Success Rates Of Dental Implant In Patients With Parkinsons Disease
Info: 4824 words Nursing Essay 11th Feb 2020
Introduction of Clinical Question
Parkinsons Disease is one of the most common conditions that present with orofacial dystonia and dyskinesia .
This leads to patients with the disease having trouble performing everyday activities such as eating, speaking and maintaining oral hygiene . Parkinsons Disease is more often seen in men than women and affects every 120 out of 100,000 people. There are two modes of this disease. The first is a genetic form which only consists of 5% of people with Parkinsons and occurs at a young age. The second occurs around the age of 57 and is deemed idiopathic as it has a more complex etiology where there is a familial and environmental component . Secondary Parkinsonism can be drug-induced. Parkinsons disease is caused by the death of dopaminergic neurons in the substantia nigra and locus coruleus. It is caused by the presence of Lewy bodies in the nerve cells in areas as such .
These neurons, which are subsequently destroyed, are necessary for the control of movement and coordination. Patients begin to experience symptoms once there is about a 65% reduction in functioning dopaminergic neurons .
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Increased Inflammation Of The Gums And Periodontal Disease
Due to the presence of teeth plaque and tartar, gums can become inflamed. The gums look red, bleed easily , and can feel painful. When the plaque is removed, the gums mostly recover. However, when not only the gums are infected, but also the underlying alveolar bone , it is called periodontal disease. When you suffer from periodontal disease, the alveolar bone weakens, and as a result teeth can become loose and eventually fall out. This process is irreversible. Inflammation of the gums and periodontal disease can be prevented by good oral hygiene and regular professional teeth cleaning. Smoking has a strongly negative effect on the gums and the periodontal system.
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Why Is Dental Health So Important In Parkinsons
Managing dental health and Parkinsons is an integral part of living well. Regular dental care can minimize your risk of experiencing pain and discomfort, but most importantly, it can reduce the risk of infection, which can be a significant stressor on the body when coupled with Parkinsons-related challenges.
In this post, we provide essential information and tools so you can learn more about dental health and Parkinsons and improve your dental health.
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Barriers To Dental Health
Long-term prescription medication usage can have an adverse effect on early and accelerated tooth decay.1 It is my opinion that some medications, although not directly to blame, do cause excessive saliva causing fungal infections in your mouth.
The same can be said about dry mouth which can lead to eroding of enamel and gum disease. The Parkinsonâs Foundation is a wonderful resource for dental health. Here are some dental health considerations:
- Dental health is rarely discussed by neurologists.
- Parkinsons symptoms often present a problem in regular dental visits.
- Deep Brain Stimulation can make visits especially complicated.
- Depending on symptoms, just getting to the dentist could be difficult.
- Your visit may result in prescribing medication that is contraindicative to your PD meds.
Mouth And Dental Issues
Some people with Parkinsons may have problems with their mouth and dental health.
A healthy mouth will help you to chew, taste, swallow and speak properly. Strong, healthy teeth allow you to enjoy your choice of food.
These can include:
Saliva is really important for good mouth health:
- It helps you taste your food.
- It lubricates food to help you swallow.
- It is antibacterial and has enzymes to help you eat and digest food.
Without enough saliva you may experience a dry mouth. A dry mouth can lead to higher rates of tooth decay and gum disease. It can increase your risk of getting tooth decay in the exposed roots. It may also cause dentures to become loose and hard to control.
A dry mouth can also increase the damaging effects of sugar on your teeth. Because of this it is important to watch what you eat and when you eat.
Some Parkinsons drugs can reduce the flow of saliva to your mouth. Tell your dentist if you experience this as they can discuss options which might help. They may ask you what drugs you take, so take a list of your medication to your appointments.
Tell your GP, specialist or Parkinsons nurse too as they may be able to prescribe different treatments that may not cause this problem. Saliva substitutes are also available. You can ask your dentist or local pharmacist about them.
The following tips may help reduce dry mouth.
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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.
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Prior To And During Dental Treatment
Ensure the patient has been compliant with medication coverage. If there are any questions regarding compliance, contact the patients physician.
Ascertain that the patient has no toxicity with the medication taken and that mental function is normal.
Patients taking valproic acid may have increased bleeding during procedures. If there are acknowledged problems, order a bleeding time assessment prior to treatment and consult with a physician if the values are questionable.
During dental treatment, be aware that a grand mal seizure could occur. If a seizure occurs, place the chair back to a supine position, turn the patient to the side, and keep the patient comfortable without restraint until it has passed. Placement of a tongue blade is not recommended unless the patient is aware of an impending seizure and can assist in its placement.
If injury to the lip or tongue occurs during a seizure, appropriate treatment such as suturing of lacerations, localization of potential fractures, removal of fragments, and follow-up dental treatment is required.
Alzheimers And Parkinsons Patients Need Hygiene Appointments Every Three Months
As our aged population develops Alzheimers and Parkinsons diseases, it will be the responsibility of care-givers, dentists and hygienists to see these patients every three months. They must monitor and treat root caries, periodontal diseases, broken restorations and teeth for people who no longer have the dexterity or ability to perform routine oral hygiene and can communicate their problems. Add this to the list of an elderly person that may have diabetes, osteoporosis, anti-coagulant therapy, as well as other medical problems. Welcome to our ever expanding scope of Dentistry!
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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.
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.
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Etiology And Neuromuscular Pathology
The neuromuscular system is a highly sophisticated network of neural and muscular fibers that work synergistically to facilitate movement. Normally, motor signals are initiated in the motor cortex of the brain and forwarded to the basal ganglia via motor neurons.7 The striatum of the basal ganglia carries these motor signals to the SN, where dopaminergic neurons are highly concentrated, and movement is regulated. Dopamine plays an important role in producing involuntary motion via motor pathways. Also, dopaminergic neurons in the SN influence the expression of neuromelanin, a substance that helps protect these neurons from oxidative stress.8 When pathologies arise within these pathways, they can manifest systemically with neuromuscular symptoms of rigidity, akinesia or dyskinesia, which are among the most prominent signs of PD.9,10
PD results in an overall deficiency of dopamine because of atrophy of the melanin-containing dopaminergic neurons within the SN and other pigmented nuclei of the brainstem.1 This reduction in pigmented nuclei is the hallmark sign of PD.2 Patients with PD may present with up to 8090% depletion in dopaminergic neurons, which significantly impairs motor regulation in the SN resulting in delayed or uncoordinated movements. The precise mechanism leading to PD is unknown, and it is thought to be better classified as a syndrome of multiple etiologies rather than a stand-alone disease.11
Association Of Tooth Loss With New
Parkinsons disease is an ongoing neurodegenerative disease represented by diverse progressive motor symptoms including postural instability, bradykinesia, rigidity, and tremor . Despite the long-term history of the disease, the etiology and causes of PD have not been well understood. Moreover, only few drugs or treatment methods have been proven effective against loss or damage of the dopamine neuron, which is a fundamental mechanism of PD development . Apparently, the current treatment methods for PD include medical therapy with levodopa, dopamine pathway-targeting drugs, and stereotaxic surgery, which are focused toward achieving only symptomatic relief . However, there is a dearth of disease-modifying agents and preventive methods for PD development. Presumably, genetic factors and environmental factors may lead to the death of dopamine neurons, which in turn result in PD, while consumption of coffee or tea may reduce the risk of PD development .
2. Materials and Methods
2.2. Study Variables and Definitions
2.3. Statistical Analysis
In a subgroup analysis, there was no statistically significant interaction between the number of tooth loss and new-onset PD regarding age, sex, alcohol intake, smoking status, regular physical activity, hypertension, diabetes mellitus, and dyslipidemia .
Conflicts of Interest
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The Causes For Dental Problems With Parkinsons
Rigidity, tremors and other motor problems can make it very difficult for Parkinsons patients to brush and floss their teeth correctly. If they do not receive proper assistance, they may become unable to take part in a routine daily dental hygiene program at home. As a result, they may suffer with tooth decay.
There are also some drugs that are taken for the treatment and management of Parkinsons can cause the patient to develop dry mouth, xerostomia. The diminished presence or lack of saliva in the mouth is one cause of periodontal disease and tooth decay. It is essential to have saliva in the mouth to keep bacteria from growing in the mouth. This bacteria can lead to tooth decay.
If this is the case, the patient may be advised to drink water more frequently, place Vaseline on their lips and chew sugar free gum often to keep saliva levels high in the mouth. It is important that the patient does not smoke because smoking can make dryness increase in the mouth.
Dental procedures that are necessary for the patient may become complicated to perform if the patient has extremely rigid muscles. Tremors and agitation can also make the completion of dental procedures difficult if the patient is not able to remain still.
It is also common for some Parkinsons patients to develop a sweet tooth. As they begin to increase their consumption of carbohydrates and refined sugar, their chances of developing tooth decay also increases.
Selection Of Studies And Data Extraction
Two authors independently reviewed the title and abstracts recovered through the search using the Rayyan platform . References identified as potentially eligible were analyzed in full text. Any disagreement was resolved by a third reviewer.
Data extraction from the studies included was performed by four independent reviewers using a pre-established data extraction form. The data gathered comprised the main characteristics of the studies included . Any disagreement was resolved by two other review authors.
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The Basics Of Oral Health And Parkinsons
Every year, the top Parkinsons experts from around the world who treat people with Parkinsons at a Parkinsons Foundation-designated Center of Excellence convene to discuss the latest Parkinsons research and treatments. This article summarizes the 2018 Center Leadership Conference presentation on oral health by neuroscientist Cameron Jeter, PhD, The University of Texas Health Science Center at Houston speech-language pathologist Linsey Heidrick, MA, CCC-SLP, University of Kansas Medical Center geriatric dentist Marsha Pyle, DDS, University of Missouri-Kansas City and moderator Irene Litvan, MD, UC San Diego School of Medicine. Read the articles covering some of the other topics discussed: intimacy issues, art therapy, new therapies in trial and music therapy.
Maintaining oral health is important for people with Parkinsons disease . Parkinsons symptoms can easily complicate dental care. A panel of PD experts at a Parkinsons Foundation conference recently discussed oral health and saliva management two PD-related issues not discussed often enough.
When it comes to Parkinsons and oral health, the goals are to preserve dental health and minimize the negative impact disease treatment may have. People with PD commonly experience problems related to the four dreaded Ds of oral health:
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Dental Caries And Periodontal Disease
A study conducted to evaluate the prevalence of periodontal disease in different groups of seniors aged between 60 and 79 years, including patients with PD, patients with mild neurological disease but no cognitive or motor impairment, and patients suffering from acute ischemic stroke revealed a higher frequency of patients with PD with untreated caries. More PD patients had caries, fewer remaining teeth, and higher rate of deep periodontal pockets compared to the other study groups.
The study proposed that many factors contributed to the inability of PD patients to maintain proper oral hygiene, including:
The physical symptoms of PD makes it hard for patents to maintain proper daily hygiene, and even harder to keep up with periodic office examinations. Typical dental care home practices require digital dexterity, muscle-eye-coordination, and tongue-lip-cheek control. Any disease that interferes with these faculties hinders the effectiveness of associated oral hygiene procedures.
Nearly 50 percent of PD patients have difficulty maintaining their daily oral hygiene regimen, which makes them less likely to clean their teeth or dentures daily.
Other symptoms of Parkinsons, such as rigidity, tremor, and abnormal posture, may make it difficult for patients to visit a dentist for oral examination. Some patients may also experience: