Earlier this week Bob Bowling wrote to the list:-
<Anne
<I believe you mentioned several weeks ago that you'd had a tough go
<with your teeth decaying from dry mouth associated with PD meds. <I
have what I believe to be a similar problem--no cavities in 20 <years,
regular dental and perio exams and cleanings but have had <10+ cavities,
all since January.
<Did you ever find a remedy or a cause? I take good care of my teeth
<(even better now as you might imagine) and don't seem to be <making any
headway.
<Any thoughts will be appreciated.
<Regards,
<Bob Bowling
<Overland Park, KS
<[log in to unmask]>
Hi Bob
I think the easiest way to reply is to post part of an article from an
old issue of the newsletter I edit . I will begin with a couple of
extra ideas of my own. Ive tried most of the suggestions and I haven't
the answer. My teeth are still in poor shape but better than before and
I now have a dentist I respect. Keeping one's mouth clean is very hard
to do when the muscles and saliva don't help.
Think about sitting down to brush. A GOOD IDEA
I brush in the shower --sitting
try a 'waterpic' to wash out bits left after brushing
sugar free gum
extra professional cleanings
There is an antibacterial treatment which may help. Your dentist may know
about it--I can't find my reference and have forgotten the name--it is
expensive. No one here does it although my dentist knows about the system.
hope this helps,
Anne [log in to unmask]
DENTAL MANAGEMENT OF PARKINSON PATIENTS
by Dr. Paul Andrews,DDS. -not complete-
FROM the Newfoundland Newsletter Vol4 Number2 APR 1993
published by the Newfoundland chapters of the Parkinson Foundation of
Canada. Reprinted from THE PARKINSON PAPER (Spring 93) with the
permission of the Parkinson Society of Ottawa-Carleton.
The dental and behavioural management of individuals with
Parkinson's is challenging. Oral health is far too often neglected as a
result of a lack of awareness regarding the dental manifestations of
Parkinson's by the medical, dental and caregiver communities.
The spouse, family member and/or caregiver should be educated and
encouraged to take a genuine interest in the patient's oral health. In
order to appropriately respond to the individual needs of a given
patient, details regarding the progression of the disease, a list of
medications, characteristics of the tremors and rigidity, time of day
when dental treatment could be best accomplished and the availability of
the caregiver should be obtained from the physician and the caregiver.
DENTAL MANIFESTATIONS
Parkinson's has many dental, oral and facial manifestations.
Tremors and rigidity may affect the face, mouth and tongue. The staring,
mask-like appearance that is caused by facial rigidity is one of the
most common and easily recognized symptoms. Swallowing problems,
drooling, dry mouth, denture sores and a high caries rate are also common
dental maifestations of the disease
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(XEROSTOMIA)
In contrast to the excessive salivation caused by the Parkinson's
disease process, drug therapy often causes the opposite problem of 'dry
mouth'. Most of the commonly prescribed medications to combat the
symptoms of Parkinson's will have dental side effects as listed below:
Medication Dental Side Effect
Artane dry mouth
Cogentin dry mouth
Eldepryl dry mouth
Parlodel swallowing problems
Pergolide swallowing problems
Sinemet both problems
Symmetrel dry mouth
Historically, it was believed that levodopa caused caries by
'softening' the teeth. This is now known to be false. The increased
caries rate is most likely due to dry mouth and a decreased ability to
perform oral hygiene procedures.
The saliva is also essential in allowing dentures to float and glide
comfortably in the mouth. A dry mouth coupled with tongue and facial
rigidity will make the use of dentures more difficult and lead to the
development of denture sores. Problems with speech, chewing and
swallowing are all accentuated as oral ulcerations develop. Furthermore,
self-image can diminish and problems with socialization may develop.
DENTAL RECOMMENDATIONS
A gentle caring approach is essential in providing oral health care
and education for the Parkinson patient and caregiver. Preventive
denstistry is the most important aspect of dental treatment. Regular
six-month dental visits to assess the oral health and reinforce home care
oral hygiene procedures are essential. Because muscle control declines,
adaptive devices may be utilized to aid in oral hygiene.
Self-sufficiency is an integral part of maintaining self-image.
Toothbrush handles can
be lengthened or thickened using a bicycle handle grip or tennis ball.
Velcro straps can be attached to aid in grasping. An electric toothbrush
may be useful for some individuals. A denture can be cleaned with a
nailbrush attached with suction cups to a sink, which allows the patient
to remove the denture and clean it using one hand, thereby minimizing
the degree of co-ordination required.
The effects of swallowing problems and dry mouth can often be
combatted through the use of frequent sips of water, or in severe cases
through the use of saliva substitutes. Although a number of saliva
substitutes are available, a recent comparison indicated that Salivart
was given the highest rating on the basis of patient acceptance.
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In order to combat the increased caries rate associated with dry
mouth, a fluoride oral rinse can be used. Mouthwash with fluoride should
be avoided due to the alcohol content which acts to dry the mouth even
more. A similar problem occurs with glycerin swabs. Fluorinse, a daily
fluoride rinse made by Oral B, contains no alcohol yet will greatly
reduce the risk of developing caries.
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