Sunday, August 7, 2022

Parkinson’s And Dental Issues

Dental Health And Parkinsons Disease

Parkinson’s Disease and Dental Health

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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The Basics Of Oral Health And Parkinsons

Every year, the top Parkinsons experts from around the world who treat people with Parkinsons at a Parkinsons Foundation-designated Center of Excellence convene to discuss the latest Parkinsons research and treatments. This article summarizes the 2018 Center Leadership Conference presentation on oral health by neuroscientist Cameron Jeter, PhD, The University of Texas Health Science Center at Houston speech-language pathologist Linsey Heidrick, MA, CCC-SLP, University of Kansas Medical Center geriatric dentist Marsha Pyle, DDS, University of Missouri-Kansas City and moderator Irene Litvan, MD, UC San Diego School of Medicine. Read the articles covering some of the other topics discussed: intimacy issues, art therapy, new therapies in trial and music therapy.

Maintaining oral health is important for people with Parkinsons disease . Parkinsons symptoms can easily complicate dental care. A panel of PD experts at a Parkinsons Foundation conference recently discussed oral health and saliva management two PD-related issues not discussed often enough.

When it comes to Parkinsons and oral health, the goals are to preserve dental health and minimize the negative impact disease treatment may have. People with PD commonly experience problems related to the four dreaded Ds of oral health:

  • Dry mouth

Problems Faced In Maintaining Good Oral Care At Home

Brushing, flossing, and interproximal brushing are critical components of oral self-care . These hygiene maneuvers require muscle-eye coordination, digital dexterity, and tongue-cheek-lip control. Such actions become more difficult to achieve as PD progresses, due to tremor of hands, lips and tongue, bradykinesia, dyskinesia of the hands and jaws, fluctuations, muscle stiffness, and postural deformities . Decline in the quality of the toothbrushing and lack of interdental cleaning reduce the efficacy of plaque control, promoting gingivitis, and initiating or aggravating periodontitis and dental caries. Moreover, such fine movement impairments induce more difficulties in the frequency and quality of prosthesis hygiene, leading to biofilm accumulation . Discomfort with mouthwashes, possibly due to dysphagia and fear of choking, has also been reported . These ineffective oral hygiene measures add to the pre-existing disturbed self-cleaning mechanisms of the mouth .

Finally, when present, neuropsychiatric disorders also contribute to patients difficulties: apathy, depression, fatigue, anosognosia, cognitive decline and dementia may all lead to negligence in daily care, making compliance with a home care regimen difficult .

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Ease Home Dental Care

These tips can help you navigate PD-related dental challenges:

  • Use a toothbrush with a large-handled grip and soft bristles. A small brush head reaches the corners better. To make the toothbrush easier to grasp, place the handle inside a bike handlebar grip or tennis ball or use an electric toothbrush.
  • Aim to brush after every meal for two minutes, also brushing the tongue. It is best to brush one-handed, using the stronger side of the body. If it is not possible to brush after a meal, simply rinsing the mouth with water will help.
  • Floss. This may mean getting help from a caregiver. For fluoride rinses, if swishing and spitting are difficult, the dentist may recommend a brush or sponge applicator. Antimicrobial mouth rinses can also be applied with a brush.

*Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.

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The chronology and combination of orofacial symptoms may give insights into disease progression . The Swedish Jönköping Parkinson Registry has recently highlighted that orofacial symptoms were correlated with PD severity, symmetry of motor disturbances, and autonomic disorders. The more severe orofacial burden was at baseline, the faster patients progressed to more advanced stages . As stated earlier, some orofacial symptoms occurs early in the disease course , whereas others are more apparent and frequent in advanced stages . Considering that only a few of these disorders have been thoroughly assessed in PD, more longitudinal studies with larger stratified samples are needed to further explore their predictive value. A recent Korean nationwide population-based cohort study has thus suggested that an increased number of missing teeth may be an important risk indicator of new-onset PD .

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Increased Decay Of Teeth

Caries is caused by bacteria in teeth plaque. These bacteria change sugar into acid, which damages the teeth. To prevent caries, it is therefore important to limit the frequency and amount of sugar intake and to remove teeth plaque from teeth surface. Fluoride in toothpaste can contribute to stronger teeth. Recent research demonstrates that people with Parkinsons tend to have more dental caries than other people.

Advice to prevent caries includes:

  • Try to limit sugary food to mealtimes only, and no more than four times a day.
  • Limit sugary drinks to mealtimes only. Tea or coffee should be taken without sugar between meals.
  • Do not rinse your mouth after brushing your teeth. This allows fluoride to continue to work to protect your teeth.
  • Try to avoid eating or drinking for 30 minutes after brushing your teeth.

Dental Health In Parkinson’s

Regular visits to the dentist are important for all of us. For a person with Parkinsons disease , dental care is particularly critical as PD can impact the health of the mouth, teeth and jaw and make dental care challenging. Poor dental hygiene can affect nutrition and increase risk for stroke, cognitive impairment and weight loss. People of all ages with PD face similar challenges, but for those who are older, the problems can be especially serious. Read below and follow the tips to enjoy eating foods you prefer for as long as possible, rather than limiting yourself to what your teeth will tolerate.

Barriers to Dental Health in PD

Physical Barriers:Because of the physical effects of Parkinsons, such as rigidity and tremor, nearly half of all people with PD have difficulty with their daily oral hygiene regimen. These symptoms also make going to the dentist more difficult and uncomfortable. Weakened swallowing ability can increase the risk of aspiration during treatment. Additionally, people with PD who have been on medications like levodopa for several years may begin to develop dyskinesias , which can affect the jaw and cause cracked teeth and teeth grinding. This may create problems during dental exams and at home.

Behavioral Barriers

People who experience cognitive changes also may be more likely to miss dental appointments and less likely to report dental pain to their care partners or dentist, leaving issues unaddressed for too long.

Maintaining Dental Care at Home

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Whom Should People With Parkinsons Disease Consult For Dental Care

You shouldconsult your dentist at regular intervals. A dental doctor will take care ofcustomized solutions to treat oral diseases in Parkinsons patients. Similarly,you can get cleaning techniques and appliances like interdental cleaners forteeth cleaning amidst the rhythmic shaking movements in your hands.

Likewise, the following medicinal practitioners also help in managing dental health in Parkinsons patients:

  • Dietician
  • Speech and Language Therapist

Why Is Dental Health So Important In Parkinsons

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Managing dental health and Parkinsons is an integral part of living well. Regular dental care can minimize your risk of experiencing pain and discomfort, but most importantly, it can reduce the risk of infection, which can be a significant stressor on the body when coupled with Parkinsons-related challenges.

In this post, we provide essential information and tools so you can learn more about dental health and Parkinsons and improve your dental health.

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Dental Health Issues In People With Parkinsons Disease

ParkinsonsDisease is a neurological illness that infects the nerve cells in the brainresponsible for body movements. The disorder begins with the selectivedestruction of mesencephalic dopaminergic neurons and it is prevalent in peopleaged above 65 years. It affects both the motor & non-motor skills of ourbody and is characterized by instability, reduced dexterity, slowness ofmovement, dizziness, etc.

As it is amultisystem disorder and affects the spontaneous movements in arms, legs, andparts of our body, handling our daily activities will become burdensome. Forinstance, tooth brushing with a shaking hand will reduce the oral hygieneactivity quality. Right?

Besides this,such motor limitations will harm our oral cavity in certain other ways.

Many dentists do not have enough experience to treat dental illnesses in people with Parkinsons Disease. Based on our experience and research, we have explained the impact of this neurodegenerative disorder on oral health and tips to combat its aftereffects to an extent here.

Do I Need To See A Dentist Who Specializes In Parkinsons

Most dentists will be able to treat you regardless of how advanced your Parkinsons disease is. However, it is vital that you tell your dentist you have Parkinsons disease and the associated symptoms.Your dentist will suggest a routine adapted to the condition of your mouth in order to prevent, identify and treat the problems most often associated with Parkinsons disease. They will also be able to give you brushing techniques that are best suited for the condition of your mouth.

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Towards Better Oral Health Awareness In Pd

Promotion of oral health awareness must be put on the agenda of movement disorders teams. Dentistry should be integrated into PD course of care, alongside neurology and other medical consultations . It is probable that patients would be more active in searching for access to oral care if they were aware of the link between oral and systemic health . Awareness-raising actions involving movement disorders teams, dental teams and PD patients associations are to be carried out.

Regarding clinicians education, oral health modules developed in cooperation with dentistry schools and targeted to neurologists and PD nurses should be considered, as previous experiences of integrating such educational programs into the medical curriculum were positively received . In order to enhance knowledge of PD oral and general specificities and limitations, dental students should join PD rounds in teaching hospitals whenever possible . PD modules targeted to educate dental students and update oral health professionals on caring for PD patients should also be created and routinely implemented. This would increase the cooperation between dentists and neurologists.

Q: How Can Medications Improve Oral Health

Speech Problems &  Parkinsons Disease

Generally speaking, medications for Parkinsons can improve oral care and oral health by improving movement and motor control. These medications allow people with Parkinsons to move with more precision and less effort which facilitates better oral care. Deep brain stimulation treatment often provides a similar effect by improving movement that can lead to better oral care.

There are no specific medications prescribed directly to improve oral health. However, your dentist may recommend special oral care devices, as well as specialized toothpastes or oral rinses. For example, an oral rinse called chlorhexidine gluconate can be very effective when used in conjunction with brushing and flossing. Chlorhexidine is preferable to many over the counter mouthwashes because it does not contain alcohol, which can exacerbate symptoms of dry mouth and irritate oral tissues. Please note that this oral rinse requires a prescription from your dentist.

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Why Are People Living With Parkinsons Disease At Risk Of Developing Oral Health Problems

Certain symptoms of Parkinsons disease and side-effects of medications can cause dental and oral problems.

Having a dry mouth can cause discomfort and difficulty swallowing and speaking, but it can also lead to more serious problems such as cavities and gum disease. Dry mouth is a common side-effect of the anticholinergic medications used to treat Parkinsons disease and other health problems you may have.

Your doctor may change or adjust your medication to alleviate your dry mouth. You can also:

  • Use over-the-counter toothpaste, mouthwash or lozenges recommended for dry mouth.
  • Have sugar-free candy or gum that contains xylitol. If you eat regular candy, be aware that you probably wont have enough saliva to neutralize the sugar in your mouth, putting you at greater risk of developing cavities.
  • Sip water frequently to hydrate your mouth.
  • Talk to your dentist about prescription fluoride treatment, as dry mouth can lead to tooth decay.
  • Avoid mouthwash that contains alcohol, as it increases dryness.
  • If you wear dentures, remove them at night to give your mouth a chance to recover.

Sometimes, the opposite problem occurs. Your mouth may have a little excess saliva due to decreased swallowing movements. You arent actually producing more saliva, youre just not swallowing as well. Your doctor or a speech therapist can help you improve your swallowing.

Parkinsons disease also affects the muscles in your jaw and face, which may contribute to your difficulty swallowing and chewing.

Dental Appointments: A Challenge To Both Patients And Dentists

The use of dental care services mainly depends on their accessibility and affordability . While several barriers have been identified at the individual, organizational and policy levels for elders and vulnerable people, PD patients have to face even more challenges in accessing and undergoing dental treatment.

Cognitive decline and dementia may prevent patients from reporting oral and dental symptomatology and complying with dental treatment . In addition, cognitive disorders make them more likely to miss dental appointments or react with care-resistant behavior when receiving assistance .

Finally, dentists may have limited knowledge and experience regarding the specific needs and management of PD patients . The patient-dentist relationship is hampered by several PD-related verbal and non-verbal communication impairments. Hypomimia and amimia are linked with reduced facial expressiveness, fixed gaze, disruption of facial emotion recognition , and alterations in the facial expression of pain . Speech and language disorders directly impair verbal communication, while cognitive impairment as well as micrography and other handwriting abnormalities complicate the picture.

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Practical Tips For Effective Oral Self

Nearly half of all people with PD have difficulty with their daily oral hygiene regimens.3 Dental hygienists should provide patients with explicit instructions to help them maintain good oral hygiene. These instructions should be provided in both written and verbal forms to patients and caregivers.15

Dental hygienists should recommend that patients sit down to brush and floss. This not only reduces the risk of falling, but also helps conserve energy. A shower or commode chair works well for this. Patients can prop their elbows up on the bathroom sink if their shoulders tire easily.16

Patients with PD?may be better served with a power toothbrush or manual toothbrush specially designed for those with limited dexterity. Oral devices can be made easier to hold by attaching a tennis ball on the end of the handle. A dental water jet to provide at-home irrigation may also be helpful. Floss threaders, floss holders, other adjuncts used with traditional floss, and interdental brushes may improve the efficacy of flossing, as well as compliance.

How Might Parkinson’s Affect Teeth And Oral Health

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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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Dental Caries And Periodontal Disease

A study conducted to evaluate the prevalence of periodontal disease in different groups of seniors aged between 60 and 79 years, including patients with PD, patients with mild neurological disease but no cognitive or motor impairment, and patients suffering from acute ischemic stroke revealed a higher frequency of patients with PD with untreated caries. More PD patients had caries, fewer remaining teeth, and higher rate of deep periodontal pockets compared to the other study groups.

The study proposed that many factors contributed to the inability of PD patients to maintain proper oral hygiene, including:

Physical Barriers

The physical symptoms of PD makes it hard for patents to maintain proper daily hygiene, and even harder to keep up with periodic office examinations. Typical dental care home practices require digital dexterity, muscle-eye-coordination, and tongue-lip-cheek control. Any disease that interferes with these faculties hinders the effectiveness of associated oral hygiene procedures.

Nearly 50 percent of PD patients have difficulty maintaining their daily oral hygiene regimen, which makes them less likely to clean their teeth or dentures daily.

Other symptoms of Parkinsons, such as rigidity, tremor, and abnormal posture, may make it difficult for patients to visit a dentist for oral examination. Some patients may also experience:

Behavioral Barriers

Future Directions And Areas For Further Study

To provide holistic care, clinicians must understand the overlap between neurology, internal medicine and dentistry in PD. As previously mentioned, oral health education and interdisciplinary cooperation are all initiatives that favor patients autonomy and would therefore be empowering. The under-reporting of oral health disorders may be partly due to anosognosia. However, the fact that clinicians do not focus on these disorders certainly contributes to such issue . This could be due to a lack of awareness, diagnostic criteria, and available routine screening tools, which need to be properly addressed.

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