Future Directions And Areas For Further Study
To provide holistic care, clinicians must understand the overlap between neurology, internal medicine and dentistry in PD. As previously mentioned, oral health education and interdisciplinary cooperation are all initiatives that favor patients autonomy and would therefore be empowering. The under-reporting of oral health disorders may be partly due to anosognosia. However, the fact that clinicians do not focus on these disorders certainly contributes to such issue . This could be due to a lack of awareness, diagnostic criteria, and available routine screening tools, which need to be properly addressed.
Towards Better Assessment And Care
The oral health deserves more attention in PD than a sole assessment of dysphagia, sialorrhea and dysarthria. To overcome the limitations of the MDS-UPDRS scale as a measurement of PD orofacial symptoms , there is a need for better tools and questionnaires assessing all the oral symptoms associated with PD that could be used routinely by the neurologist and dental teams . Fully addressing these disorders is a first step for offering optimal treatment .
In general, patients and caregivers should be encouraged to be aware of oral symptoms and to report them during consultations. Specific PD patient-rated assessments of discomfort and oral health impact on quality of life should also be developed, to favor symptoms reporting during dental and neurology consults.
Amalgams And Teeth Bleaching:
Little has been done to warn the public about this very serious hazard.Teeth bleaching with peroxide whiteners will trigger the release of mercury when in contact with silver-mercury amalgam dental fillings.The quantity of peroxide in the whitener and the duration of treatment are important factors which affect amount of mercury released.It has been shown that a silver colored, toxic slurry of mercury can be found in the “trays” after a multi-hour whitening treatment.DON’T DO IT!!!
- “The tested bleaching products significantly elevated the surface mercury levels of amalgam in vitro.”
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Quality Dental Care & Parkinsons Disease
Dr. Kurtzman and the staff at David Kurtzman, DDS have worked very hard to create a practice that provides safe, effective and pain free Atlanta dental care for patients with Parkinsons Disease. Our office is specially equipped to handle special care patients, however, it is safer to treat many patients with Parkinsons Disease in a hospital setting.
Dr. Kurtzman treats patients with Parkinsons Disease in specially equipped operating rooms at Wellstart Windy Hill and Kennestone Hospitals. In the hospital setting, patients are placed under general anesthesia by Anesthesiologists or specially trained Anesthetists under a doctors supervision. To assure the patients safety, the Anesthesiologist or Anesthetist monitors their health and breathing while they are under general anesthesia. Treating these special care patients in a hospital setting with close monitoring enables Dr. Kurtzman to provide them with effective, pain free dental care while at the same time ensuring their safety.
Dr. Kurtzman welcomes patients with Parkinsons Disease who are referred by other dental practices. In fact, patients with Parkinsons Disease travel from as far as South Georgia, Alabama and Tennessee to see Dr. Kurtzman. Dr. Kurtzman provides them with the special care they need and then returns them to their referring practice for recall and recare.
Disadvantages Of Silver Fillings:
Silver fillings have many drawbacks. The edges of the silver filling can wear down, become weak or break. This results in the tooth not being protected and lets cavities get started once again. With age, the metal of a silver filling expands, contracts, and can split.
Silver fillings contain 50 percent mercury. They can corrode, leak and cause stains on your teeth and gums.
Fortunately, silver fillings can safely be replaced with Tooth-Colored Restorations.
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Why Are People Living With Parkinsons Disease At Risk Of Developing Oral Health Problems
Certain symptoms of Parkinsons disease and side-effects of medications can cause dental and oral problems.
Having a dry mouth can cause discomfort and difficulty swallowing and speaking, but it can also lead to more serious problems such as cavities and gum disease. Dry mouth is a common side-effect of the anticholinergic medications used to treat Parkinsons disease and other health problems you may have.
Your doctor may change or adjust your medication to alleviate your dry mouth. You can also:
- Use over-the-counter toothpaste, mouthwash or lozenges recommended for dry mouth.
- Have sugar-free candy or gum that contains xylitol. If you eat regular candy, be aware that you probably wont have enough saliva to neutralize the sugar in your mouth, putting you at greater risk of developing cavities.
- Sip water frequently to hydrate your mouth.
- Talk to your dentist about prescription fluoride treatment, as dry mouth can lead to tooth decay.
- Avoid mouthwash that contains alcohol, as it increases dryness.
- If you wear dentures, remove them at night to give your mouth a chance to recover.
Sometimes, the opposite problem occurs. Your mouth may have a little excess saliva due to decreased swallowing movements. You arent actually producing more saliva, youre just not swallowing as well. Your doctor or a speech therapist can help you improve your swallowing.
Parkinsons disease also affects the muscles in your jaw and face, which may contribute to your difficulty swallowing and chewing.
Whom Should People With Parkinsons Disease Consult For Dental Care
You shouldconsult your dentist at regular intervals. A dental doctor will take care ofcustomized solutions to treat oral diseases in Parkinsons patients. Similarly,you can get cleaning techniques and appliances like interdental cleaners forteeth cleaning amidst the rhythmic shaking movements in your hands.
Likewise, the following medicinal practitioners also help in managing dental health in Parkinsons patients:
Pd: An Impediment To Oral And Dental Care
Despite being aware of the importance of good oral care and displaying normal to high toothbrushing habits and yearly dental visits , PD patients do not seem to perform and receive sufficient quality of care. This could be related to the fact that PD has direct and indirect impact on oral health and hygiene. As highlighted in Fig. 1, the physical, psychological, and iatrogenic patterns associated with PD are predisposing factors of diminished oral health . PD severity and duration are both associated with an increased severity of orofacial and dental problems . Motor difficulties, cognitive deficiencies and behavioral changes compromise daily activities, reducing the quality and quantity of daily oral care and dental care utilization . Additionally, PD patients are more prone to falls, owing to several conditions, such as gait disorders, postural instability and orthostatic hypotension . Falls can in turn lead to maxillofacial trauma and traumatic dental injuries .
The direct and indirect impact of Parkinsons disease on oral health and hygiene: contributing physical, psychological and iatrogenic factors.
Antiparkinsonian treatments and dentistry: potential local and general side effects and drug interactions
Why Or When Would A Dental Filling Need To Be Replaced
There are three main reasons why dental fillings would need to be replaced.
- Normal wear and tear: Constant pressure from chewing, grinding or clenching can cause dental fillings to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up.
- Filling fails and decay develops: If the seal between the tooth enamel and the filling breaks down, food particles and decay-causing bacteria can work their way under the filling. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscessed tooth.
- Filling and/or decay is large: If the filling is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.
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How Does Parkinsons Disease Affect Our Dental Health
Theprogressive movement disorder also affects the orofacial muscular system thatleads to problems like difficulties in chewing and swallowing. Likewise, theanti-parkinsonian medications also tend to create an imbalance in the pH ofsaliva. It leads to less salivary flow in PD patients than normal.
Such reduced salivation flow & hindered nutrient intake due to poor chewing will weaken your oral cavity. This is followed by the proliferation of harmful microbes in the mouth and ends in dental illnesses as follows:
As swallowingbecomes difficult due to compromised orofacial muscular system, it disruptssaliva production. Meanwhile, the muscles that seal lips also become weakennow. So they cannot control the saliva, causing excessive drooling.
On the other hand, the partnership of poor quality dental hygiene actions and the bacteria attacks weaken your oral cavity. For instance, researchers observed that people suffering from Parkinsons disease have higher chances of bone loss followed by plaque build-up than others.
How Should I Care For My Teeth With Fillings
To maintain your fillings, you should follow good oral hygiene practices:
- Visiting your dentist regularly for cleanings.
- Brush with a fluoride-containing toothpaste.
- Floss at least once daily.
- Your tooth is extremely sensitive.
- You feel a sharp edge.
- You notice a crack in a filling or if a piece of the filling is missing.
Your dentist will take X-rays if he or she suspects that one of your fillings might be cracked or is leaking .
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Are Silver Amalgam Fillings Safe
The American Dental Association , the FDA and numerous public health agencies say that silver amalgam fillings are safe. However, the FDA recently issued updated recommendations about the use of amalgam fillings in certain individuals. They state that the following individuals may be at greater risk for potential harmful health effects of mercury vapors and should avoid getting these fillings whenever possible.
- People at greater risk include:
- Pregnant women and their developing fetuses.
- Women who are planning to become pregnant.
- Nursing women and their newborns.
- Children, especially those younger than six years of age.
- People with pre-existing neurological diseases including Alzheimer’s disease, multiple sclerosis or Parkinsons disease.
- People with impaired kidney function.
- People with sensitivity or allergy to mercury or other components of dental amalgam.
The FDA does not recommend removing dental amalgam in people at higher risk if the amalgam is in good condition, suggesting that to do so would increase exposure to mercury vapor and result in more risks than benefits.
Will My Parkinsons Mean I Need To See A Specialist Dentist
Its important to tell your dentist that you have Parkinsons and how it affects you.
Most dentists will be able to treat people at all stages of the condition.
If your dentist feels you need specialist care, they will refer you to a colleague on the General Dental Councils special care register.
If you have to have dental surgery, talk to your dentist about Parkinsons symptoms you experience and how these may affect your operation.
You should also tell your dentist about your drug regime so that you continue to get the right dose when you have your operation.
If youve had deep brain stimulation and you now need to have a dental operation, you will need to take antibiotics. This will help make sure that you dont get an infection or another issue that could affect your deep brain stimulation device.
If you wear dentures Parkinsons may mean you have difficulty controlling them. This could be because of:
- problems controlling your facial muscles
- loss of muscle tone
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Why Do I Feel Pain Around My Dental Filling
There are several reasons why you might have pain after a dental filling. Each has a different cause.
- Pain when you bite: Your filling is interfering with your bite. Return to your dentist and have the filling reshaped.
- Pain when your teeth touch: Your pain is likely caused by the touching of two different metal surfaces . This pain should go away on its own within a short period of time.
- Toothache-type pain: This pain might occur if the decay was very deep to the pulp of the tooth. This toothache response may mean this tissue is no longer healthy and a root canal procedure is needed.
- Referred pain: Referred pain is pain or sensitivity in other teeth besides the one that was filled. Theres likely nothing wrong with your teeth. The filled tooth is simply passing along pain signals its receiving to other teeth. This pain should decrease on its own over one to two weeks.
Oral Health Disorders: What Is At Stake For Pd Patients A Review And New Hypotheses
Oral diseases are associated with a variety of local and general disorders and can severely impair quality of life . Being chronic and progressive, they are major functional, psychosocial and economic burdens , like PD. Epidemiological data, and studies on microbiological and inflammatory processes have highlighted a link between dysregulated immune and inflammatory response in periodontitis and the initiation and progression of systemic diseases, such as diabetes, cardiovascular disease , cancer, Alzheimers disease, or respiratory tract infections . The inattention to oral health is therefore concerning in PD patients, considering its direct and indirect impacts . Table 3 summarizes the possible etiologies and contributing factors to oral health disorders in PD patients, their consequences on general health and available prevention/management strategies.
More than meets the eye: Consequences of oral health disorders in Parkinsons disease.
The interplay between oral health disorders and Parkinsons disease.
Oral health disorders in parkinsonian patients: symptoms, etiologies, consequences and available prevention and management strategies
AB, awake bruxism BMS, burning mouth syndrome BTX, botulinum toxin CNS, central nervous system DA, dopaminergic L-dopa, levodopa MAO-B, monoamine oxidase-B PD, Parkinsons disease SB, sleep bruxism.
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Do I Need To See A Dentist Who Specializes In Parkinsons
Most dentists will be able to treat you regardless of how advanced your Parkinsons disease is. However, it is vital that you tell your dentist you have Parkinsons disease and the associated symptoms.Your dentist will suggest a routine adapted to the condition of your mouth in order to prevent, identify and treat the problems most often associated with Parkinsons disease. They will also be able to give you brushing techniques that are best suited for the condition of your mouth.
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Q: How Can Medications Improve Oral Health
Generally speaking, medications for Parkinsons can improve oral care and oral health by improving movement and motor control. These medications allow people with Parkinsons to move with more precision and less effort which facilitates better oral care. Deep brain stimulation treatment often provides a similar effect by improving movement that can lead to better oral care.
There are no specific medications prescribed directly to improve oral health. However, your dentist may recommend special oral care devices, as well as specialized toothpastes or oral rinses. For example, an oral rinse called chlorhexidine gluconate can be very effective when used in conjunction with brushing and flossing. Chlorhexidine is preferable to many over the counter mouthwashes because it does not contain alcohol, which can exacerbate symptoms of dry mouth and irritate oral tissues. Please note that this oral rinse requires a prescription from your dentist.
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Barriers To Dental Health In Pd
Physical Barriers:Because of the physical effects of Parkinsons, such as rigidity and tremor, nearly half of all people with PD have difficulty with their daily oral hygiene regimen. These symptoms also make going to the dentist more difficult and uncomfortable. Weakened swallowing ability can increase the risk of aspiration during treatment. Additionally, people with PD who have been on medications like levodopa for several years may begin to develop dyskinesias , which can affect the jaw and cause cracked teeth and teeth grinding. This may create problems during dental exams and at home.
Difficulty swallowing saliva can lead to a fungal infection at the corners of the mouth, which is easily treated. On the other hand, people with PD may experience dry mouth, which can increase the risk of cavities and add to chewing difficulties or denture discomfort. In fact, people with Parkinsons are less likely than others in their age group to clean their dentures daily
People who experience cognitive changes also may be more likely to miss dental appointments and less likely to report dental pain to their care partners or dentist, leaving issues unaddressed for too long.
Oral Health In Parkinsons Disease: A Complex Picture
Oral health is multidimensional , subjective, and dynamic. It is essential for daily functions like eating, swallowing, speaking, and socializing . These functions involve the action of the teeth, lips, cheeks, tongue, and oro-facial-pharyngeal muscles. The imbalance caused by motor , nonmotor, and sensory deficits in PD leads to a variety of orofacial manifestations . To date, there is no consensus regarding the most prevalent issues in PD patients, and results vary across studies . Several factors may account for these discrepancies , as many papers failed to adjust for clinical, environmental, and pharmaceutical variables. Differences are identified within study populations: gender, age, comorbidities, and subjects randomly selected or actively seeking dental treatment. Moreover, specific differences are also found within PD groups: idiopathic PD versus parkinsonism, PD stage, subtype, severity, and duration, antiparkinsonian medications, living at home versus institutionalized. The quality, accessibility and affordability of the healthcare systems also account for discrepancies. Other contributing factors are methodological: subjective and objective assessments, questionnaires, and ambiguous definitions. However, all studies but two point out towards a weakened or disturbed oral status with objective and subjective differences between PD patients and control groups.
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