Dentistry and Parkinson's disease: learnings from two case reports

Kaka, Shazia; Lane, Helen; Sherwin, E.

doi:10.1038/s41415-019-0470-9

Cited by 8 publications

(13 citation statements)

References 30 publications

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“…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 [3,4,18,28,30,48,52,76,102,103]. Decline in the quality of the toothbrushing (not necessarily in the frequency [74]) and lack of interdental cleaning reduce the efficacy of plaque control, promoting gingivitis, and initiating or aggravating periodontitis and dental caries.…”

Section: Problems Faced In Maintaining Good Oral Care At Homementioning

confidence: 99%

“…Because of motor and nonmotor fluctuations, patients' behavior can change from minute to minute and may require stopping dental procedures [18,83], while anxiety and stress worsen motor symptoms [111]. Muscle rigidity, poor muscle control (lips, jaw, tongue), oral festination [57], facial dystonia [56], orolingual tremor [34,35,[112][113][114], dyskinesia (flycatcher tongue), impaired neck and head posture, or dysphagia (saliva accumulation) lead to difficulties in dental examination and oral rehabilitation [30,48,83,102,108,109], and can even compel the use of general anesthesia [102].…”

Section: Dental Appointments: a Challenge To Both Patients And Dentistsmentioning

confidence: 99%

“…Finally, dentists may have limited knowledge and experience regarding the specific needs and management of PD patients [17,74,86,102]. The patient-dentist relationship is hampered by several PD-related verbal and non-verbal communication impairments.…”

Section: Dental Appointments: a Challenge To Both Patients And Dentistsmentioning

confidence: 99%

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Oral Health Disorders in Parkinson’s Disease: More than Meets the Eye

Auffret

Meuric

Boyer

et al. 2021

JPD

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Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.

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Section: Problems Faced In Maintaining Good Oral Care At Homementioning

confidence: 99%

Section: Dental Appointments: a Challenge To Both Patients And Dentistsmentioning

confidence: 99%

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Oral Health Disorders in Parkinson’s Disease: More than Meets the Eye

Auffret

Meuric

Boyer

et al. 2021

JPD

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“…Kaka, et al described a case with two patients, who suffered dyskinesias, which main relief of symptoms were observed from 30 to 60 minutes after taking medication and their symptoms started reappearing 3 hours after (in this case, the drug that was used was co-careldopa). Also, the same scientists suggested, that for longer treatment periods, a small dosage of Intravenous (IV) midazolam sedation can help reduce the symptoms [6]. Moreover, Boyd, et al described, that when the patient uses anti-PD drugs (like levodopa, which enhances brain levels of dopamine), it can cause nausea and vomiting, which may aggravate any prosthetic procedure inside the patient's mouth [16].…”

Section: Evaluation Of the Best Prosthetic Dentistry Treatment Timing After Consuming Pd Medicationmentioning

confidence: 99%

“…This affects not only the patients themselves, but also their families and caregivers, because of restricted mobility and control of their muscles [5]. Various treatment options can help the patient, including drugs, such as dopamine agonists, monoamine oxidase B inhibitors, COMT inhibitors, and Levodopa (L-dopa) formulations [6]. In dentistry, the main goal of prosthodontists should be to guarantee a good quality of life for patients who have PD.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2020

Int J Oral Dent Health

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Background: Parkinson's disease is one the most widespread illnesses in the world, affecting up to 1% of the whole population above 60 years. It is also considered the most frequent movement disorder and the second most common degenerative disease of the central nervous system. The main goal of prosthodontists should be to guarantee a good quality of life for patients ill with Parkinson's disease (PD). Methods:The PubMed database was used to search the literature published from January 1, 2015 until February 20, 2020. The aim was: 1) To critically review the literature on dental prosthetic treatments that can be done for patients, who have Parkinson's disease; 2) To analyze what is the best time to assign the treatment; 3) To find out how it affects the patients quality of life. Analysis of literature was performed using the PRISMA analysis protocol. Articles were identified in both PubMed and ScienceDirect databases. In each of the studies, we analyzed information for: Prosthetic dental treatment options for patients with PD, most successful approaches to the treatment and factors ensuring good life-quality afterwards.Results: 15 studies were included in the systematic review, according to inclusion and exclusion criteria. It is suggested, that the best way to restore PD patients' masticatory function, is by using implant-supported fixed prosthesis. Also, removable dentures are a viable restorative option for PD patients, although, reduced biting forces and lower jaw movements need to be taken into consideration. Moreover, before any prosthetic dental treatment, the doctor has to be informed about the patients' medication consumption time, to prevent the occurrence of tremors during the visit. In addition, the most viable treatment plan should always be chosen according to patients' quality of life as one of the main factors. For this reason, it is concluded, that non removable restorations increase the patients' quality of life significantly more than removable ones. Conclusions:Parkinson's disease affects not only mastication, but also swallowing and verbal functions. In order to improve patients' quality of life, these functions need to be rehabilitated by using implant-fixed dental prosthesis as the best option. Because of functional impairment, prosthodontists should pay attention to keeping the patient in vertical sitting position, strictly control salivation, and also assess patients' medication intake time. Moreover, when helping the patients to clearly understand the treatment plan and maintain good oral hygiene, caregivers' assistance is needed. In addition, during aftercare, an electric toothbrush is recommended, since PD patients have trouble sustaining repetitive motions. This is the best way to ensure a successful prosthetic treatment.

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