As Parkinson’s disease progresses, many other symptoms and problems start developing, some due to the disease process itself and others due to the effects of natural aging. Of these, dental diseases and the problems associated with them need to be tackled as soon as possible so as to make the patient’s life more comfortable.

Causes of Dental Diseases in Parkinson’s Disease

• Motor problems such as tremor and rigidity may make it difficult for a Parkinson’s disease (PD) patient to brush their own teeth. Without proper assistance, a patient may be unable to tend to their daily dental hygiene regimen, which may lead to tooth decay.

• Certain PD drugs cause xerostomia or dry mouth. Lack of or diminished saliva in the mouth can cause tooth decay and periodontal (gum) diseases since saliva is necessary to fight off bacteria in the mouth which cause these dental problems.

• Necessary dental procedures may be difficult to undertake in a PD patient especially where muscle rigidity, tremor, or other types of agitation prevent the patient from remaining still in a dentist’s chair.

• Bruxism or tooth grinding, especially at night, is common in PD patients and can cause abnormal wear and tear of the teeth. It may also contribute towards temporomandibular joint (TMJ) dysfunction.

Behavioral changes in PD such as disinterest, apathy, forgetfulness and depression may make a PD patient take less interest in maintaining proper dental hygiene.

• Developing a “sweet-tooth” by taking easier to eat carbohydrates in the form of sweets and desserts can increase the risk of cavities.
• Poor denture care.
• PD patients with cognitive changes are more likely to miss dental appointments, or neglect to report dental pain or other problems to their dentist or caregiver. Therefore dental problems may only be noticed at a much later stage.

Types of Dental Diseases

Due to the above factors, a Parkinson’s patient may be more likely to suffer from the following :

• Tooth decay
• Dental cavities
• Toothache
• Accumulation of dental plaque
• Periodontal disease, such as periodontitis or gingivitis (gum inflammation)
• Teeth damage caused by bruxism can present as broken, chipped, or sensitive teeth. There may be associated soreness in the mouth, pain in the teeth and gums, jaw pain, earache, and headache.

Effects of Poor Dental Health

• Chewing difficulties – there is a tendency to avoid food that needs to be chewed, resulting in poor nutrition and weight loss.
• It can lead to swallowing difficulties.
• Speech impairment, frequently due to loose or missing teeth, and defective dentures.
• Difficulty with dentures – small partial dentures may be dislodged and swallowed, while larger dentures may not fit properly. Ill-fitting dentures can cause pain and ulceration of the supportive gum tissue.
• Change in facial contour, distortion of face and lips.

The above factors can lead to loss of self esteem and social isolation.

Management

• Regular dental checkups by a dentist, at least every 6 months.
• Regular brushing with a fluoride toothpaste to fight tooth decay.
• Use of toothbrushes with specially designed handles for better grasp or using an electric toothbrush.
• If chewing is a problem, eat smaller quantities or avoid food that needs chewing and opt for more soft or pureed food.
• Ask for assistance with daily oral and dental hygiene.
• Medicines to stimulate saliva production.
• Mouth guards or dental appliances to protect the teeth against the effects of teeth grinding.

References

1. Dental Health and Parkinson’s Disease. Parkinson’s Disease Foundation
2. Oral Health Conditions in Patients with Parkinson’s Disease. PubMed.gov