Dr. Aviv Ouanounou, fron the University of Toronto, comes back to offer tips on how to manage the patient with Parkinson’s disease in the dental office.
Highlights
Parkinson’s disease is a progressive and degenerative neurological disorder characterized by:
bradykinesia, tremors, rigidity and postural stability. This disease affects ~2 million people in the United States and every year 80,000 new cases are diagnosed. While this disease is usually found in those 65 and older, approximately 10% of Parkinsonian patients are younger than 45 years of age.
There are 4 main classes of medications used to treat the disease.
- Levo-dopa (with Carbi-dopa)
- Most common
- Side-effects: “on and off” fluctuations in motor functions, anxiety, xerostomia, psychosis, dyskinesia, hallucinations, nausea and vomiting
- Monoamine oxide inhibitors
- Side-effects: anxiety, insomnia, xerostomia,
- Dopamine agonists
- Combined with levo-dopa and carbi-dopa
- Less side-effects, usually
- Anticholinergic drugs
- Side-effects: urinary retention, xerostomia, confusion, hallucinations
Oral Complications
- Involuntary movements of the mandible, tongue, lips
- Xerostomia resulting in dental caries, periodontal disease
- Difficulty in denture retention
- Atypical orofacial pain, TMJ problems
- Sialorrhea
- Angular chelitis
- Impaired oral hygiene
Dental Management
A consultation with the patient and his/her neurologist may be required to determine the stage of the disease. In later stages, the patient may need to be referred to a hospital dental clinic for treatment. Informed consent issues may arise if the patient and practitioners may need to discuss treatment needs with the family member or caregiver who has Power of Attorney.
Special care must be taken to ensure a proper medical and medications history is acquired and updated regularly. In this way, practitioners can avoid drug interactions as well as note the progression of the disease through changes or additions to the medications list.
Preventive oral hygiene is important for the patient and family members and caregivers should be instructed on proper oral hygiene methods and the importance of good oral care for their loved one.
When appointments are booked for these patients, short, early appointments are best and coordinated with their medication. They will require assistance to be seated and they should be raised slowly after their treatment has been completed to prevent orthostatic hypotension.