Challenges of Successive Dental Treatment Under General Anesthesia in a Patient With Drug Resistant Epilepsy: A Case Report

ABSTRACT Pediatric patients with uncontrolled tonic–clonic epilepsy and cognitive impairment present substantial challenges for dental pain management when cooperation is limited. We report a 13‐year‐old nonverbal male with lifelong generalized epilepsy, who underwent two comprehensive dental rehabilitations under general anesthesia. The first session included full‐mouth prophylaxis, extraction of retained primary molars (54, 64, 75, 85), and stainless‐steel crowns on permanent first molars (16, 26, 36, 46) with increased vertical dimension; peri‐operative ASMs (antiseizure medications) were continued, and anesthesia was induced. Despite intact restorations, persistent orofacial discomfort manifested as repeated face‐hitting at 6 months. After multidisciplinary reassessment, conservative measures were deemed insufficient, and a second GA was performed for full‐mouth extraction to eliminate potential nociceptive sources. Following extraction, self‐injurious behavior markedly decreased and feeding improved; at follow‐up the patient remained clinically stable with seizure control maintained under neurology. This case highlights the need for interdisciplinary planning and flexible treatment goals in nonverbal children with epilepsy, where radical interventions may be necessary to restore safety and quality of life.