Regular Parkinson's dental care can minimize the risk of experiencing pain and discomfort, but most importantly, it can reduce the risk of infection. Understanding medication side effects is an important step to improving dental health.
Q: Which Parkinson’s-related medications cause oral side effects?
To understand medication’s side effects, you must first understand the critical role of saliva in relation to oral health. In addition to keeping the tissues inside of the mouth healthy and moist, saliva washes away harmful bacteria and acids on the teeth. When saliva production is significantly reduced, this equilibrium is disrupted and causes a potentially substantial impact upon oral health such as tooth decay.
Anticholinergic medications, used to treat resting tremor in Parkinson’s, commonly cause dry mouth symptoms (xerostemia). Medications such as amantadine, typically prescribed to reduce Parkinson’s-related dyskinesia, are not considered anticholinergic medications, but do have some “anticholinergic effects” that can also cause dry mouth. Individuals using Carbidopa/Levodopa or MAO-B Inhibitor medications, used to treat Parkinson’s motor symptoms, have also reported symptoms of dry mouth.
Medications taken for common non-motor Parkinson’s symptoms such as anxiety or depression, orthostatic hypotension and urinary incontinence may also cause dry mouth. There are also less common medications used to treat non-Parkinson’s related symptoms such as allergy, cold, diarrhea and nausea that can cause dry mouth.
Review your medications with your physician. Your physician may recommend alternative medications, changes to the medication schedule or changes to the dosage in order to minimize dry mouth symptoms. Do not change your medication regimen without consulting with your physician.
Q: How can medications improve oral health?
Generally speaking, medications for Parkinson’s can improve oral care and oral health by improving movement and motor control. These medications allow people with Parkinson’s to move with more precision and less effort which facilitates better oral care. Deep brain stimulation treatment (DBS) often provides a similar effect by improving movement that can lead to better oral care.
There are no specific medications prescribed directly to improve oral health. However, your dentist may recommend special oral care devices, as well as specialized toothpastes or oral rinses. For example, an oral rinse called chlorhexidine gluconate can be very effective when used in conjunction with brushing and flossing. Chlorhexidine is preferable to many over the counter mouthwashes because it does not contain alcohol, which can exacerbate symptoms of dry mouth and irritate oral tissues. Please note that this oral rinse requires a prescription from your dentist.
Q: How do Botulum Toxin injections affect oral health?
In some instances, medications can be prescribed to control excessive saliva or drooling (sialorrhea) for people with Parkinson’s. Sometimes these medications are not effective enough to satisfactorily control drooling. In that case, your physician might suggest injections of botulinum toxin. Small amounts of botulinum toxin are injected directly into the salivary glands inside the mouth in order to temporarily shut down saliva production. Typically, botulinum toxin is injected into the parotid glands and/or the submandibular glands. Parotid glands are activated during chewing and submandibular glands produce a significant amount of saliva (Kalf, DeSwart, Borm Bloem and Munneke, 2009). These injections can be an effective approach to addressing drooling and can provide relief for up to 3 months at a time. Another benefit may include keeping dentures properly sealed and reducing breakdown of the skin in the corners of the mouth.
Occasionally this approach can simply be “too effective” at reducing saliva production, causing dry mouth. As previously outlined in this article, dry mouth caused by lack of saliva can have a negative impact on oral health.
Suck on sugar free hard candies or chew sugar free cinnamon (not mint!) gum to initiate saliva production.
Q: How can occupational therapy treatment improve oral health?
Occupational therapists specialize in improving fine motor control with exercise and adaptive modifications. By following instructions and recommendations from your occupational therapist, you can improve your ability to perform oral care and many other common daily activities (often referred to as activities of daily living or ADL’s). Consider asking your doctor for a referral to an occupational therapist to see if there are ways to improve your ability to brush and floss your teeth.
Incorporating adaptive tools into your dental routine can also improve your oral care. For example, electric toothbrushes are an easy way to incorporate adaptive tech into your daily routine. As an added bonus, many of these toothbrushes have handles that are easier to hold and grip. A number of electric toothbrushes offer timers that beep every 30 seconds to remind you to move on to another “quadrant” of your mouth so you brush for the recommended length of two minutes.
Another simple way to alleviate symptoms of dry mouth is to stay properly hydrated. Every healthy adult should drink 8 to 10 pint sized glasses of water each day in addition to incidental liquids obtained through food and other sources.
Keep a water bottle with a tight fitting lid nearby so you can take small sips throughout the day to increase your water intake. This additional hydration will also improve medication efficiency and potentially improve symptoms of orthostatic hypotension (lightheadedness that can appear after standing).
M.Cicci`u, G. Risitano, G. lo Giudice, and E. Bramanti, “Periodontal health and caries prevalence evaluation in patients affected by Parkinson’s disease,” Parkinson’s Disease, vol. 2012, Article ID 541908
- Kalf, B. J. M. de Swart, G. F. Borm, B. R. Bloem, and M. Munneke, “Prevalence and definition of drooling in Parkinson’s disease: a systematic review,” Journal of Neurology, vol. 256, no. 9, pp. 1391–1396, 2009.
- Sheffield and J. Jankovic, “Botulinum toxin in the treatment of tremors, dystonias, sialorrhea and other symptoms associated with Parkinson’s disease,” Expert Review of Neurotherapeutics, vol. 7, no. 6, pp. 637–647, 2007.