Parkinson’s Disease and the surprising impact on dental health
By: Carly Taylor
A commonly overlooked issue regarding Parkinson’s Disease is the challenges it can place on patients’ dental care and oral health (Auffret et al., 2021). The actual symptoms themselves, the severity of the disease, or the types of medications PD patients take can all contribute in their own ways (Verhoeff et al., 2023). Oral health is an important puzzle piece to overall health and quality of life, and should be given greater attention particularly in the realm of Parkinson’s Disease as a poorer oral health status can impact disease progression. Importantly, proper education, training, and equipment for dentists to treat this population of patients can be limited, making it all the more challenging for many to receive adequate care (Rozas et al., 2022).
Depending on the degree and severity of motor impairments, PD patients are more challenged with maintaining the same level of oral health as healthy individuals (Verhoeff et al., 2023). Loss of dexterity hinders their ability to properly brush their teeth. Moreover, Parkinson’s patients are likely to develop a weakened ability to swallow, causing food and saliva to remain in the mouth for longer. This increases their risk for developing gum disease, tooth decay, or other oral conditions and can put them at a greater risk of choking during treatment (“Dental Health in PD”, 2023). Another motor-related manifestation of PD is impaired voluntary movement, or dyskinesias. Patients may develop involuntary jaw movements (oro-buccal dyskinesias), where frequent involuntary teeth grinding, for example, can cause teeth to become cracked or worn down (“Dental Health in PD”, 2023). Parkinson’s patients may have trouble chewing, creating the tendency for them to avoid eating foods that are hard or crunchy, which are commonly those with high nutritious value (“Dental Health in PD”, 2023). Instead, they lean towards consuming unhealthier foods that are more likely to eventually cause problems like plaque buildup and cavity formation (“Dental Health in PD”, 2023).
Dentist appointments become challenging for patients as their motor control abilities including tremors, rigidity, and impaired oral control impede proper executions of treatments and checkups (Auffret et al., 2021). It becomes difficult to use dental tools such as drills when patients exhibit uncontrolled movement behaviors (“Dental Health in PD”, 2023). If severe enough, these symptoms can cause cessations of appointments, preventing patients from receiving the care and attention to which they are entitled (Auffret et al., 2021). This is especially problematic when dentists lack knowledge of the needs of PD patients and how to optimally work with them (Auffret et al., 2021).
Aside from the more common motor-related symptoms, the behavioral changes that can accompany Parkinson’s Disease, like apathy or depression, can also put patients at greater risk for poorer dental health (“Dental Health in PD”, 2023). With these obstacles, they become more inclined to care less about maintaining good oral health and begin to neglect every-day dental hygiene practices. Additionally, some Parkinson’s patients experience cognitive decline where they may become more forgetful with keeping up with oral care, and become more prone to missing dental appointments, leaving any potential dental concerns unaddressed for too long (“Dental Health in PD”, 2023). A study revealed that in Parkinson’s Disease, the more cognitive function declines, the greater the number of untreated cavities (Verhoeff et al., 2023).
Collectively, the typical multiple medications used to manage PD negatively impact oral health by virtue of their side effect of dry mouth (Verhoeff et al., 2023). Saliva helps to remove leftover food in the mouth, and the enzymes contained in it help to further break down food to prevent it from sticking to the teeth (Altima Dental, 2019). Dry mouth is therefore associated with an increased risk of cavities because of this reduced capacity to eliminate this material.
Levodopa is a commonly used medication for PD patients. After taking levodopa for multiple years, this drug can induce dyskinesia, including oro buccal dyskinesias mentioned previously (“Dental Health in PD”, 2023). Although requiring further study, patients taking levodopa were found to differ in their oral microbiota (the composition of microorganisms residing in the mouth) as compared to patients not on this medication, and that this different microbiota is associated with worse oral health (Verhoeff et al., 2023).
The impact of Parkinson’s Disease on dental health should continue to be thoroughly researched. While some remarkable efforts have been made to address these issues and promote more effective training and tailored care, it is still important to keep this relationship between dental health and PD in mind. Efforts should continue to be made to further educate medical professionals, especially dentists, on the course and symptoms of Parkinson’s Disease in order to develop more effective treatment and management options that are specifically accommodated to their needs. This will maximize their dental care and help to best prevent and manage oral complications, consequently granting them improved overall health and quality of life.
Altima Dental. (2019, May 10). How dry mouth can cause cavities. Altima Dental. https://www.altimadental.com/how-dry-mouth-can-cause-cavities/#:~:text=Dry%20mouth%20increases%20your%20chances,stuck%20to%20your%20teeth%20easier
Auffret, M., Meuric, V., Boyer, E., Bonnaure-Mallet, M., & Vérin, M. (2021). Oral Health Disorders in parkinson’s disease: More than meets the eye. Journal of Parkinson’s Disease, 11(4), 1507–1535. https://doi.org/10.3233/jpd-212605
Dental Health in PD. Parkinson’s Foundation. (2023). https://www.parkinson.org/library/fact-sheets/dental-health#:~:text=For%20a%20person%20with%20Parkinson’s,cognitive%20impairment%20and%20weight%20loss.
Rozas, N. S., Strassner, H. D., Sadowsky, J. M., & Jeter, C. B. (2022). Barriers and motivations to provide dental care to adult patients with movement disorders. International Journal of Environmental Research and Public Health, 19(9), 5256. https://doi.org/10.3390/ijerph19095256
Verhoeff, M. C., Eikenboom, D., Koutris, M., de Vries, R., Berendse, H. W., van Dijk, K. D., & Lobbezoo, F. (2023). Parkinson’s disease and oral health: A systematic review. Archives of Oral Biology, 151, 105712. https://doi.org/10.1016/j.archoralbio.2023.105712