Oral Health Recommendations for People With Parkinson Disease

People with Parkinson disease (PD) were associated with reduced quality of oral health and hygiene, and exhibited a high prevalence of mostly preventable oral conditions, such as tooth decay and gingival recession, according to study findings published in Neurology and Therapy.

As a multisystem disorder characterized by potentially debilitating motor and nonmotor symptoms, the researchers highlight that oral health is often an afterthought for patients, caregivers, and physicians in managing PD.

“The physiopathology of oral disorders in patients with PD is complex and is not fully understood,” note the researchers. “Patients with PD present a variety of oral diseases that can be worsened by xerostomia and sialorrhea. The patients’ physical limitations, for example rigidity and tremor, add to the difficulty of oral care by the general dental surgeon.”

Seeking to better understand the full scope of oral health implications in PD, as well as to establish preventive evidence-based recommendations for patients, the researchers conducted a systematic review of 14 studies (reported in 16 papers) on the topic. “These involved associations between different aspects of PD and oral cavity diseases, along with any type of treatment or preventive strategies.”

In finding that people with PD exhibited reduced quality of oral health and hygiene, the review also showed that presence of PD was associated with gingival recession, periodontal disease, dental calculus (tartar), tooth decay, tooth mobility and loss, drooling, xerostomia, dysphagia, and temporomandibular disorders.

Notably, the study authors said that most studies offered class IV evidence, indicating significant potential for bias, with 1 study providing class II evidence. “Despite the relatively low level of evidence in studies on oral health among patients with PD, the data retrieved for this systematic review allowed us to create a set of simple guidelines," they said.

Addressing general dental care, the researchers recommend:

• During neurological consultations, the physician needs to introduce the issue of visits to a dentist
• Should the patient not have regular dental appointments, the neurologist should refer this individual to an oral health care center
• Teeth brushing needs to be done regularly and should be performed by alternating the right and the left hands, since rigidity and tremor may be more disabling in one limb as PD progresses; the patient should learn to use either hand for oral hygiene
• Individualized instructions regarding oral hygiene, together with chewing and lip exercises, can improve oral health in PD cases

The researchers additionally provided recommendations for salivation, tooth decay and loss, peridontal disease, temporomandibular disorder, and burning mouth syndrome.

“Patients with PD have a variety of oral diseases that need to be prevented, diagnosed, and treated,” concluded the study authors.

Reference

Martimbianco ALC, Prosdocimi FC, Anauate-Netto C, dos Santos EM, Mendes GD, Fragoso YD. Evidence-based recommendations for the oral health of patients with Parkinson’s disease. Neurol Ther. Published online March 18, 2021. doi:10.1007/s40120-021-00237-4