Parkinsons Disease and

Dental Treatment

Dental Hygiene III

Kirkwood Community College
Natalie Mick

Parkinsons disease is a disorder that affects the central nervous system and typically is
seen in elderly adults. It was first recognized by ancient Indians and called kampavata and in
175 AD, it was given the name shaking palsy by Galen. A doctor from London named James
Parkinson published An Essay on the Shaking Palsy in 1817, and 60 years later, the condition
was named after Parkinson by Jean Martin Charcot (Parkinson's Disease Information). The
cause of Parkinson's disease is related to a dopamine deficiency in the brain. Dopamine is what
aids in nerve transmission and controls coordination and movement. There is some evidence that
Parkinson's is genetic by way of mutations, but environmental factors have also shown to play a
role. Head trauma and stress are considered predisposing factors along with folate deficiency
and agricultural work due to exposure to herbicides and pesticides (Parkinson's Disease
Information). This disease can affect any race and ethnic background. Parkinson's affects
mainly elderly and middle aged adults, but it is possible for an early onset to occur in those
younger than 40. Approximately one million Americans suffer from Parkinson's disease, with
men being more likely to develop it than women (Wilkins, 2013).
Parkinson's disease affects the body physically in a number of different ways. Some of
the most noticeable symptoms are tremors, slumped posture, and slowed speech. Other
symptoms include muscle rigidity, drooling, slow movements, loss of balance, less frequent
blinking and a blank stare (Hebl, 2015). Patients with Parkinson's may also suffer from
depression, perhaps due to feelings of helplessness and hopelessness, but it may also have
something to do with a lack of dopamine in the brain. There are a few medication options for
Parkinson's sufferers, but none of which can cure the individual. Medications only alleviate
symptoms of the disease. Levodopa was developed in the 1960s and has been the most common
drug prescribed since. It elevates dopamine levels in the brain so the patient suffers less from

tremors, imbalance, and uncontrolled motions. A couple other medications that are used to
lessen symptoms are Sinemet, ropinirole (Requip), and pramipexole (Mirapex). As with many
medications, there are some undesirable side effects. Confusion, hallucinations, and paranoia are
some of the more severe side effects. Patients can also experience dizziness, nausea, vomiting,
and drowsiness as well. From a dental standpoint, xerostomia, orthostatic hypotension, and
dyskinesia are effects that need to be considered when administering treatment (Parkinson's
Disease Information). Parkinson's is a progressive disease with no states of remission. Once a
patient is diagnosed with it, they will suffer from it for the rest of their life. Since it is
progressive, there are different stages of the disease. After approximately 20 years of having
Parkinson's, the patient may need to be placed in a nursing home or be under the complete care
of a loved one due to mental deterioration (Wilkins, 2013).
While there are not many direct physical effects on the oral cavity for patients that have
Parkinson's, there are a few that can lead to dental disease. Parkinson's patients have increased
salivation, which is good for buffering the saliva after eating and drinking, but on the other hand,
excessive drooling could cause angular cheilitis. Overall oral health is diminished due to the
patients inability to perform simple tasks, such as daily brushing and flossing, due to tremors.
Poor oral health can lead to an increased caries risk which, accompanied by an unhealthy mouth
and excessive amounts of bacteria, can lead to periodontal disease. Xerostomia caused by
medications also increases the patients risk of caries (Hodgson, Norman, & Simmer-Beck,
2014).
Depending on the state of the patients Parkinson's disease, it may be beneficial to have a
caretaker or other friend or relative present at dental appointments to ensure proper care is being
administered outside of the dental office. The patient will possibly need nutritional counseling in

order to make healthier and wiser decisions to maintain oral health. Someone suffering from
Parkinson's probably has feelings of despair due to their condition, so it is always important to
use words of encouragement to assure the patient they are doing well so they do not give up.
Since they will most likely develop dexterity issues, an electric toothbrush or a manual
toothbrush with a large handle is recommended. Using a regular toothbrush with a round piece
of foam or a tennis ball are other options that may be easier to assemble (Hebl, 2015). Regular
flossing is not generally an option so a floss threader, floss holders, or oral irrigators are great
alternatives for interdental cleaning (Hodgson, Norman, & Simmer-Beck, 2014). Appointment
modifications unquestionably need to be made to accommodate patients with Parkinson's
disease. Short appointments, preferably in the morning, are best, and it is ok to need more than
one appointment to fully clean the patients mouth. It is also important to make sure the patient
has taken his or her medications. The patient will still experience tremors so a bite block can be
used to stabilize the jaw so the clinician does not get bit. Use of a saliva ejector is recommended
so the patient does not choke on their saliva. Patients with Parkinson's are not always able to
communicate effectively so watch their eye movements to monitor if they are experiencing pain
or discomfort. Finally, it is very important to involve the caretaker in oral health instruction so
that they are able to assist the patient or perform daily tasks for the patient (Hebl, 2015).
While treating a patient with Parkinson's disease poses a number of complications, it is
important that they still receive treatment in order to maintain their overall health. With over a
million Parkinson's patients in the United States, it is likely that every dental office sees at least
one. By making the necessary adjustments to a routine appointment, those affected can get the
care that they need without apprehension. One of the best things we can do as dental hygienists

is to give these patients and their caregivers the right tools and information to be able to take care
of themselves to the best of their ability.

REFERENCES

Hebl, L. (2015) Dental Hygiene III, Kirkwood Community College.

Hodgson, M., Norman, M., & Simmer-Beck, M. (2014). Providing care to patients with
Parkinsons disease. Dimensions of Dental Hygiene, 12(3). Retrieved June 26, 2015,
from
http://www.dimensionsofdentalhygiene.com/2014/03_March/Features/Providing_Care_to
_Patients_with_Parkinsons_Disease.aspx
National Parkinson's Foundation. (n.d.). Parkinson's Disease Information. Retrieved June 26,
2015, from www.parkinsons.org
Wilkins, E. (2013). Clinical Practice of the Dental Hygienist (11th ed.). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins.