Oral Health and Hygiene

The symptoms of Parkinson’s disease (PD) can present unique challenges in maintaining oral health and hygiene. Age-related dental problems can be especially difficult to manage for people with PD who may have difficulties with symptoms ranging from mobility issues to anxiety and apathy.

To date, studies of dental health in people with Parkinson’s hold varying results. Some studies have found that people with PD are missing more teeth, and have more cavities than people without the disease; other studies suggest the opposite. Despite conflicting evidence, it is generally understood that, in most cases, Parkinson’s does not negatively affect oral health, but rather one’s ability to perform daily hygiene and self-management tasks that can, in turn, determine health outcomes.

A recent Brazillian study of people with Parkinson’s used subjective means of measuring oral health, looking not only at dental problems, but also at chewing difficulties, denture discomfort, motor symptoms, and self-perception (Ribero et al., 2016). This study found that people with Parkinson’s had the same age-related dental concerns as the control group, though those with PD reported more negative self-perceptions of their oral health. This is likely due to the discomfort and difficulty of self-management caused by the motor symptoms of PD, and may additionally be tied to the increased anxiety and apathy present in people with Parkinson’s.

Self-management

With adequate medication management, people with Parkinson’s can maintain good oral health and hygiene, despite the challenges of motor symptoms like rigidity, tremor, and loss of manual dexterity. Here are some strategies to keep in mind:

• Whenever possible, perform your oral hygiene tasks during times when your medications are most effective.
• To get the most out of brushing your teeth, as well as to protecting your gums, brush for longer, rather than more vigorously.
• Electric toothbrushes and handle-style floss holders can help make it easier to brush and floss with a tremor.

Your dentist can help you create a personalized oral care plan, tailored to your needs. Parkinson’s can increase the risk of dental decay and injury, depending on the symptoms you experience. For example, dyskinesia affecting the mouth may cause grinding or chipping of the teeth, while balance and mobility issues can increase fall risk, and with it, the risk of damage to your teeth. PD and its medications can also cause changes in your saliva production, or a dry mouth. It is important to discuss your unique symptoms with your dentist, and report any changes with each visit.

Non-motor symptoms may also affect your oral health in a more indirect way. It is important to note any cognitive changes, depression, anxiety, apathy, or impulse control problems when visiting the dentist. As noted by Ribero et al., these symptoms can affect your perception of your oral health. This may mean that you experience greater frustration and discomfort, which can make self-care and hygiene seem more difficult. If this subsequently results in an aversion to these tasks, your oral health can decline. Your dentist can support you by providing easier options for oral care, such as prescription-strength topical fluoride and chlorohexidine brushes for greater tooth protection.

Oral care is especially important for those with late-stage PD. With disease progression, many people with PD can experience cognitive changes, speaking difficulties, and a lack of facial expression. With this, it can be extremely challenging to convey pain and discomfort. Parkinson’s progression is nearly impossible to predict, and varies greatly between individuals, so consider involving your carepartner in your oral care routine early. They can help you detect any changes in your teeth, gums, and mouth, as well as your ability to perform daily brushing and flossing.

Outside the Dentist’s Chair

While it is crucial to report all oral health concerns to your dentist, there are certain issues for which you may need to consult other healthcare professionals. Excessive dry mouth or decreased saliva production may be a complication of your medications, and should be discussed with your neurologist. Saliva is critical for oral health; it acts as an antibacterial agent, and protects your mouth by neutralizing acidic foods.

Conversely, if you experience excess saliva and drooling, along with symptoms including difficulty swallowing, a gurgly-sounding voice, or coughing when eating or drinking, you may also need referral to a Speech-Language Pathologist. Difficulties swallowing cannot be addressed by your dentist, though they may be able to suggest certain changes to your diet, such as the consistency of food and fluid, which can make it easier to swallow.

Anxiety and Phobia

Phobia of dentists and dental work is extremely common, and can be brought about or worsened by the anxiety caused by PD. Some concerns include the fear of possible pain, needles, or restraint; feelings of helplessness or loss of control; embarrassment about your oral health; or anxiety about the cost of care (Bottger & Seltzer, 2018). If you share any of these concerns, it is important to remember that dentists are specially trained to ensure patient comfort and safety, and in most cases, there is no dental or oral problem they are unprepared to treat.

Planning and preparing for your dental appointments can make a difference in your overall comfort. Consider the following:

• If you need multiple interventions, book several short appointments, rather than a single long one.
• Plan appointments around your medication on-times.
• Use the washroom prior to your appointment.
• Ask if medications used during the treatment could adversely interact with PD medication.
• Find and agree upon signals with your dentist, that will indicate if you are uncomfortable, and to what degree. Be sure to have a signal for an emergency.
• If you have a tremor that affects your jaw or mouth, discuss the possible use of conscious sedation.
• At the completion of the procedure, sit up slowly and carefully, remaining seated for several minutes if necessary. Let your dentist know that you may need extra time to leave the chair.

Anxiety is known to exacerbate the symptoms of PD. Allow yourself enough time in the waiting room to recuperate after your appointment. Tell the receptionist in advance that you may do this.

Sources

Bottger, K., Seltzer, L.F. (2018). How to Overcome Dental Anxiety. Psychology Today. Retrieved from https://www.psychologytoday.com/ca/blog/evolution-the-self/201802/how-overcome-dental-anxiety

Riberio, G.R., Campos, C.H., Garcia, R.C.G. (2016). Oral Health in Elders with Parkinson’s Disease. Brazilian Dental Journal, 27(3). 340-344. Retrieved from http://dx.doi.org/10.1590/0103-6440201600881 

This content was published in the Spring 2019 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.