Dental Implant for a Patient with Narcolepsy: A Case Report

Narcolepsy is a neurological disorder characterised by cataplexy, sleep paralysis and excessive daytime sleepiness. The literature on dental managements of patients with narcolepsy is lacking with no set guidelines for dental practitioners. A 31-year-old female presented to the dental office with a dull pain related to the maxillary left lateral incisor with Grade 2 mobility and isolated 8 mm periodontal pocket. In addition, there was loss of buccal gingiva with radiographic changes suggestive of caries and fractured crown. The patient had a history of narcolepsy with cataplexy and hypertension controlled with bisoprolol and desvenlafaxine in addition to clonazepam 1 mg/day as needed to prevent episodes of cataplexy. Patient was asked to take 2 mg clonazepam and 600 mg ibuprofen one hour before procedure. The maxillary left lateral incisor was extracted atraumatically and an immediate implant combined with allogenic bone graft and collagen membrane was placed. The procedure was uneventful, and patient left conscious and stable. After three months, the implant was restored with porcelain fused-to-metal crown and followed-up for six months without any complications. This is the first case describing a narcolepsy patient who successfully received a dental implant without developing a cataplexy episode. Clonazepam prophylaxis may be considered prior to dental procedures for similar situations.