A Surprising Reason to See the Dentist: Oral Hygiene & Parkinson's

People with Parkinson’s disease, especially in later stages, can experience a wide array of oral hygiene issues.¹

• Excessive saliva, or its opposite symptom, dry mouth
• Swallowing dysfunction
• Pain in the face or jaw, or “Burning mouth syndrome”

Oral hygiene and Parkinson's

These symptoms may make it really hard for someone with PD to keep their teeth or dentures to clean, not mention willingly visit their dentist.¹

For instance, they might forget to brush daily, or they may have facial pain that is an obstacle to practicing oral hygiene, or they could fall into depression—which can lead to inadequate self-care.¹

A person with PD may also struggle to endure a dental visit because of their lack of control with movement and coordination, and bad experiences with dental professionals who aren’t experienced in treating patients with PD can make a future visit something to dread.¹

However, poor oral hygiene can lead to a path of additional pain and problems. Obvious concerns are tooth loss and cavities. Sometimes people with PD who have oral pain will also avoid eating or will make poor nutrition choices to avoid pain.¹

One serious oral health problem related to PD that may not be apparent—but requires checking by a dental professional—is nocturnal bruxism.

What is nocturnal bruxism?

Nocturnal bruxism describes nighttime tooth clenching or grinding. Like many of the movement behaviors in PD, nocturnal bruxism is an involuntary behavior and not simply the result of stress.² It’s considered both a symptom of PD and a free-standing sleep disorder.

It’s interesting to note that, while bruxism can happen at any time of day, daytime versions are seldom a complaint in someone with PD.³

Caregivers might notice the actual sound of tooth grinding coming from their loved ones as they sleep. Or it not might be apparent at all. Clenching of the jaw is another form of bruxism that, while silent, can be just as damaging.

Complaints of morning jaw pain, or the discovery of loosened or even broken teeth, may signal a case of nocturnal bruxism. Tight or sore neck muscles are also common. It might be easy to blame the pillow or aging for these problems, but it would be better to rule out bruxism first, as it can be treated.

Why treat nocturnal bruxism?

The involuntary movements of the jaw in PD, such as nocturnal bruxism, can lead to cracked teeth, the wearing away of tooth enamel—exposing nerve endings—and even changes in the fit and wear of dentures.⁴

Add these to the long list of other oral hygiene problems that occur as the result of PD and one can only expect to experience more and worsening dental problems—and more of those dreaded dental appointments.

Treatments

Since nocturnal bruxism is a movement disorder, it is treated in much the same way as PD.

Oral drugs such as muscle relaxants or anticholinergic drugs (especially trihexyphenidyl) can provide relief, but they do have side effects such as drowsiness and dry mouth.¹

For people with PD who have extreme bruxism, it may become so severe that they cannot open their mouths to chew food; in this case, Botox injections, which paralyze specific muscles in the jaw, can be effective.³

How to ensure success at a dental visit

The Parkinson’s Foundation offers these tips for treating dental concerns in those with PD:⁴

• Alert the dentist of your (or your loved one’s) PD symptoms, if you haven’t already. Or, if you have, and the visits have not gone well, consider switching to a clinic where the hygienists and dentists specialize in treating PD patients. (Note: If you aren’t sure of PD severity, it may be determined by a dentist specializing in PD according to the modified Hoehn and Yahr scale.)⁵
• Consider the time of the day when reserving a time slot. When are PD symptoms best controlled during the day? Try for an appointment then.
• The dentist will need to know about any PD-related medications, as some of them can interact with anesthetic drugs used in dental procedures.
• If PD is in an early stage, this is the optimal time to take care of replacements of old dental work (bridges, crowns, or fillings) or poorly fitting mouthguards or dentures. It’s much harder to perform these important dental care procedures in people with later-stage PD.