Implant‐supported denture in a patient with Huntington's disease: interdisciplinary aspects

Abstract

Patients with extrapyramidal diseases often cannot maintain independent, efficient oral hygiene due to restricted motor ability of the upper extremities and lack of coordination. The hermetic closure of the mouth and lips, and the associated ability to keep liquid and toothpaste in the mouth, can become so weak that effective oral hygiene cannot be maintained. Over a period of many years, this illness leads to loss of teeth and the need for complete prosthodontic care. Dyskinesia and hyperkinesia of the tongue and the peri-oral musculature, combined with xerostomia and pooling of saliva, make it impossible for the patient to wear a conventional complete denture, despite an anatomically-adequate bearing area. In such cases, an implant-supported prosthesis is a better therapeutic measure, although some aspects of oral hygiene must initially be disregarded. Two ITI implants were inserted into the anterior mandibular region of a patient with Huntington's chorea, because a complete denture could not be retained on the alveolar ridge, despite adequate vestibule depth, due to tongue dyskinesia. A bar joint was used to anchor this mucosal-borne denture. This implant-supported complete denture led to a clear improvement in the patient's chewing function when observed over a period of a year.

Oral and dental health in Huntington‘s disease - an observational study

“…An inefficient oral hygiene due to restricted motor ability of the upper extremities, a lack of coordination and/or an impairment of the hermetic closure of the mouth and lips due to more dys- and hyperkinesia of the tongue and of the perioral musculature might contribute to the impaired dental health status in HD [3]. We could not reveal any correlation between dental status and the mini-mental score and, therefore, we are not able to underline the thesis of cognitive decline as a reason for an impaired teeth status.…”

“…Finally, the different factors lead to a poor oral health status and loss of teeth. In the reported case an implant-supported complete denture led to a clear improvement in the patient's chewing function [3]. …”

Critical appraisal of evidence supporting the placement of dental implants in patients with neurodegenerative diseases

“…Of the 11 included papers, eight were case reports [9][10][11][12][13][14][15][16] and three were case series (including two case series with three patients each) [17][18][19] . Seven reports 9,10,12,13,16-18 were related to patients with PD, two reports 11,15 were related to Huntington's disease (HD), and two reports were related to dementia 14,19 . Initially, one case series 20 on the placement of dental implants in patients with various systematic diseases and congenital defects (including one case of amyotrophic lateral sclerosis, a neurodegenerative disease) was included.…”

Characterization of dental pulp stem/stromal cells of Huntington monkey tooth germs

“…The hallmark of HD is neurodegeneration, predominantly in the striatum and cortex [19]. Many HD patients do suffer from tooth decay; however this decay is due to medication and lack of motor skills to perform teeth maintenance procedures [20,21]. Here we have used transgenic HD monkeys [22] as a model for investigating the effect of mutant htt on the properties of DPSCs.…”