Frequently, people with PD have cravings for sweet foods. The importance of good oral health must not be underestimated. PD can affect the mouth and subsequently oral health in several ways:
Saliva maintains hygienic moisture, preventing bacterial growth, moistens food as part of the digestive process and assists with maintaining healthy gums and teeth. In PD, xerostomia (dry mouth) is related to the disease process and is also a common side effect of PD medications and other medications. Xerostomia is detrimental to oral hygiene causing decay that encircles the tooth. Such decay cannot be filled and the tooth must be removed. In addition, mouth ulcerations and poor digestion of food are common. Xerostomia can add to existing changes in articulation.
Sialorrhea (drooling) is commonly experienced in PD and is related to poor mouth closure, reduced frequency of swallowing and poor posture rather than an over-production of saliva. As a result, saliva accumulates in the mouth and overflows. Sialorrhea can occur overnight even when xerostomia is experienced during the day. Saliva can at times be thick and “ropey”.
Weight loss which occurs frequently in PD can lead to changes in mouth structures and subsequently ill-fitting dentures. The continual movement of the dentures can cause mouth ulcers leading to pain and infection. Xerostomia affects denture control as saliva assists in holding dentures in place.
Most PD medications will have an anti-cholinergic effect including xerostomia. Other medications including those used to treat depression and bladder control may have a similar side effect.
Levodopa oxidizes easily. If this medication is in prolonged contact with oral structures for example, teeth discoloration will occur.
Tremor, a common symptom of PD, may affect the tongue and lips. This can be disconcerting. In addition repetitive automatic movements for example, teeth brushing and flossing can be disrupted by bradykinesia leading to ineffective oral hygiene. Poor coordination of muscles of the tongue and throat may affect rinsing.
Dyskinesia (involuntary movements – a side effect of levodopa) is frequently seen to affect the lips and mouth. This can be misconstrued as inappropriate smiling and may interfere with eating and oral hygiene.
Inadequate lip seal is frequently seen in PD and can result in sialorrhea as previously discussed. Overnight, poor lip closure will result in mouth breathing and xerostomia or conversely, sialorrhea.
If sialorrhea does not respond to simple measures, some specialists will recommend Botox injection into the salivary glands. This may provide relief for up to four months. However, as in the case of all drugs, side effects are possible.
In extreme cases, radiation treatment may be considered.
“Ropey” saliva may respond to the use of papaya extract. Please note that this must not to be used in conjunction with Warfarin.
If levodopa is chewed or liquid Sinemet® or Madopar Rapid® is used attention to oral hygiene or at least rinsing of the mouth is recommended following each dose. This will assist in preventing discoloration of the teeth due to oxidization.
Using an electric tooth brush will assist with repetitive automatic task problems and bradykinesia. Avoiding dual tasking will also help. The use of a straw will assist with rinsing.
An occupational therapist can review daily activities that are affected by tremor or bradykinesia and provide helpful strategies.
Prompt assessment by a speech pathologist is recommended to avoid or manage the issues which may interfere with oral hygiene. Regular dental check-ups are essential.
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