Dental Diseases and Oral Health in Parkinson’s Patients

The chronic progressive neurodegenerative disorder Parkinson’s disease occurs due to dopamine deficiency and represents a constellation of continually debilitating symptoms. While the symptoms might range from premotor to motor effects, i.e. from constipation, sleep disturbances, olfactory and gustatory loss to tremors, stiffness, dyskinesia followed by a loss over muscle control and coordination.

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. The dental problems arise mainly because of the nature of Parkinson’s and some of the medications used to treat the condition. Also the symptoms associated with Parkinson’s disease makes it difficult for the patients to clean their teeth.

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 properly. 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. The patient is then advised to try to take frequent sips of water, to use vaseline over the lips, to chew sugar free gum to maintain proper salivation in the mouth and to eat a healthy diet. Such patients must not smoke, as it makes the dryness worse.
  • 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.

 

  • Increase in tooth decay: The bacteria in the plaque leads to cavities and tooth decay. It also depends upon the length of contact of the teeth with sugar, rather than the amount of sugar patient consumes. Such patients are advised not to eat or drink sugary things between the meals. Also, the patient must brush his/her teeth twice a day with a concentrated fluoride toothpaste.

 

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.

Oral Health Problems in Parkinson’s Disease

 

  • Chewing and Swallowing difficulties: The facial and jaw muscles weaken as a result of the Parkinson’s disease,  and adversely affect the control over the chewing and swallowing process. Also, the weakened muscle makes it difficult to close the lips tightly and further aggravates the swallowing difficulty leading to poor nutrition and eventual weight loss. This condition is rectified by the speech and language therapist, who suggests exercises to strengthen the lips, tongue, and throat. He also advises certain changes in the diet to include foods and liquids that are comparatively easier and safer to swallow.
  • Drooling: Drooling is a common symptom of patients with Parkinson’s disease and the condition is associated with the fact that the Parkinson’s patients are not being able to swallow as they used to do before. Incomplete swallowing causes the accumulation of saliva in the mouth. This salivary pool overflows from the corners of the mouth instead of being properly swallowed. It might complicate into sores and cracks at the corners of the mouth. Such cracks usually get infected making it difficult for the patient to carry out everyday activities which involves talking, eating meals or having a drink. The drooling gets aggravated if the Parkinson’s patient have the characteristics stooped or head-down position in which it is hard to close their lips thereby making it harder to control the saliva flowing out from the mouth. In such cases, the patient advice to follow simple facial exercises at home and help prevent the drooling
  • 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 visits to the dentist will help to identify and provide early treatment to any problem and prevent them from getting worse.
  • 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

 

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