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Parkinson’s And Dental Issues

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Dental Caries And Periodontal Disease

What is Parkinson’s 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:

Physical Barriers

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:

Behavioral Barriers

How Might Parkinson’s Affect Teeth And Oral Health

Keeping teeth and gums healthy can be more difficult if you have Parkinsons disease. Motor symptoms, such as bradykinesia and rigidity, may hamper good daily oral hygiene care. Parkinsons disease can also effect the orofacial muscular system, causing difficulties in swallowing, chewing and controlling dentures. In addition, the oral environmental balance and the quality of the saliva can be influenced by medication.

The paragraphs below illustrate the most common problems related to the mouth in people with Parkinsons.

The Neurologists Role In Supporting Successful Prevention Management And Follow

Oral and dental problems caused by PD are accentuated by physicians lack of dental knowledge and dentists lack of awareness of many of the oral implications of PD . However, oral diseases are largely preventable even in vulnerable populations . The maintenance of the oral health of PD patients should be of prime importance in providing complete health care . Initial steps have been recently taken, with the publication of clinical practice guidelines , although evidence-based recommendations are still scarce . As dentists and dental hygienists play an integral role in providing health care to PD patients, they must be involved as early and often as possible .

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How Do I Prevent Aspirating During The Dental Visit If I Have Pre

  • Avoid being fully flat or supine

  • Ask if an extra employee is available for suctioning/positioning help and if not ask them to pause more to suction.

  • Use rubber dental dams or gauze screens or alternatively use clasps with floss .

  • Have a plan with the dentist/hygenist to employ aggressive oral suctioning.

  • Have a plan for the dentist/hygenist to potentially use smaller amounts of water and to be careful when spraying water in the mouth.

Dr. Subramanian is co-editor of the parkinsonsecrets.com bog and host of Wholistic. Dr. Okun is author of 10 Secrets to a Happier Life, Ending Parkinsons Living with Parkinsons and is also a co-host of the blog.

Dr, Jonny Acheson is the gifted artist for the parkinsonsecrest.com blog.

What Is A Swallowing Evaluation

Parkinson disease

If because of the above signs there is concern that swallowing difficulties exist, your doctor may recommend a swallow evaluation, which can be performed by a speech and language pathologist.

There are two main ways to evaluate someones swallow:

  • Modified barium swallow study This is the most common test that is performed. The person is asked to ingest different consistencies of barium and moving x-rays are taken that follow the barium as it is swallowed. This x-ray video pinpoints the areas of the swallow that are problematic and helps to determine the correct exercises to address the problem.
  • Fiberoptic endoscopic evaluation of swallowing is another type of test that can be performed to evaluate swallow. During this procedure, a very thin flexible fiberoptic tube which is hooked up to a camera and light source, is passed through the nasal passage. The tube does not go down the throat, but allows swallowing to be observed. This procedure is painless and well-tolerated by most individuals.

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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.

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

Behavioral Barriers

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.

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I Used To Suffer Parkinsons

Case study: Steve Peterson

I still have Parkinsons Disease. My specialist told me I always will.

But I dont suffer from the illness any more. And thats the difference.

Despite everything medical that was going wrong for me then my life is now back to normal.

Actually, a little better than normal.

Im one of thousands who have transformed their health. But I still feel blessed.

Let me tell you how this turnaround happened.

How Can Medications Contribute To Dry Mouth

Neurology – Topic 13 – Parkinson’s disease female patient
  • Medication side effects can possibly lead to dry mouth .

  • Mediations such as anticholinergics , selegeline, amantadine and Botulinum toxins A and B can dry the mouth.

  • Some bladder medicines and some mood medicines can lead to dry mouth.

  • Amantadine can lead to a dry mouth as can some antidepressants.

  • Entacapone has been reported to lead to darkened saliva darkened teeth. The urine has also been reported to be orange.

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How Does Chemotherapy Affect Your Taste

Chemotherapy is known for causing a bitter, metallic or chemical taste in the mouth , with around half of people treated reporting taste changes.

Some chemotherapy drugs are thought to damage the delicate cells in the lining of the mouth, while others can change the balance of bacteria in the mouth, leading to taste changes. Meanwhile, certain chemotherapy treatments are specifically known to cause a metallic taste you can talk to your medical team to find out whether your particular chemo treatment is likely to have this side effect.

Its important to remember that taste changes caused by chemotherapy usually wear off around 3-6 weeks after your treatment has stopped.

Oral Dysfunction In Parkinsons: Swallowing Problems And Drooling

Two common and distressing problems that can develop in Parkinsons disease are swallowing dysfunction and drooling. I want to help you better understand these issues and learn what you can do to improve them so read on!

Thank you to Christine Sapienza, PhD, CCC-SLP and Bari Hoffman Ruddy, PhD, CCC-SLP for providing some of the material below.

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How Might Parkinsons Affect Teeth And Oral Health

Keeping teeth and gums healthy can be more difficult if you have Parkinsons disease. Motor symptoms, such as bradykinesia and rigidity, may hamper good daily oral hygiene care. Parkinsons disease can also effect the orofacial muscular system, causing difficulties in swallowing, chewing and controlling dentures. In addition, the oral environmental balance and the quality of the saliva can be influenced by medication.

The paragraphs below illustrate the most common problems related to the mouth in people with Parkinsons.

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Eligibility Criteria For Including Studies

Parkinsons Disease: Symptoms, Diagnosis and Treatment  Healthsoul

Clinical trials and observational studies assessing different aspects of oral health among patients with PD were included in this review. These involved associations between different aspects of PD and oral cavity diseases, along with any type of treatment or preventive strategies. Case reports, reviews, guidelines and experimental studies were excluded. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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What Is Tardive Dyskinesia

Tardive dyskinesia is a drug-induced movement disorder. Taking specific medications, often for a mental health disorder, can cause it.

Tardive dyskinesia causes involuntary facial tics . It can also cause uncontrollable movements like lip-smacking.

Tardive means delayed or late. Dyskinesia refers to involuntary muscle movements. With this condition, theres a delay between when you start a medicine and when you develop dyskinesia. Most people take a medicine for years before developing the disorder.

Q: How Do Botulum Toxin Injections Affect Oral Health

In some instances, medications can be prescribed to control excessive saliva or drooling for people with Parkinsons. Sometimes these medications are not effective enough to satisfactorily control drooling. In that case, your physician might suggest injections of botulinum toxin. Small amounts of botulinum toxin are injected directly into the salivary glands inside the mouth in order to temporarily shut down saliva production. Typically, botulinum toxin is injected into the parotid glands and/or the submandibular glands. Parotid glands are activated during chewing and submandibular glands produce a significant amount of saliva . These injections can be an effective approach to addressing drooling and can provide relief for up to 3 months at a time. Another benefit may include keeping dentures properly sealed and reducing breakdown of the skin in the corners of the mouth.

Occasionally this approach can simply be too effective at reducing saliva production, causing dry mouth. As previously outlined in this article, dry mouth caused by lack of saliva can have a negative impact on oral health.


Suck on sugar free hard candies or chew sugar free cinnamon gum to initiate saliva production.

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And Now I Know Why We Dont

There are 8 main factors leading to Parkinsons. Some have a small effect. A couple are huge.

Together theyre essential in beating this horrible condition.

In truth, some of them my health-care center already acted on.

For example, they prescribed dopamine-enhancing drugs. For sure, I needed more dopamine.

I had tests and underwent occupational therapy. Again, good stuff it helped me manage my problems with balance, movement, stiffness.

But I also realized they were not helping me to avoid the worst symptoms of this disease. At best, they were just delaying it.

Yet thats what I wanted most to not end up with my own personal Parkinsons horror story.

Which is why I went headlong into my own research about my illness and, eventually, found my way out.

We Have Choices About How This Condition Plays Out

Parkinson’s Disease Symptoms, Treatment, Nursing Care, Pathophysiology NCLEX Review

In fact, medical scientists have proved that many people with a genetic disposition to this never get it.

While others with no genetic disposition at all still get full-on Parkinsons that ravages their mental health quickly and remorselessly.

Its not genetics. Its a basic illness with recognized causes.

Remember: the substantia nigra produces dopamine. Its the loss of substantia nigra nerve cells that leads to the loss of dopamine.

And that loss of dopamine leads to Parkinsons Disease.

So the big question is:

Why on earth is the substantia nigra losing those dopamine-producing cells in the first place?

I was shocked to discover that we already know why were losing those priceless, life-giving substantia nigra cells.

Yet still do almost nothing about it

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How Does Poor Dental Health Affect My Parkinsons Disease Symptoms

  • Chronic Inflammation and infections in the mouth and teeth may lead to more systemic inflammation which can potentially worsen motor and non-motor symptoms.

  • Poor dental health can lead to more issues with aspiration pneumonia and a worsened quality of life possibly even a worsened disease course particularly if left unaddressed.

  • Poor dentition can lead to poor nutrition, due at least in part to difficulty chewing. This can lead to, poor health overall and to worsened PD outcomes.

  • A bad dental infection can lead to worsened general health and possibly other infections sepsis.

  • Poor dentition can alter the microbiome in the mouth and the gut. This may lead to worsened gut health and to worsened medication absorption.

Are Persons With Parkinson Predisposed To More Issues With Their Dental Health

  • PWPs have more of a predisposition to dental caries and periodontal disease. They have more mobile and missing teeth, perhaps partially due to grinding which can also lead to broken teeth, tongue biting and orofacial pain.

  • TMJ and headaches can also commonly occur.

  • PWP commonly report more issues with chewing, swallowing, and mouth discomfort. And, Parkinsons disease can change the sense of taste and also of smell.

  • Some PWP have higher rates of maxillofacial trauma due to falling.

  • The motor issues of PD such as slowness and stiffness can lead to less effective brushing and flossing.

  • Mental health issues in PD can lead to decreased motivation to care for teeth

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Diet Exercise And Physical Wellbeing

A healthy lifestyle is important for everyone, but this is particularly the case if you have Parkinson’s. Click on the headings below to explore how small adjustments can help you lead as healthy and active a life as possible.

In this section

  • Related reading
  • Dental and oral care is very important for general good health. Oral diseases, such as caries and periodontal disease, may impact a number of systemic conditions. Furthermore, keeping your mouth healthy is essential for tasting, chewing, swallowing and speaking and will contribute to a better general well-being. A healthy mouth can prevent oral pain and discomfort. A good oral hygiene routine, together with a well-balanced diet and regular visits to the dentist, is vital to maintaining a healthy mouth.

    Advice for good oral health includes:

    • Brush your teeth twice a day with a fluoride toothpaste.
    • Brush last thing at night and one other time during the day.
    • Try not to rinse your mouth after spitting out toothpaste so that fluoride continues to work.
    • Limit sugary food and drinks to mealtimes only and no more than four times a day.
    • Visit your dentist regularly.

    Your dentist and dental hygienist can provide you with personal advice.

    S To Making It Happen

    How To Cure and What To Avoid in Parkinsons Disease?

    Thankfully, Jodis program isnt a long list of donts. Theres no calorie counting, strange potions or weird rituals.

    Instead its a fairly short list of powerful, practical, easy-to-implement dos.

    Jodi Knapp has broken her program into 12 small habits that you can introduce into your life in order to undo the causes and symptoms of brain degeneration.

    Theres no revolution here. I made one simple change, and when I was sure Id got it I went on to the next one.

    Stuff so stupidly easy I did wonder with a couple of them how they could possibly have any effect at all.

    But this is the thing: it was tiny bad habits that got me so ill in the first place.

    So it only requires tiny good ones to undo it all.

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    Problems Faced In Maintaining Good Oral Care At Home

    Brushing, flossing, and interproximal brushing are critical components of oral self-care . 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 . Decline in the quality of the toothbrushing and lack of interdental cleaning reduce the efficacy of plaque control, promoting gingivitis, and initiating or aggravating periodontitis and dental caries. Moreover, such fine movement impairments induce more difficulties in the frequency and quality of prosthesis hygiene, leading to biofilm accumulation . Discomfort with mouthwashes, possibly due to dysphagia and fear of choking, has also been reported . These ineffective oral hygiene measures add to the pre-existing disturbed self-cleaning mechanisms of the mouth .

    Finally, when present, neuropsychiatric disorders also contribute to patients difficulties: apathy, depression, fatigue, anosognosia, cognitive decline and dementia may all lead to negligence in daily care, making compliance with a home care regimen difficult .

    Why Jodis Method Works

    Remember: standard drug remedies tackle the disease further along the chain at the point where theres a dopamine shortage.

    Doctors simply dont address the reason that dopamine is in short supply in the first place.

    Jodi does.

    She addresses the specific reasons why cells in the substantia nigra are dying off.

    Then she addresses low dopamine itself.

    Then she undoes the symptoms of the illness the part of the disease that you and I experience.

    Jodi Knapp cant teach her methods face-to-face to everyone who needs them. So she created a written version of her approach. Its called The Parkinsons Protocol.

    And its The Parkinsons Protocol that changed not only my present life it changed my future life too.

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