A patient with Parkinson’s disease has to contend with major signs and symptoms, such as tremor, rigidity, slowness of movement, and postural disturbances, but sometimes minor problems, such as mouth ulcers can, cause much distress. It is important that care givers treat even these minor ailments with care and concern as a Parkinson’s patient is scared and concerned of even the slightest physical problem. A Parkinson’s patient may be educated about the disease but nevertheless, even unrelated signs and symptoms can be distressing and upsetting for them.
Mouth ulcers, also known as oral canker sores, are open sores in the soft tissues of the mouth, occurring under the tongue, inside the cheeks or lips or at the base of the gum. They may also occur on the lips, angle of the mouth or around the mouth and may be extremely painful. Most mouth ulcers are small and heal on their own, but when they become large or painful, treatment is necessary. In a patient with Parkinson’s disease, treatment should be supervised by a doctor, even for a minor ailment like mouth ulcers.
Causes of Mouth Ulcers in Parkinson’s Disease
A number of factors related to Parkinson’s disease may cause mouth ulcers, apart from the common causes in persons without the disease.
- Decreased immunity due to old age as well as due to Parkinson’s disease itself.
- Deficiency of vitamin B-12, folic acid, zinc or iron possibly a result of difficulty in swallowing and poor nutrition in Parkinson’s disease.
- Treatment of hypersalivation in Parkinson’s disease by intraglandular botulinum toxin injection or by radiation often leads to dry mouth, which predisposes to formation of mouth ulcers.
- Ill-fitting dentures, especially in older patients.
- Emotional stress and depression.
- Minor injury to the mouth by accidental cheek or tongue bite, hard toothbrush, acidic or spicy food, or injury during a dental procedure.
- Certain brands of toothpastes or mouth wash.
- Food sensitivity or allergies in Parkinson’s disease.
- Certain foods and drinks such as coffee, chocolate, strawberries, pineapple, or nuts which may cause tiny cuts and irritation of the mouth lining.
Treatment of Mouth Ulcers in Parkinson’s Disease
Small ulcers of the mouth often heal on their own but if the ulcers persist, or cause pain on opening the mouth or eating, treatment has to be undertaken. Relief of symptoms is the main aim of treatment but the cause should be identified and treated too.
- Mouth rinses containing corticosteroids may help to reduce pain and inflammation.
- Applying topical pastes to the ulcers at an early stage help to reduce pain and cause rapid healing of the ulcers.
- Oral medicines such as cimetidine and colchicine, though not specific for mouth ulcers, often help in healing. Always consult with your doctor before using any additional medication so as not to interfere with your drug therapy for Parkinson’s disease.
- A topical solution which heals by chemically cauterizing the ulcer. There are many brands on the market and you should discuss your options with your doctor.
- Nutritional supplements containing vitamins B-6, B12, folic acid, iron, or zinc should be administered if there is a deficiency.
- Alternative treatments may be tried such as using zinc lozenges, rinsing the mouth with salt water or elixir of diphenhydramine (without swallowing it), or applying a dab of milk of magnesia to the ulcer.
- Issues related to problems with eating have to be tackled, such as cutting up the food into smaller pieces or serving soft, mashed or pureed food.
Prevention of Mouth Ulcers
These measures apply to any person with mouth ulcers and are no different for Parkinson’s patient.
- Good oral hygiene.
- Eating a healthy balanced diet.
- Avoiding foods that irritate the mouth.
- Proper fitting dentures.