November 28, 2014
Oral Health and Parkinson's Disease
A prosthodontic practice has a large senior citizen contingent, and those patients have many of the diseases and conditions common with late adulthood. Understanding them is critical to our approach to dental treatment and the ability of patients to maintain their oral health. One of those diseases is Parkinson's Disease.
The type and severity of symptoms vary with each individual and the stage of the disease. They usually begin appearing between the ages of 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them. The most common symptoms include: tremor or shaking, in a hand, arm or leg. It occurs when awake and sitting or standing still (resting tremor) and subsides when the body part is moved.
One of the most common early signs is a reduced arm swing on one side when walking that is caused by rigid, stiff or aching muscles. Bradykinesia--slow, limited movement--is another, especially when moving from a resting position, like getting out of a chair or rolling over in bed. Weakness of facial or throat muscles affecting the ability to talk or swallow, causing choking, coughing or drooling, is seen, often with softer speech and a monotone. Loss of movement of facial muscles causes a vacant facial expression, called "Parkinson's mask".
Gait disturbance and postural instability, exhibited as difficulty with walking and balance, causes small steps, shuffling with feet close together, a stooped posture (bent forward slightly at the waist) and difficulty turning around. Balance and posture problems may result in frequent falls. Emotional and physical stress tend to make tremors more noticeable, whereas sleep, complete relaxation, and intentional action or movement usually stop the tremor. There are other physical and psychological symptoms that become more pronounced as the disease progresses.
From a prosthodontic standpoint, these patients require more frequent maintenance due to their increased difficulty in cleaning their teeth and the oral side effects of their medication regimen.
Robert G. Tupac, DDS, FACP, Inc., Diplomat, American Board of Prosthodontics
5060 California Ave., #170
Bakersfield, CA 93309