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Parkinson’s And Mouth Problems

What Causes Dyskinesia In Parkinsons Disease

Parkinsons Disease – Speech and Swallowing Problems: Karen Kluin

Unlike off time, patients typically experience dyskinesia in Parkinsons when medications are working and other symptoms are under control. Researchers arent exactly sure what causes dyskinesia, but it is believed to be a side effect of long-term levodopa use, not a symptom itself. Levodopa-induced dyskinesia can look like fidgeting, writhing, wriggling, head bobbing, or body swaying. LID can sometimes be confused with Parkinsons tremor, which is a back and forth shaking caused by the disease.

Because levodopa is taken throughout the day, dopamine levels in the brain rise and fall. These fluctuating levels of dopamine combined with the continued loss of dopamine in the brain make it difficult to maintain regular dopamine levels, and lead to dyskinesia.

Individuals diagnosed with Parkinsons at a younger age are more likely to experience dyskinesia. Its also more common in later stages of Parkinsons or in those who have taken levodopa for several years.

Embarrassing Symptoms Of Parkinsons Disease

Some symptoms that may occur in people with Parkinsons disease are not typical of it and so people noticing them may misunderstand them. These symptoms can be particularly embarrassing in social situations where other people witness their discomfort. They distress some people so much that they avoid company other than close friends or family. Most of these symptoms are caused by Parkinsons but some are side effects of the medicines used to treat it. All the symptoms tend to fluctuate in relation to the medication, and some people had learnt to adjust their medicine regime to minimise these effects.

Eating can cause embarrassment in several ways. Both tremor and dyskinesia affect the physical job of cutting up food and directing it into the mouth . Several people had a problem with a piece of steak or chicken that might fly off the plate as they tried to cut it up, or they had a choking fit if they unwisely took too big a piece into their mouth. Humphrey disliked eating out with friends because he tended to drop things.

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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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What Causes Dry Mouth In People With Parkinsons

Dry mouth can be caused by several factors including:

  • Medications: Prescription and over the counter medicines are some of the most common causes of dry mouth. Reducing, stopping or changing certain medications can relieve dry mouth.
  • Age: Advanced age alone is not a cause of dry mouth but half of those over age 60 take multiple maintenance medications that can trigger it.
  • Medical conditions: Diabetes, Sjögrens Syndrome and Parkinsons disease can all cause you to experience dry mouth.

There are several connections between Parkinsons disease and dry mouth. Repeated swallowing consumes the available saliva that keeps the mouth moist. It is often related to the drugs used to manage PD, particularly anticholinergics. A physician may be able to change or adjust medications and dosages to reduce dry mouth.4

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Graphites For Foul Smell Like Burnt Hair

Parkinson

Graphites is an excellent medicine to treat cases in which a person experiences a bad smell from the nose, as from burnt hair. They also have discharge of thick, yellowish, offensive mucus from nose and stoppage of nose. They may also have hard masses, dry scabs or crusts in the nostrils.

For Increased Sensitivity to Smell

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Tips For Coping With Speech Difficulties

  • Exercise your voice by reading out loud or singing every day.
  • Drink enough water, avoiding shouting and rest your voice when it is tired.
  • Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
  • Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
  • If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
  • Make eye contact with the person to whom you are speaking.
  • Reduce background noise.
  • Socialize in small groups or one-on-one.
  • If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
  • Determine which times of day your speech is best. Plan social engagements around those times.

Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

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Increased Decay Of Teeth

Caries is caused by bacteria in teeth plaque. These bacteria change sugar into acid, which damages the teeth. To prevent caries, it is therefore important to limit the frequency and amount of sugar intake and to remove teeth plaque from teeth surface. Fluoride in toothpaste can contribute to stronger teeth. Recent research demonstrates that people with Parkinsons tend to have more dental caries than other people.

Advice to prevent caries includes:

  • Try to limit sugary food to mealtimes only, and no more than four times a day.
  • Limit sugary drinks to mealtimes only. Tea or coffee should be taken without sugar between meals.
  • Do not rinse your mouth after brushing your teeth. This allows fluoride to continue to work to protect your teeth.
  • Try to avoid eating or drinking for 30 minutes after brushing your teeth.

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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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How Might Parkinson’s Affect Teeth And Oral Health

Parkinson’s Disease (Shaking Palsy) – Clinical Presentation and Pathophysiology

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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When To See A Healthcare Professional

A metallic taste in your mouth will often go away once the underlying cause has been treated, especially if the cause is temporary. You should contact your doctor if the bad taste persists.

Your doctor will often refer you to an otolaryngologist, also known as an ear, nose, and throat doctor.

An otolaryngologist may order a taste test to help determine the cause and extent of the taste disorder. Taste tests measure a persons response to different chemicals. Your doctor may also order imaging studies to look at your sinuses.

Loss of taste can be a serious issue. Taste is important for identifying spoiled foods. It also helps you feel satiated after a meal. Distorted taste can lead to malnutrition, weight loss, weight gain, or depression.

For those who must stick to certain diets, such as people with diabetes, distorted taste can make it challenging to eat the required foods. It can also be a warning sign of some diseases, including Parkinsons or Alzheimers diseases.

Dental Risks Related To Parkinsons

Knowing about these PD-related dental challenges can help prevent future complications.

  • Parkinsons can alter face and tongue muscle function, affecting speech and chewing. Missing teeth can further hinder those abilities and may contribute to depression and unhealthy dietary adjustments.
  • Swallowing problems can accompany Parkinsons. Healthy teeth allow less labored and more effective chewing. Poorly chewed food can increase the risk of choking and aspiration, which can contribute to life-threatening pneumonia.
  • Inflamed gums can signal periodontal disease, which destroys the bone supporting teeth. A cavity is a breeding ground for bacteria that can easily infiltrate the bloodstream and harm other parts of the body.
  • Infected teeth and gums can harbor bacteria that may infect devices, such as deep brain stimulation electrodes, prosthetic hips and knees, vascular stents and grafts.
  • PD-related rigidity, tremor and dyskinesia can make it hard to brush ones teeth. These symptoms can also cause cracked teeth, tooth wear, changes in the fit and wear of dentures and tooth grinding.
  • Symptoms such as fatigue, anxiety and tremor can make the commute to appointments, sitting still in the dentists chair or opening the mouth wide challenging.
  • Too much saliva can lead to a fungal infection at the corners of the mouth. By contrast, too little saliva or dry mouth increases the risk of cavities.

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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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Improve Your Dental Routine

Parkinsons Disease

It is critical to brush your teeth for two minutes twice a day. It is also important to floss once a day to remove food and bacteria between your teeth. If you find that brushing and flossing are difficult due to your Parkinsons symptoms, we have created this Dental Worksheet with suggestions for modifying your oral care.

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Weird Taste In Your Mouth These Drugs Could Be The Cause

First, a little reminder about taste. Our sensory system for taste is remarkably sensitive, made possible by our taste buds. Taste buds are each made up of taste receptor cells which bind to small molecules related to flavor. Through sensory nerves, the receptors relay the taste information to the brain and this allows us to discern five basic tastes .

An unpleasant taste or lack of taste can affect appetite, and even lead to depression. If your taste buds dont seem right, rule out sinus or nasal issues, viral upper respiratory infections, or other common causes, then take a look at your meds.

With certain medications, these changes in taste may occur:

Bitter taste:

  • Stimulants used in the treatment of ADHD may cause a bitter taste in your mouth. Adderall and methylphenidate decrease the threshold for the bitter taste in your mouth, making you more sensitive to the perception that something is bitter.
  • Altitude sickness prevention in travelers can be overcome with Diamox which may also leave you with a bitter taste in your mouth.

Metallic taste:

Loss of sour taste:

  • Isotretinoin is used for the treatment of severe acne, and you may notice the loss of sour taste while taking it. Isotretinoin disrupts ion channels, leading to loss of sour taste.

Persistent sweet, sour, salty, bitter or metallic taste :

  • Captopril, enalapril and lisinopril are ACE inhibitors used to lower blood pressure. They cause disrupted taste, likely by causing zinc deficiency.

Dr O.

If I Have Parkinsons Disease What Kind Of Speech And Voice Problems May I Experience

If you have Parkinsons disease, some of the voice and speech difficulties seen include:

  • Softened voice. Reduced volume to your voice.
  • Speaking in an unchanging pitch .
  • Having a hoarse or strained quality to your voice.
  • Having a breathiness to your voice. Breathiness in the quality of your voice that is easily heard by your listeners. It takes more effort and energy to speak. You run out of gas as you speak.
  • Trouble clearly and easily pronouncing letters and words.
  • Tremor in your voice.
  • Using short rushes of speech.
  • Loss of your facial expression.

If you have Parkinsons disease, you may not be aware of the problems with your spoken communication. Changes in the quality of your voice may be the first sign of speech problems followed by the inability to have fluid speech and clear and distinct speech sounds. Speech problems that are severe enough to reduce your ability to be easily understood usually do not occur until later in the course of Parkinsons disease.

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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:

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 Is Tardive Dyskinesia Managed Or Treated

What is Parkinson’s Disease?

Your healthcare provider may gradually lower your medication dose. Eventually, you may stop the drug. If you need ongoing treatment, your healthcare provider may prescribe a different medicine.

For some people, these changes end tardive dyskinesia symptoms. You should only make medication changes under your healthcare providers care.

Some people still have symptoms despite medication changes. Over time, the symptoms may improve and go away. Rarely, symptoms become worse.

If symptoms persist, these treatments may help:

  • Tetrabenazine, the only approved drug for the treatment of movement disorder symptoms.
  • Botulinum toxin injections , which blocks facial nerve signals for a few months.
  • Deep brain stimulation, an implantable device that blocks irregular nerve signals to areas of the brain that control movements.

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Objective Measures Of Flow/volume

Objective measurements of milliliters or milligrams secretion per minute typically center around gathering saliva at regular intervals over given time periods.68,69 Sampling methods include collecting saliva from cups placed over salivary ducts, expectoration into pots or tubes, weighing of gauze or cotton rolls held at given loci in the mouth, use of centrifuges to extract saliva from the gauze to quantify the volume of saliva absorbed or allowing saliva to dribble from the mouth with the head held forwards over receptacles.

As secretion is sensitive to a number of influences, gathering ideally occurs under controlled conditions. Posture is controlled the environment is quiet, with absence or minimization of visual, olfactory or gustatory stimuli known to prompt increased flow. Comparability of stimulated flow across patients and time demands use of standard stimulatory material and doses . To assure inter- and intra-individual comparability, evaluations ideally happen at the same time of day at the same point in the drug cycle in the same relationship to meal times . Onoff status and fluctuations need to be monitored as well as presence and severity of dyskinesias that may affect measurements.70

Preparation Of Taste Samples

Identical discs were cut from filter paper sheets . Twelve solutions, three for each basic tastant, were prepared with sterile deionised water and stored at room temperature. The paper discs were dipped into the sucrose , quinine hydrochloride , citric acid , or sodium chloride solutions until they were completely soaked. Another set of discs were soaked in deionised water only, to serve as control cues. The filter papers were allowed to dry at room temperature, packed in separate airtight envelopes, and stored at 4°C. The filter paper methodology was used instead of tastant solutions to avoid olfactory stimulation via the so-called retronasal route, which could be a confounding factor, as PD has been linked to early diminution of olfactory function.

A row of the sweet, bitter, sour, salty, and water discs was prepared for each participant 1 hour before the test and stored at room temperature. Each participant received and rated 13 different filter paper discs. The order of sample administration was counterbalanced across the subjects, although the bitter papers were always administered at the end. The 100 ml samples of chocolate and vanilla milk were prepared for each subject from commercially available ultra heat treated milk products . The same volume of deionised water was prepared as another control stimulus.

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