Oral hygiene and dental care are aspects of Parkinson’s disease (PD) that can be easily overlooked, though it is estimated that 50% of people with the disease will encounter challenges in this area (Parkinson’s Foundation, n.d). Symptoms of PD can present unique challenges in maintaining oral hygiene. In early stages of PD, the development of motor symptoms can interfere with tooth brushing and flossing. In later stages, possible cognitive decline, softened voice, and diminished facial expression can make it difficult for the person to report dental pain and to describe any problems effectively to their dentist or healthcare team. Those who experience dyskinesia as a side effect of their medication may find that the involuntary movements result in cracked teeth and jaw clenching and/or grinding (Parkinson’s Foundation, n.d).

In addition, complications of certain medications, chronic dry mouth, chewing difficulties, and inadequate nutrition can contribute to dental problems in people with PD. Saliva production is also an important factor in optimal dental health – too much saliva can cause fungal infections in the corners of the mouth, and too little can cause cavities (Parkinson’s Foundation, n.d.).

Mental health conditions that may be experienced by people with Parkinson’s, such as depression, anxiety, or apathy, can also have consequences on dental health and oral hygiene.

There are several negative health effects that may arise from poor dental health and oral hygiene. If teeth start to decay or degrade, they can chew food less effectively, which can increase the risk of choking and aspiration, especially for people with PD (Parkinson’s Foundation, n.d.).

Additionally, many people may have heard about recent studies linking gum disease with cardiovascular issues, including heart attack and stroke. One reason there may be a link between these conditions is because harmful bacteria in the gums enter the bloodstream, where they are transported to tissues throughout the body, including the heart (Penn Medicine, 2022). A similar situation may occur in people with Parkinson’s who have devices such as Deep Brain Stimulation (DBS) electrodes – the bad bacteria in their mouth can infect their DBS device if they have uncontrolled gum disease or infected teeth (Parkinson’s Foundation, n.d.).

 

Oral Hygiene at Home

Motor symptoms of Parkinson’s, such as loss of manual dexterity, rigidity, and tremor, can make at-home dental care difficult. Follow these tips for more effective oral hygiene:

  • Use an electric toothbrush and a handle-style floss holder. Make sure to brush for at least two minutes, twice a day. Many electric toothbrushes come with a built-in timer that will beep once the two minutes are up, but if your does not, set an egg timer or one in your smartphone.
  • Use your stronger arm for brushing.
  • Ask your dentist about prescription-strength topical fluoride and chlorhexidine brushes for greater tooth protection. If you frequently experience choking episodes, mouthwash may not be suitable for you (Parkinson’s Foundation, n.d.).
  • Talk to your neurologist if you have a dry mouth or excessive saliva.
  • Make sure to clean your dentures. If you find this difficult, consider attaching a toothbrush to a suction cup on your bathroom counter, and move your dentures back and forth across the brush.

 

Conversations with Your Dentist

Make an appointment to talk to your dentist about Parkinson’s disease. Your dentist may or may not have an understanding of PD, but they need to know about your unique symptoms. The following information is important for your dentist to know ahead of a clinical appointment:

  • the name and contact information of the doctor who manages your PD
  • a list of your medications, vitamins, and supplements, and their dosages and timing. It is especially important for your dentist to know if you are taking an MAO-B inhibitor, such as rasagiline or selegiline, because this class of drugs can interact with anesthetics commonly used in dentistry (Parkinson’s Foundation, n.d.)
  • your most challenging symptoms (particularly tremors, rigidity, dystonia, lack of facial expression, and excessive daytime sleepiness)
  • whether you have swallowing and speaking difficulties
  • if you experience dyskinesia (particularly if it affects your mouth) or teeth grinding
  • whether you have excess saliva or a history of dry mouth
  • low blood pressure concerns, and/or a history of falls
  • how to help you if you experience an “off period” during your visit
  • your anxiety levels relating to PD, and general anxiety relating to dentistry

 

Preparing for Dental Appointments

Anxiety during a dental appointment is extremely common. Planning and preparing for your appointment can make a difference to your overall comfort. Consider the following:

  • If you need multiple interventions, book several short appointments rather than a single long one.
  • If you know you will need extensive dental work done, such as a tooth restoration, consider scheduling it as early as possible in your disease progression, as this will help you reduce any risks (Parkinson’s Foundation, n.d.).
  • Plan appointments around your medication “on” times.
  • Use the washroom prior to your appointment.
  • Ask if medications used during the treatment could adversely interact with PD medication.
  • Find and agree upon signals with your dentist that will indicate if you are uncomfortable, and to what degree. Be sure to have a signal for an emergency.
  • If you have a tremor that affects your jaw or mouth, discuss the possible use of conscious sedation. Make sure your dentist is informed about and comfortable giving a person with Parkinson’s disease sedating drugs, because many anesthetics can have negative interactions with PD medication.
  • At the completion of the procedure, sit up slowly and carefully, remaining seated for several minutes if necessary. Let your dentist know that you may need extra time to leave the chair.

Anxiety is known to exacerbate the symptoms of PD. Allow yourself time in the waiting room to recuperate after your appointment. Tell the receptionist in advance that you may do this.

When preparing for an appointment, also remind yourself to bring the following with you:

  • a list of your doctors’ contact information, and your medications and their dosages
  • extra medication, in case you need to take a dose before leaving
  • your Aware in Care medication card and form, with information on contraindicated medications
  • a U-shaped pillow for your neck

 

Sources

Noble, James M. (2009). Dental Care Needs Extra Focus with Parkinson’s. Parkinson’s Post. Northwest Parkinson’s Foundation.

Parkinson’s Foundation (n.d.). Dental Health. https://www.parkinson.org/living-with-parkinsons/management/dental-health

Parkinson’s Foundation (n.d.). Dental Health in PD. https://www.parkinson.org/library/fact-sheets/dental-health

Penn Medicine (2022). The Link Between Gum Disease and Heart Disease. https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2019/march/gum-disease-and-heart-disease

Scully, C. (2010). Medical problems in dentistry (6th ed.). Edinburgh: Churchill Livingstone.


Last updated: January 2, 2024