: BP 118/74 mmHg · HR 78 bpm

Findings: Tooth #8 has a large failing composite with a fracture line. Heavy wear on the anterior teeth. Rest of the dentition intact.

Question 1

Before preparing tooth #8 for a crown, what is the most appropriate FIRST step?

  1. Shade selection
  2. Analysis of the occlusion
  3. Fabrication of the provisional crown
  4. Placement of a retraction cord
Show answer and explanation

Correct answer: B. Analysis of the occlusion

  • A. Shade is selected early in the appointment, before the teeth dehydrate, but it is not a diagnostic step and it does not change the treatment plan.
  • B. CORRECT. The anterior wear tells you the fracture was not an accident — something in the occlusal scheme broke this tooth, and a crown placed into that same scheme will fracture too. Occlusal analysis comes first: mounted casts if needed, evaluation of anterior guidance and excursive contacts, and a decision about whether the vertical dimension or the guidance must change before any preparation is cut.
  • C. The provisional is fabricated from a matrix taken AFTER the diagnostic workup and preparation design are settled — it is a step, not the first step.
  • D. Retraction cord is placed at impression-taking, after the preparation is complete.

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Question 2

Each of the following is related to this patient's seizure disorder EXCEPT one. Which is the EXCEPTION?

  1. Repetitive verbal phrases and echolalia
  2. Risk of tooth fracture or tongue laceration during an episode
  3. Loss of consciousness with tonic-clonic movements
  4. A post-ictal period of confusion and drowsiness
Show answer and explanation

Correct answer: A. Repetitive verbal phrases and echolalia

  • A. CORRECT as the exception. Repetitive speech and echolalia are features of AUTISM SPECTRUM DISORDER, not of the seizure disorder. They belong to the restricted, repetitive patterns of behaviour that define ASD, and they are present between episodes as a stable communication style. Attributing them to epilepsy conflates the two diagnoses this patient carries.
  • B. Orofacial trauma during a seizure is common and clinically important: fractured teeth, tongue and cheek lacerations, and TMJ injury. It is one reason to protect the airway and clear the mouth but never to force anything between the teeth.
  • C. Loss of consciousness with tonic then clonic phases is the definition of a generalised tonic-clonic seizure.
  • D. Post-ictal confusion, drowsiness and headache follow a generalised seizure and can last from minutes to hours — relevant to whether you can safely discharge a patient after an office episode.

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