Oral Rehabilitation Of Parkinsons Disease Patient: A Review And Case Report
Mohammed M. Al Moaleem
1Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Khalid University, P.O. Box 3263, Abha 61471, Saudi Arabia
2Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, P.O. Box 114, Jazan, Saudi Arabia
3Division of Oral Medicine, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Najran University, Najran, Saudi Arabia
4Division of Periodontology, Department of Preventive Dental Sciences, College of Dentistry, King Khalid University, P.O. Box 3263, Abha 61471, Saudi Arabia
5Division of Oral Biology, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Khalid University, P.O. Box 3263, Abha 61471, Saudi Arabia
6Division of Oral Pathology, Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Khalid University, P.O. Box 3263, Abha 61471, Saudi Arabia
2. Case Report
Conflict of Interests
Prior To And During Dental Treatment
Ensure the patient has been compliant with medication coverage. If there are any questions regarding compliance, contact the patients physician.
Ascertain that the patient has no toxicity with the medication taken and that mental function is normal.
Patients taking valproic acid may have increased bleeding during procedures. If there are acknowledged problems, order a bleeding time assessment prior to treatment and consult with a physician if the values are questionable.
During dental treatment, be aware that a grand mal seizure could occur. If a seizure occurs, place the chair back to a supine position, turn the patient to the side, and keep the patient comfortable without restraint until it has passed. Placement of a tongue blade is not recommended unless the patient is aware of an impending seizure and can assist in its placement.
If injury to the lip or tongue occurs during a seizure, appropriate treatment such as suturing of lacerations, localization of potential fractures, removal of fragments, and follow-up dental treatment is required.
Dental Treatment Of Patients With Stroke Residual
In patients who have experienced physical deficits , personal oral hygiene efforts may be compromised. Treatment planning should include the following:
Comprehensive oral hygiene instruction that may include instruction on use of an electric toothbrush or a large hand-held toothbrush or water irrigation instrument coupled with plaque-revealing tablets running a washcloth through the vestibule can help to reduce accumulation of food matter
Recommendation regarding anticaries preparations, including rinses containing fluoride and xylitol or the use of xylitol lozenges to help reduce the oral bacterial burden of Streptococcus mutans
The possible need for an antifungal prescription, as the accumulation of saliva in patients with facial palsy may be problematic at the corners of the mouth and can predispose the patient to fungal infection
Awareness that depending on the type of stroke, the poststroke patient may have been prescribed anticoagulant medication
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Communication With Your Dentist
As I mentioned before, I was recently at the dentist to remove some bad teeth that had broken and were giving me trouble. I knew deep down the importance of healthy teeth and the adverse health effects overall if I waited. So, I chose a dentist based on a recommendation by my neurologist, with whom he consulted with regarding sedation and other precautions.
This gave me a little less anxiety, but I feared the pain and anguish of drooling all over myself. Which I did! But I digress. After the procedure, I was prescribed appropriate pain medication and given instructions that would avoid infection.
Looking back at the whole experience, I needed to address two real problems: the importance of oral health in general and, ensuring the dentist is understanding and accommodating for people with Parkinson’s. I cant say that I am for sure dento-phobic, but I am assured that my dentist understands my Parkinsons and accommodates me accordingly.
Increased Inflammation Of The Gums And Periodontal Disease
Due to the presence of teeth plaque and tartar, gums can become inflamed. The gums look red, bleed easily , and can feel painful. When the plaque is removed, the gums mostly recover. However, when not only the gums are infected, but also the underlying alveolar bone , it is called periodontal disease. When you suffer from periodontal disease, the alveolar bone weakens, and as a result teeth can become loose and eventually fall out. This process is irreversible. Inflammation of the gums and periodontal disease can be prevented by good oral hygiene and regular professional teeth cleaning. Smoking has a strongly negative effect on the gums and the periodontal system.
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Barriers To Dental Health
Long-term prescription medication usage can have an adverse effect on early and accelerated tooth decay.1 It is my opinion that some medications, although not directly to blame, do cause excessive saliva causing fungal infections in your mouth.
The same can be said about dry mouth which can lead to eroding of enamel and gum disease. The Parkinson’s Foundation is a wonderful resource for dental health. Here are some dental health considerations:
- Dental health is rarely discussed by neurologists.
- Parkinsons symptoms often present a problem in regular dental visits.
- Deep Brain Stimulation can make visits especially complicated.
- Depending on symptoms, just getting to the dentist could be difficult.
- Your visit may result in prescribing medication that is contraindicative to your PD meds.
Selection Of Studies And Data Extraction
Two authors independently reviewed the title and abstracts recovered through the search using the Rayyan platform . References identified as potentially eligible were analyzed in full text. Any disagreement was resolved by a third reviewer.
Data extraction from the studies included was performed by four independent reviewers using a pre-established data extraction form. The data gathered comprised the main characteristics of the studies included . Any disagreement was resolved by two other review authors.
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Ways Of Better Ensuring Good Dental Care In Parkinsons Reviewed
Another PD issue that can affect oral health is swallowing. Dry mouth and decreased strength in jaw, tongue, or facial muscles affect swallowing. Eating nutritious foods because of problems with chewing and swallowing can lead to more dental problems such as cavities and mouth ulcers.
Bev had speech therapy for swallowing issues that started in the past year. The therapist recommended taking smaller bites when chewing and before swallowing, eating more slowly before swallowing, and sitting upright with her head up when eating.
Jaw exercises to strengthen muscles in the mouth and jaw may also help PD patients with improved quality of life and oral health.
A literature review titled Evidence-Based Recommendations for the Oral Health of Patients with Parkinsons Disease, published last March in the journal Neurology and Therapy, concluded that Patients with PD had reduced quality of oral health and hygiene, and high prevalence of gingival recession , periodontal disease , dental calculus , tooth decay, tooth mobility and loss, drooling, xerostomia , dysphagia and temporomandibular disorders.
Because of the challenges of oral health for people with PD, routine consultations with an oral surgeon in addition to a general dentist may be recommended.
How Might Parkinson’s Affect Teeth And Oral Health
Keeping teeth and gums healthy can be more difficult if you have Parkinsons disease. Motor symptoms, such as bradykinesia and rigidity, may hamper good daily oral hygiene care. Parkinsons disease can also effect the orofacial muscular system, causing difficulties in swallowing, chewing and controlling dentures. In addition, the oral environmental balance and the quality of the saliva can be influenced by medication.
The paragraphs below illustrate the most common problems related to the mouth in people with Parkinsons.
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Etiology And Neuromuscular Pathology
The neuromuscular system is a highly sophisticated network of neural and muscular fibers that work synergistically to facilitate movement. Normally, motor signals are initiated in the motor cortex of the brain and forwarded to the basal ganglia via motor neurons.7 The striatum of the basal ganglia carries these motor signals to the SN, where dopaminergic neurons are highly concentrated, and movement is regulated. Dopamine plays an important role in producing involuntary motion via motor pathways. Also, dopaminergic neurons in the SN influence the expression of neuromelanin, a substance that helps protect these neurons from oxidative stress.8 When pathologies arise within these pathways, they can manifest systemically with neuromuscular symptoms of rigidity, akinesia or dyskinesia, which are among the most prominent signs of PD.9,10
PD results in an overall deficiency of dopamine because of atrophy of the melanin-containing dopaminergic neurons within the SN and other pigmented nuclei of the brainstem.1 This reduction in pigmented nuclei is the hallmark sign of PD.2 Patients with PD may present with up to 8090% depletion in dopaminergic neurons, which significantly impairs motor regulation in the SN resulting in delayed or uncoordinated movements. The precise mechanism leading to PD is unknown, and it is thought to be better classified as a syndrome of multiple etiologies rather than a stand-alone disease.11
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A Letter To My Dentist
- I have PD and it is difficult for me to sit still.
- Ive also had deep brain surgery, and now I have medical implants.
- You might want to warn the x-ray tech. Its not a tumor!
- I am experiencing some anxiety about this procedure.
- Could you consult with my neurologist prior to this procedure?
Dont be scared. Even those people living with PD need regular dental checkups. Maybe you can get a sticker too that says really cool patient! Remember to keep battling my friends.
Success Rates Of Dental Implant In Patients With Parkinsons Disease
Info: 4824 words Nursing Essay 11th Feb 2020
Introduction of Clinical Question
Parkinsons Disease is one of the most common conditions that present with orofacial dystonia and dyskinesia .
This leads to patients with the disease having trouble performing everyday activities such as eating, speaking and maintaining oral hygiene . Parkinsons Disease is more often seen in men than women and affects every 120 out of 100,000 people. There are two modes of this disease. The first is a genetic form which only consists of 5% of people with Parkinsons and occurs at a young age. The second occurs around the age of 57 and is deemed idiopathic as it has a more complex etiology where there is a familial and environmental component . Secondary Parkinsonism can be drug-induced. Parkinsons disease is caused by the death of dopaminergic neurons in the substantia nigra and locus coruleus. It is caused by the presence of Lewy bodies in the nerve cells in areas as such .
These neurons, which are subsequently destroyed, are necessary for the control of movement and coordination. Patients begin to experience symptoms once there is about a 65% reduction in functioning dopaminergic neurons .
Patients Presentation of Condition or Risk
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Q: How Do Botulum Toxin Injections Affect Oral Health
In some instances, medications can be prescribed to control excessive saliva or drooling for people with Parkinsons. Sometimes these medications are not effective enough to satisfactorily control drooling. In that case, your physician might suggest injections of botulinum toxin. Small amounts of botulinum toxin are injected directly into the salivary glands inside the mouth in order to temporarily shut down saliva production. Typically, botulinum toxin is injected into the parotid glands and/or the submandibular glands. Parotid glands are activated during chewing and submandibular glands produce a significant amount of saliva . These injections can be an effective approach to addressing drooling and can provide relief for up to 3 months at a time. Another benefit may include keeping dentures properly sealed and reducing breakdown of the skin in the corners of the mouth.
Occasionally this approach can simply be too effective at reducing saliva production, causing dry mouth. As previously outlined in this article, dry mouth caused by lack of saliva can have a negative impact on oral health.
Suck on sugar free hard candies or chew sugar free cinnamon gum to initiate saliva production.
Dental Health And Parkinsons Disease
Parkinsons disease is a disorder of the nervous system that affects motor skills. It is a progressive disease that impacts about one million people in the United States. It occurs most often in older people but can also be seen in people under the age of forty.
Special Needs DentistryInterested in more Special Needs Dentistry posts from the Center for Dental Anesthesia? .
Parkinsons disease is a movement disorder. The most common physical symptoms include loss of dexterity, tremors, impaired balance, and slowness of motion. Due to the impact on fine motor skills, these symptoms can seriously affect a patients oral and dental health.
It can also make it difficult for someone to simply get to the dentists office. Even then, many dentists have not had much experience with PD patients. But at the Center for Dental Anesthesia in Alexandria, special needs patients, including those with Parkinsons, are a big focus of our practice.
Dental Health Issues
Nearly half of all PD patients have a problem with brushing and flossing their teeth. This is a serious matter, since the link between oral health and general health is by now well-established.
Dental health issues common in PD patients include:
Because of these and other dental health issues associated with PD, regular visits to the dentist are recommended.
PD Patients in the Dental Chair
A dentist and hygienist are essential to the oral health care of Parkinsons patients.
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Mouth And Dental Issues
Some people with Parkinsons may have problems with their mouth and dental health.
A healthy mouth will help you to chew, taste, swallow and speak properly. Strong, healthy teeth allow you to enjoy your choice of food.
These can include:
Saliva is really important for good mouth health:
- It helps you taste your food.
- It lubricates food to help you swallow.
- It is antibacterial and has enzymes to help you eat and digest food.
Without enough saliva you may experience a dry mouth. A dry mouth can lead to higher rates of tooth decay and gum disease. It can increase your risk of getting tooth decay in the exposed roots. It may also cause dentures to become loose and hard to control.
A dry mouth can also increase the damaging effects of sugar on your teeth. Because of this it is important to watch what you eat and when you eat.
Some Parkinsons drugs can reduce the flow of saliva to your mouth. Tell your dentist if you experience this as they can discuss options which might help. They may ask you what drugs you take, so take a list of your medication to your appointments.
Tell your GP, specialist or Parkinsons nurse too as they may be able to prescribe different treatments that may not cause this problem. Saliva substitutes are also available. You can ask your dentist or local pharmacist about them.
The following tips may help reduce dry mouth.
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Will My Parkinsons Mean I Need To See A Specialist Dentist
Its important to tell your dentist that you have Parkinsons and how it affects you.
Most dentists will be able to treat people at all stages of the condition.
If your dentist feels you need specialist care, they will refer you to a colleague on the General Dental Councils special care register.
If you have to have dental surgery, talk to your dentist about Parkinsons symptoms you experience and how these may affect your operation.
You should also tell your dentist about your drug regime so that you continue to get the right dose when you have your operation.
If youve had deep brain stimulation and you now need to have a dental operation, you will need to take antibiotics. This will help make sure that you dont get an infection or another issue that could affect your deep brain stimulation device.
If you wear dentures Parkinsons may mean you have difficulty controlling them. This could be because of:
- problems controlling your facial muscles
- loss of muscle tone
Eligibility Criteria For Including Studies
Clinical trials and observational studies assessing different aspects of oral health among patients with PD were included in this review. These involved associations between different aspects of PD and oral cavity diseases, along with any type of treatment or preventive strategies. Case reports, reviews, guidelines and experimental studies were excluded. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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