Parkinson's Practical Tips to survive and thrive at the dentist
Dr. Manon Auffret- PharmD is based in France and author of a recent paper on dental care and Parkinson.
Shafaq Hussain Ali, a dentist living with Parkinson Disease in UK
Manon Auffret is an amazing PharmD in France who wrote an awesome recent review paper in the Journal of Parkinson Disease on ‘oral health issues.’ Many of the tips from this paper I will summarize in this blog (I.S.)
Dr.Shafaq Hussain Ali is a brilliant UK based dentist living with Parkinson’s disease. I (I.S.) had the pleasure of interviewing Shafaq and learning about her inspiring advocacy work and as part of this blog I include a link to this interview.
Are persons with Parkinson predisposed to more issues with their dental health?
PWPs have more of a predisposition to dental caries (cavities) and periodontal disease. They have more mobile and missing teeth, perhaps partially due to grinding (bruxism) 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, Parkinson’s 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 (apathy, depression, fatigue and anxiety. )
How does poor dental health affect my Parkinson’s 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.
How can medications contribute to dry mouth?
Medication side effects can possibly lead to dry mouth (xerostomia).
Mediations such as anticholinergics (trihexphenidyl), 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.’
What are some practical tips to help ‘dentition’ in PD?
1. See a dentist as soon as your PD is diagnosed in order to assess your baseline dental health including your teeth, gum health and also to establish pro-active, regular cleanings and followups. Assess the quality of your brushing since it can be affected by impaired head or neck posture, tremor in your hands/ body/ tongue, stiffness, slowness, apathy, depression or even fatigue. Learn and employ techniques to improve the quality of your brushing. Your dentist can help you along with the dental hygienist. Ask them the areas you need to pay attention to when brushing.
2. Work with your physicians to optimize ‘motor and non-motor’ function; this cab have downstream effects on your dental hygiene.
3. Work to educate your caregivers/loved ones on keeping your teeth clean. Bring family to your appointments.
4. Use an electric tooth brush if possible. Use a tooth brush with a thickened handle/wider grip, a soft bristle, and use one with small heads. Change the tooth brush/tooth brush head every 3 months. Brush at least twice per day. If using medications which will dry your saliva you may need to brush more than twice a day to avoid cavities.
5. Since the quality of flossing can suffer because of PD motor features; consider the use of a water pick.
6. If you use mouthwash; use non-alcoholic fluoridated products. Make sure you don’t have swallowing issues if you use a mouthwash (coughing after use may be a clue).
7. Use a fluoridated toothpaste (2500-5000 ppm of fluoride).
8. Use a toothpaste pump if you have a hard time squeezing the tube.
9. Work with swallow therapists and cut food into bite size pieces; try to alter texture/consistency to facilitate swallowing if you have issues with chewing or swallowing.
10. For dry mouth, use sugar free gums/hard candies (xylitol containing). Use artificial saliva or lubricating sprays. Sipping water frequently or using a humidifier may possibly help. Review medications and eliminate the offending agents which may be drying your mouth; pharmacists can help with this issue.
11. For dental erosion, avoid acidic or fizzy drinks. Acid reflux treatment and fluoride treatments may possibly be better for tooth enamel.
12. Avoid sticky and sweet foods; though this may prove nearly impossible.
13. If you experience teeth grinding, a custom fitted mouth guard can be crafted for you.
14. Avoid electric cautery or diathermy if you have deep brain stimulation unless if you use a bipolar mode
15. Schedule visits from dentists to your skilled nursing facility or to home if you are home-bound.
16. Don’t forget about good ‘denture hygiene.’ Some PWP may experience difficulty keeping dentures in place due to tremor and dyskinesia. Good cleaning, brushing and ‘sodium hypochlorite soaks’ can be helpful.
Is there anything I can do if I have a fear (phobia) of my dentist?
It is important to understand why you have a fear of the dentist. One tip is to share your fear and to ask that you have the same dentist/hygienist at every visit. Open communication, trust and consistency all can help in overcoming a fear of dentists. You will need to ‘feel heard’ and to be reassured about your concerns. Understanding each step of every procedure they will perform is also helpful in many cases.
You may be worried about sitting in the chair for a long time due to urinary urgency. It is best to empty your bladder before getting in the chair and to communicate this issue to the dentist/hygenist. Most of the time the team will be more than happy to ‘pause’ and to allow you to use the restroom.
Consider booking a longer appointment to minimize stress in ‘rushing’ through a visit.
Plan extra time if the office is cramped office or you need to use the stairs to enter.
Let the staff know you may have trouble and need help getting in and out of the dental chair.
Get up slowly from the chair soas to avoid dizziness.
Share any fears about keeping still due to dyskinesia or tremor so you can brainstorm with the dentist a solution.
If you can’t open your mouth wide or keep it open a bite block can sometimes be the answer.
Having a caregiver or loved one present in the room can be helpful. Use good judgement as sometimes a caregiver/partner may increase anxiety.
Plan the visit when medications are “on”, Sometime this means allowing meds to kick in. Ideally a mid- morning visit works for some folks.
Breathing or ‘grounding’ techniques can be used to reduce anxiety.
Ask up front for ‘breaks’ or ask if they can pause if you ‘report pain.’ Working out a plan before they start can be helpful. A signal can be used to alert them to pause; raising your arm for example.
How do I prevent aspirating during the dental visit if I have pre-existing swallowing issues?
Avoid being fully flat or supine ( 30-45 degrees is a good rule)
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 (small) gauze screens (to protect the oropharynx); or alternatively use clasps with floss (small-sized objects which can be be secured with dental floss to aid in later retrieval).
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 Parkinson’s Living with Parkinson’s and is also a co-host of the blog.
Dr, Jonny Acheson is the gifted artist for the parkinsonsecrest.com blog.