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Camacho LO, Jahangiri L, Iseringhausen J, Goldstein GR. Parkinson's disease - The dentist's role as part of the healthcare team. J Prosthodont 2024. [PMID: 38689457 DOI: 10.1111/jopr.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain. While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs. Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients. Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.
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Affiliation(s)
- Liliana Ortiz Camacho
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Leila Jahangiri
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Jenna Iseringhausen
- Department of Neurology and Movement Disorders, New York University Langone Health, New York, New York, USA
| | - Gary R Goldstein
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
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Blasi AM, Derman SHM, Kunnel A, Pape P, Röhrig G, Barbe AG. Oral Health and the Association with Blood Parameters in Neurogeriatric Inpatients without Relevant Systemic Inflammation: An Observational Study. Geriatrics (Basel) 2024; 9:55. [PMID: 38804312 PMCID: PMC11130911 DOI: 10.3390/geriatrics9030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
As little evidence is available, we report the oral health of neurogeriatric inpatients and the association with hematological parameters representing systemic health. We performed a cross-sectional investigation of 30 patients undergoing neurogeriatric early rehabilitation and excluded systemic inflammation as a trigger for oral infection (C-reactive protein >5 mg/dL). Outcomes included oral health and hygiene status and routine laboratory parameters. Patients (mean age 79 ± 6 years, mean comorbidities 7 ± 3, and mean Barthel Index at hospital admission 31 ± 18) had impaired oral health (mean 18 ± 7 of their own teeth, elevated plaque indices (2.5 ± 0.4), and bleeding on probing (26 ± 17)), representing short- and long-term reduced oral hygiene. Twenty-four (80%) patients had periodontitis. Laboratory parameters for inflammation, nutrition, and anemia did not correlate with oral health parameters (p > 0.05). The number of teeth correlated moderately with total protein (Spearman's rank correlation coefficient (rs) = 0.524; p = 0.003). Plaque indices correlated weakly with number of teeth (rs = -0.460; p = 0.010) and periodontitis diagnosis (rs = 0.488; p = 0.006). Thus, highly vulnerable neurogeriatric inpatients had reduced oral health and hygiene independent of laboratory parameters, representing a high-risk population for oral health problems even without clinically proven systemic infection. This should be considered in future interprofessional therapy planning.
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Affiliation(s)
- Alicia Maria Blasi
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
| | - Sonja Henny Maria Derman
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
| | - Asha Kunnel
- Clinic for Early Neurological and Interdisciplinary Rehabilitation, St. Marien-Hospital, D-50668 Cologne, Germany; (A.K.); (P.P.)
| | - Pantea Pape
- Clinic for Early Neurological and Interdisciplinary Rehabilitation, St. Marien-Hospital, D-50668 Cologne, Germany; (A.K.); (P.P.)
| | - Gabriele Röhrig
- Department of Health, EUFH-European University of Applied Sciences, D-50996 Cologne, Germany;
| | - Anna Greta Barbe
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
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3
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Lee NE, Yoo DM, Han KM, Kang HS, Kim JH, Kim JH, Bang WJ, Choi HG, Kim NY, Park HY, Kwon MJ. Investigating the Connection between Chronic Periodontitis and Parkinson's Disease: Findings from a Korean National Cohort Study. Biomedicines 2024; 12:792. [PMID: 38672147 PMCID: PMC11048377 DOI: 10.3390/biomedicines12040792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Recent research suggests a potential relevance between chronic periodontitis (CP) and Parkinson's disease (PD), raising concerns about comorbid PD among elderly CP patients. However, the epidemiologic basis for this association remains unclear. Employing a nested case-control design, this study explored the association between CP and subsequent PD occurrences in Korean adults, leveraging a validated national population-based dataset covering the period from 2002 to 2019. It included 8794 PD patients and 35,176 matched control individuals, established through propensity score matching for age, sex, residential area, and income. Baseline characteristics were compared using standardized differences, and logistic regression was employed to assess the impact of CP histories on PD likelihood while controlling for covariates. We performed a thorough examination of CP events within both 1-year and 2-year intervals preceding the index date, incorporating subgroup analyses. Our analysis revealed no statistically significant association between CP history and PD development overall. However, subgroup analysis revealed a slightly increased likelihood of PD development among CP individuals with a high disease burden (Charlson Comorbidity Index score ≥ 2). In conclusion, although our study did not find a significant overall association between CP history and PD development, the elevated likelihood of PD in subgroups with high disease burden may suggest that comorbidities influence PD probability among certain CP patients. Considering comorbid conditions in PD screening for some individuals with CP may be also important.
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Affiliation(s)
- Na-Eun Lee
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (N.-E.L.); (D.M.Y.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (N.-E.L.); (D.M.Y.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kyeong Min Han
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (N.-E.L.); (D.M.Y.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Mi Jung Kwon
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
- Division of Neuropathology, Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
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E Tebbutt J, Marshman Z, R Baker S. Oral health experiences of people living with Parkinson's disease: a scoping review. Br Dent J 2024:10.1038/s41415-024-7058-8. [PMID: 38326461 DOI: 10.1038/s41415-024-7058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 02/09/2024]
Abstract
Background and aim Parkinson's disease is the fastest growing and second most common progressive neurodegenerative condition in the UK; poised to represent a major societal and health care challenge. The scoping review aims to provide an overview of the literature on the oral health (OH) experiences of people living with Parkinson's, identifying current research gaps and future priorities.Method Search strategies included three electronic databases, two grey literature databases, relevant organisations, specialist journals and hand searching of the reference lists. A data extraction tool was developed and piloted.Results A total of 121 items were included in the review. Four themes were identified: OH impact, education and training, service delivery and wider impacts of OH for people with Parkinson's (PwP). The majority of studies included were cross-sectional in design, describing the OH status of PwP.Conclusion The majority of research to date has focused on OH impact. Areas for future research include use of qualitative studies exploring the experiences, attitudes and priorities of PwP and their care partners. Inclusion of medical, dental and allied health care professionals, together with people with lived experience, is required to develop, implement and evaluate interventions to support OH.
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Affiliation(s)
- Jessie E Tebbutt
- Academic Clinical Fellow in Special Care Dentistry, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, S10 2TA, UK.
| | - Zoe Marshman
- Professor/Honorary Consultant of Dental Public Health, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, S10 2TA, UK
| | - Sarah R Baker
- Professor of Psychology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, S10 2TA, UK
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Morimoto Y, Hayashi M, Tanaka Y, Mikuzuki L, Nishizaki H. Management for the patients with severe Parkinson's disease during dental treatments and tooth extractions: A retrospective observational study. J Dent Sci 2024; 19:261-267. [PMID: 38303822 PMCID: PMC10829563 DOI: 10.1016/j.jds.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose When Parkinson's disease (PD) progresses, oral and swallowing functions decline, and special care is necessary when performing dental treatments. This study aimed to retrospectively investigate the records of patients with PD and analyze dental and general problems to establish countermeasures during dental treatments. Materials and methods We retrospectively examined the medical records of patients with PD to obtain data on dental treatments and management methods. Results Of the 27 patients, 40% had severe grade IV or higher Hoehn-Yale (HY) scores, and the wearing-off phenomenon was observed in those with grade III or higher. Additionally, 19% of the patients were receiving levodopa 500 mg/day or more. Intravenous sedation was administered 21 times (three patients) and general anesthesia eight times (three patients). Discontinuation of tooth extraction was observed in four patients: two with difficulty in opening the mouth, one with respiratory failure caused by the wearing-off phenomenon, and one with excessively elevated blood pressure due to the interaction between adrenaline in local anesthesia and the catechol-O-methyltransferase inhibitor. Tooth extraction was performed by adjusting the time of levodopa administration in two patients, under general anesthesia in one patient, and using adrenaline-free local anesthetics under intravenous sedation in one patient. Conclusion When PD progresses, oral and swallowing functions decline and body motor function deteriorates. Thus, the respiratory and circulatory conditions and the wearing-off phenomenon during dental treatments should be properly managed in patients with severe PD.
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Affiliation(s)
- Yoshinari Morimoto
- Corresponding author. Department of Geriatric Dentistry, Kanagawa Dental University, 82, Inaoka-cho, Yokosuka, Kanagawa, Japan.
| | | | | | - Lou Mikuzuki
- Department of Geriatric Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
| | - Hitomi Nishizaki
- Department of Geriatric Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan
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Al-Kheraif AA, Javed R, Al-Momani MM, Wasi A, Mohamed BA, Khan AA. Effectiveness of photodynamic therapy on clinical and biomarker related periodontal parameters and oral health related quality of life (OHRQoL) in Parkinson's disease patients with stage III periodontitis. Photodiagnosis Photodyn Ther 2023; 43:103690. [PMID: 37422202 DOI: 10.1016/j.pdpdt.2023.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
AIMS To evaluate the clinical, radiographic, immune modulatory biomarkers and quality of life with the application of photodynamic therapy (PDT) as an adjunctive treatment to dental scaling and root planing (SRP) in patients with chronic periodontitis and Parkinson's disease. METHODOLOGY Individuals who had a confirmed diagnosis of stage III periodontitis and stage 4 Parkinson's disease according to Hoehn and Yahr scale were involved in this study. The participants were divided into two groups: Group SRP (n = 25) received traditional dental scaling procedure including full-mouth debridement and disinfection, and Group PDT + SRP (n = 25) received both traditional cleaning procedures along with adjunctive chloro‑aluminum phthalocyanine (CAPC) gel (0.005% concentration) mediated PDT. CAPC photosensitizer was activated using a diode laser (wavelength=640 nm, energy=4 J, 150 mW power, and overall power density of 300 J/cm2) for 60 s. The study measured clinical parameters such as plaque score (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and radiographic alveolar bone loss (ABL). Proinflammatory cytokine levels such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) and oral health related quality of life were also assessed. RESULTS The mean age of patients in Group SRP was 73.3 years, while the mean age in Group PDT + SRP was 71.6 years. The PDT + SRP group showed a significant reduction in all clinical parameters at 6 and 12 months compared to the SRP group alone (p < 0.05). IL-6 and TNF-α levels were significantly reduced in the PDT + SRP group at 6 months compared to the SRP group alone (p < 0.05). However, at 12 months, both groups showed comparable TNF-α levels. The results showed that Group PDT + SRP had significantly lower OHIP scores compared to Group SRP, with a mean difference of 4.55 (95% confidence interval [CI]: 1.98 to 7.12) (p < 0.01). CONCLUSION Combined SRP with PDT showed significant improvement compared to SRP alone in terms of clinical parameters, cytokine levels, and oral health-related quality of life in individuals diagnosed with stage III periodontitis associated with Parkinson's disease.
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Affiliation(s)
- Abdulaziz A Al-Kheraif
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Ravish Javed
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Mahmoud Al-Momani
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Aisha Wasi
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Badreldin A Mohamed
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Aftab Ahmed Khan
- Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Talman L, Safarpour D. An Overview of Gastrointestinal Dysfunction in Parkinsonian Syndromes. Semin Neurol 2023; 43:583-597. [PMID: 37703887 DOI: 10.1055/s-0043-1771461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gastrointestinal (GI) dysfunction is a common nonmotor symptom in Parkinson's disease (PD) as well as other parkinsonian syndromes and may precede the onset of motor symptoms by decades. Involvement of all segments of the GI tract can lead to altered responses to medications and worsened quality of life for patients. While some GI symptoms occur in isolation, others overlap. Therefore, understanding the changes in different segments of the GI tract and how they relate to altered responses to PD treatment can guide both diagnostic and pharmacological interventions. Gut microbiota plays a critical role in immune activity and modulation of the enteric and central nervous systems. Understanding this bidirectional relationship helps to elucidate the pathogenesis of neurodegeneration. This review will describe the current understanding of how GI dysfunction develops in parkinsonian syndromes, common symptoms in PD and related disorders, and available treatments.
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Affiliation(s)
- Lauren Talman
- Department of Neurology School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Delaram Safarpour
- Department of Neurology School of Medicine, Oregon Health & Science University, Portland, Oregon
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Baram S, Thomsen CE, Øzhayat EB, Karlsborg M, Bakke M. Orofacial function and temporomandibular disorders in Parkinson's Disease: a case-controlled study. BMC Oral Health 2023; 23:381. [PMID: 37308874 DOI: 10.1186/s12903-023-03051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The difficulties and challenges faced by people with Parkinson's disease (PD) in performing daily orofacial function are not systematically investigated. In this study, specific orofacial non-motor and motor symptoms and functions were systematically examined in PD patients in comparison to a matched control group. METHODS The clinical case-controlled study was conducted from May 2021 to October 2022 and included persons with PD and age- and gender-matched persons without PD. The participants with PD were outpatients diagnosed with PD at the Department of Neurology at Bispebjerg University Hospital in Copenhagen, Denmark. The participants underwent a systematic clinical and relevant self-assessment of the orofacial function and temporomandibular disorders (TMD). The primary outcomes were objective and subjective assessments of the general orofacial function, mastication, swallowing, xerostomia and drooling. The secondary outcomes were the prevalence of TMD and orofacial pain. The difference in outcome measures between the two groups was analysed using chi-square and Mann-Whitney U test. RESULTS The study included 20 persons with PD and 20 age- and gender-matched persons without PD. Both objectively and subjectively, persons with PD had poorer orofacial function than the control group. Persons with PD had also a significantly more severe limitation of jaw mobility and jaw function. The objective masticatory function was also significantly reduced for persons with PD compared to the control group, and 60% of persons with PD found it difficult to eat foods with certain consistencies while 0% of the control group reported that problem. Persons with PD could swallow less water per second and the average swallowing event was significantly longer for PD persons. Even though PD persons reported more xerostomia (58% for persons with PD and 20% for control persons), they also reported significantly more drooling than the control group. Additionally, orofacial pain was more prevalent in PD persons. CONCLUSIONS Persons with PD have a compromised orofacial function. Furthermore, the study indicates a link between PD and orofacial pain. In order to screen and treat persons with PD accordingly, healthcare professionals should be aware of and address these limitations and symptoms. TRIAL REGISTRATION The trial was approved by the Regional Committee on Research Health Ethics of the Capital Region (H-20,047,464), the Danish Data Protection Agency (514 - 0510/20-3000), and registered at ClinicalTrials.gov (NCT05356845).
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Affiliation(s)
- Sara Baram
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark.
| | - Carsten Eckhart Thomsen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
| | - Merete Karlsborg
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 20 Nørre Allé, Copenhagen N, DK-2200, Denmark
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Baram S, Rosing K, Bakke M, Karlsborg M, Øzhayat EB. Dental care utilization among persons with Parkinson's disease in Denmark. Community Dent Oral Epidemiol 2023; 51:527-534. [PMID: 36317764 DOI: 10.1111/cdoe.12809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Persons with Parkinson's disease (PD) have a higher prevalence of oral diseases and orofacial dysfunction, but knowledge about the use of dental care and whether their dental care needs are met is sparse. This study aimed to investigate the dental attendance and usage of dental care services of the total PD population in Denmark and compare it with a control group. METHODS National registers were used to identify the total PD population in Denmark (n = 6874) and to obtain data on their dental care from 2015 to 2019. These data were compared with a five-fold age-, gender- and geographically matched control group without PD (n = 34 285). Register data on age, gender, civil status, educational level, income, nursing homes status and mortality were also collected and adjusted for in the analyses. The dental attendance was analysed using χ2 -test with Bonferroni correction, and the type of dental care services was analysed using negative binomial regression analysis. RESULTS A significantly higher proportion of persons with PD were irregular attenders of the dental care system (21.0%), compared with the control group (16.9%). Persons with PD had a significantly higher overall usage of dental cares services. Most prominent was the high usage of treatment services, where persons with PD had a 1.50 times higher incidence rate of tooth extractions and a 1.71 times higher incidence rate of tooth fillings in the five years compared with the control group. CONCLUSION Persons with PD are more often irregular users of dental care and receive more treatment services than the control group. This indicates a need for high-quality prophylactic initiatives to prevent high filling and tooth extraction rates. Furthermore, this knowledge can be used by clinicians and decision makers to ensure optimal dental care for persons with PD.
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Affiliation(s)
- Sara Baram
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Rosing
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Karlsborg
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Verhoeff MC, Eikenboom D, Koutris M, de Vries R, Berendse HW, van Dijk KD, Lobbezoo F. Parkinson's disease and oral health: A systematic review. Arch Oral Biol 2023; 151:105712. [PMID: 37120970 DOI: 10.1016/j.archoralbio.2023.105712] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE in patients with Parkinson's Disease (PD), oral health can be affected by motor and non-motor symptoms and/or medication use. Therefore, the aim was to systematically review the literature on oral health and associated factors of oral health in PD patients. DESIGN a literature search was performed from inception up to April 5th, 2023. Original studies that assessed oral health-related factors in PD patients and were written in English or Dutch, were included. RESULTS 11276 articles were identified, of which 43 met the inclusion criteria (quality range poor-good). A higher prevalence of dental biofilm, bleeding/gingivitis, pocket depth (≥4 mm), tooth mobility, caries, and number of decayed missing filled teeth/surfaces was found in PD patients than in controls. However, no difference between both groups was found when analysing edentulism and wearing dentures. Poor oral health of PD patients was associated with a longer disease duration, higher disease severity, and more prescribed medications. CONCLUSIONS oral health of PD patients is worse than that of healthy individuals. It is associated with the duration and severity of PD and medication use. Therefore, we advise regular appointments with oral health care professionals, with an important focus on prevention.
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Affiliation(s)
- Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Denise Eikenboom
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Amsterdam, the Netherlands
| | - Henk W Berendse
- Amsterdam University Medical Centres (Amsterdam UMC), Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Karin D van Dijk
- Amsterdam University Medical Centres (Amsterdam UMC), Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, Amsterdam, the Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Santos-García D, de Deus Fonticoba T, Cores Bartolomé C, Feal Painceiras MJ, Íñiguez-Alvarado MC, Jesús S, Buongiorno MT, Planellas L, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor García-Soto J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LML, McAfee D, Martinez-Martin P, Mir P, COPPADIS SG. Prevalence and Factors Associated with Drooling in Parkinson’s Disease: Results from a Longitudinal Prospective Cohort and Comparison with a Control Group. PARKINSON'S DISEASE 2023; 2023:3104425. [PMID: 37065970 PMCID: PMC10101739 DOI: 10.1155/2023/3104425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 04/09/2023]
Abstract
Introduction. Drooling in Parkinson’s disease (PD) is frequent but often goes underrecognized. Our aim was to examine the prevalence of drooling in a PD cohort and compare it with a control group. Specifically, we identified factors associated with drooling and conducted subanalyses in a subgroup of very early PD patients. Patients and Methods. PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30-day follow-up (V2) from 35 centers in Spain from the COPPADIS cohort were included in this longitudinal prospective study. Subjects were classified as with or without drooling according to item 19 of the NMSS (Nonmotor Symptoms Scale) at V0, V1 (1-year ± 15 days), and V2 for patients and at V0 and V2 for controls. Results. The frequency of drooling in PD patients was 40.1% (277/691) at V0 (2.4% (5/201) in controls;
< 0.0001), 43.7% (264/604) at V1, and 48.2% (242/502) at V2 (3.2% (4/124) in controls;
< 0.0001), with a period prevalence of 63.6% (306/481). Being older (OR = 1.032;
= 0.012), being male (OR = 2.333;
< 0.0001), having greater nonmotor symptom (NMS) burden at the baseline (NMSS total score at V0; OR = 1.020;
< 0.0001), and having a greater increase in the NMS burden from V0 to V2 (change in the NMSS total score from V0 to V2; OR = 1.012;
< 0.0001) were identified as independent predictors of drooling after the 2-year follow-up. Similar results were observed in the group of patients with ≤2 years since symptom onset, with a cumulative prevalence of 64.6% and a higher score on the UPDRS-III at V0 (OR = 1.121;
= 0.007) as a predictor of drooling at V2. Conclusion. Drooling is frequent in PD patients even at the initial onset of the disease and is associated with a greater motor severity and NMS burden.
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Affiliation(s)
| | | | | | | | | | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | | | | | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ines Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Jorge Hernández Vara
- Hospital Universitario Vall d’Hebron, Barcelona, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | - Isabel González Aramburu
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Maria A. Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L´Hospitalet, L´Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS), Institut Català de La Salut, Girona, Spain
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, Madrid, Spain
| | - Sonia Escalante
- Hospital de Tortosa Verge de La Cinta (HTVC), Tortosa, Tarragona, Spain
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | | | | | | | - Maria G. Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | | | - Jaime Kulisevsky
- Hospital de Sant Pau, Barcelona, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), Pontevedra, Spain
| | | | | | | | | | | | | | | | | | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Seville, Spain
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), Madrid, Spain
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12
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Verhoeff MC, Koutris M, Vries RD, Berendse HW, Dijk KDV, Lobbezoo F. Salivation in Parkinson's disease: A scoping review. Gerodontology 2023; 40:26-38. [PMID: 35246869 DOI: 10.1111/ger.12628] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to provide an overview of the available literature that includes both objective assessments (namely hypersalivation and hyposalivation) and the subjective experience (namely xerostomia and drooling) of salivary problems in patients with Parkinson's disease. BACKGROUND In patients with Parkinson's disease, there may be complaints of salivary problems such as xerostomia or drooling. This can have consequences for their oral health and quality of life. To date, systematic reviews have focused on drooling only. MATERIALS AND METHODS A literature search in 4 databases was performed up to 12 February 2021. Two researchers independently assessed studies for eligibility. RESULTS In total, 63 studies were included. The prevalence of self-reported xerostomia ranged from 49% to 77%, and that of self-reported drooling ranged from 5% to 80%. Ten articles reported a significantly lower mean salivary flow in patients with Parkinson's disease than in controls. None of the articles with both a control group and a patient group reported a significantly higher salivary flow in patients with Parkinson's disease. When questioned about subjective salivary problems, a significantly higher prevalence of both xerostomia (7 studies) and drooling (14 studies) was found in patients with Parkinson's disease than in controls. Patients with Parkinson's disease have a lower salivary flow rate and higher prevalence of both xerostomia and drooling than controls. CONCLUSION The complexity of salivary problems present in patients with Parkinson's disease necessitates a multidisciplinary approach in order to avoid mutually counteracting treatments from different healthcare professionals.
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Affiliation(s)
- Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, Amsterdam, The Netherlands
| | - Henk W Berendse
- Amsterdam University Medical Centres (Amsterdam UMC), Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karin D van Dijk
- Amsterdam University Medical Centres (Amsterdam UMC), Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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13
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Dismore L, Montague K, Carvalho L, Guerreiro T, Jackson D, Guan Y, Walker R. A protocol for the evaluation of a wearable device for monitoring of symptoms, and cueing for the management of drooling, in people with Parkinson's disease. PLoS One 2023; 18:e0280727. [PMID: 36827274 PMCID: PMC9955579 DOI: 10.1371/journal.pone.0280727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/16/2022] [Indexed: 02/25/2023] Open
Abstract
Drooling is a common symptom of Parkinson's Disease (PD) experienced in up to 70% of people with PD (PwP). Drooling can be a major problem in PwP leading to adverse physical and psychosocial issues. Current medical treatments decrease the production of saliva, whereas the problem is due to decreased swallowing frequency, not over production of saliva. Such treatments are problematic as saliva is essential for good oral health. Therefore, non-invasive treatments options such as behavioural cueing methods are recommended. A wrist-worn device delivering haptic cueing has been demonstrated to be an effective treatment method to increase swallowing frequency and a socially acceptable solution for PwP. However, the device had limited functionality and was tested on a small sample size over a short period of usage. Further work is required to understand the real-world behaviours and usage of the intervention to understand the longer-term effects with a larger sample size. This research will deploy CueBand, a discrete and comfortable wrist-worn device designed to work with a smartphone application to support the real-world evaluation of haptic cueing for the management of drooling. We will recruit 3,000 PwP to wear the device day and night for the intervention period to gain a greater understanding of the effectiveness and acceptability of the technology within real-world use. Additionally, 300 PwP who self-identity as having an issue with drooling will be recruited into an intervention study to evaluate the effectiveness of the wrist-worn CueBand to deliver haptic cueing (3-weeks) compared with smartphone cueing methods (3-weeks). PwP will use our smartphone application to self-assess their drooling frequency, severity, and duration using visual analogue scales and through the completion of daily diaries. Semi-structured interviews to gain feedback about utility of CueBand will be conducted following participants completion of the intervention.
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Affiliation(s)
- Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, Innovation, Research and Development, North Tyneside General Hospital, North Shields, United Kingdom
| | - Kyle Montague
- Computer & Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Luis Carvalho
- Computer & Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Portugal, Portugal
| | - Dan Jackson
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yu Guan
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Innovation, Research and Development, North Tyneside General Hospital, North Shields, United Kingdom
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14
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Chen Y, Jin Y, Li K, Qiu H, Jiang Z, Zhu J, Chen S, Xie W, Chen G, Yang D. Is There an Association Between Parkinson's Disease and Periodontitis? A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1107-1125. [PMID: 37899063 PMCID: PMC10657691 DOI: 10.3233/jpd-230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis. OBJECTIVE This systematic review and meta-analysis was conducted to ascertain their bidirectional relationship. METHODS A literature search for relevant studies was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases from inception to December 19, 2022. Effect sizes (ES) with 95% confidence intervals were pooled under the random-effects model. Then, leave-one-out sensitivity analysis and contour-enhanced funnel plot were applied to assess the stability of the results. RESULTS A total of 34 studies and 24 studies were included for systematic review and quantitative meta-analysis, respectively. Pooled ES indicated that periodontitis was not significantly associated with PD risk (HR = 1.13, 95% CI 0.88-1.45, n = 3; OR = 1.94, 95% CI 0.55-6.90, n = 7), while the Mendelian randomization study revealed no association between PD and periodontitis risk (coefficient [B] = -0.0001, standard error = 0.0001, p = 0.19). Furthermore, PD patients exhibited higher levels of periodontal pocket depth (SMD = 1.10, 95% CI 0.53-1.67), clinical attachment level (SMD = 1.40, 95% CI 0.55-2.26), plaque index (SMD = 0.81, 95% CI 0.22-1.39), and Oral Health Impact Profile-14 score (SMD = 0.91, 95% CI 0.33-1.49) compared to healthy controls. CONCLUSIONS Our meta-analysis identified no bidirectional association between PD risk and periodontitis risk, though the prevalence of periodontitis and poorer oral status was higher in PD patients.
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Affiliation(s)
- Yiqun Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yining Jin
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kun Li
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Haojie Qiu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zihan Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinrong Zhu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Siqi Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Xie
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Systemic Diseases with Oral Manifestations and Their Impact on Health-Related Quality of Life. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Health-related quality of life is a multidimensional concept established to evaluate the physical, psychological, and social impacts of health conditions on individuals’ well-being. Various tools for measuring health-related quality of life can be categorized into two subsets: generic and disease–specific instruments. The oral cavity can be stricken by a broad range of local and systemic diseases and their systemic treatment modalities. The most common systemic illnesses associated with oral lesions are hematologic disorders, endocrinopathies, neurological disorders, gastrointestinal conditions, mucocutaneous and rheumatic diseases, and neoplastic processes. Their manifestations in the oral cavity are, in most cases, rather nonspecific but should not be overlooked. Oral health is one of the most important parts of overall health, thus it has been proposed that poor oral health may affect health–related quality of life. The presence of oral manifestations of systemic diseases has a negative impact on the daily functioning of patients, decreasing their overall well-being. This article will review the most common systemic diseases with oral manifestations and their impact on the health–related quality of life. Oral health researchers should put a stronger emphasis on the patient-reported quality of life as a primary outcome in future clinical trials. The significance of this area has still not been widely understood in the current dental literature even though it could help improve patients’ health-related quality of life.
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16
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Gong S, Gao Y, Liu J, Li J, Tang X, Ran Q, Tang R, Liao C. The prevalence and associated factors of dysphagia in Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13:1000527. [PMID: 36277913 PMCID: PMC9582284 DOI: 10.3389/fneur.2022.1000527] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence and associated factors of dysphagia in Parkinson's disease (PD) are different in studies conducted in different countries. The purpose of our systematic review and meta-analysis was to evaluate the prevalence of dysphagia in PD and to clarify its associated factors. Methods Two researchers systematically searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, SinoMed and VIP databases and manually searched references in the retrieved articles to identify potential research subjects. The last search was conducted on June 28, 2022. Finally, a total of 58 studies including 60 observations with 20,530 PD patients were included in our meta-analysis. Results The meta-analysis estimated that the pooled prevalence rate of dysphagia in PD was 36.9% (95% CI: 30.7–43.6%) and instrumental examination showed a higher prevalence (57.3%, 95% CI: 44.3–69.1%). Oceania showed the highest prevalence of dysphagia in PD (56.3%) compared to Africa (39.5%), Asia (38.6%), Europe (36.1%) and America (28.9%). Dysphagia in PD was associated with older age, lower body mass index, longer disease duration, higher Hoehn and Yahr stage and levodopa equivalent daily dose, PIGD subtype, severe motor symptoms, drooling and higher levels of depression, and lower quality of life. Conclusions In conclusion, our meta-analysis showed that dysphagia occurs in more than one-third of PD patients and was associated with several demographic characteristics and PD-related characteristics, motor symptoms, non-motor symptoms, as well as decreased quality of life. It deserves early screening, diagnosis, and treatment in clinical practice to prevent serious complications from dysphagia.
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Affiliation(s)
- Siyuan Gong
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Gao
- Nursing Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jihong Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueqin Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Ran
- Endocrinology Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongzhu Tang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunlian Liao
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Chunlian Liao
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17
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Pathophysiology and Symptomatology of Drooling in Parkinson’s Disease. Healthcare (Basel) 2022; 10:healthcare10030516. [PMID: 35326994 PMCID: PMC8951596 DOI: 10.3390/healthcare10030516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/29/2022] Open
Abstract
Drooling can present in patients with Parkinson’s disease (PD), and it is manifested as an excessive pooling of saliva inside the oral cavity. Currently, the exact pathophysiological mechanism of drooling in PD is not yet fully explicated. Thus, it becomes crucial to understand if some clinical characteristics may emphasize drooling or if they are just concomitant. In PD, excessive drooling has been associated with a higher burden of non-motor symptoms, such as cognitive impairment, sleep problems, autonomic dysfunction, constipation and orthostatic hypotension, and of worse severity of motor fluctuations and bradykinesia. PD patients with excessive drooling also showed a reduction of striatal DAT availability at DaTSCAN imaging. Excessive drooling in patients with Parkinson’s cannot be attributed to a single factor but to a mixture of factors, including but not limited to impaired nigrostriatal pathways.
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18
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Verhoeff MC, Lobbezoo F, van Leeuwen AM, Schuller AA, Koutris M. Oral health-related quality of life in patients with Parkinson's disease. J Oral Rehabil 2022; 49:398-406. [PMID: 35000220 PMCID: PMC9306816 DOI: 10.1111/joor.13304] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022]
Abstract
Background Parkinson's disease (PD) is a neurodegenerative condition affecting the quality of life. Due to a worsening of oral health in PD patients with the progression of the disease, oral health‐related quality of life (OHRQoL) could be impaired as well. Objectives To assess whether PD patients in The Netherlands experience worse OHRQoL than historical controls, and to investigate which factors are associated with OHRQoL in PD patients. Materials & Methods In total, 341 PD patients (65.5 ± 8.4 years) and 411 historical controls (62.6 ± 5.3 years) participated. Both groups completed a questionnaire. The PD patients were asked questions regarding demographics, PD, oral health, and OHRQoL. The historical controls filled in demographic information and questions regarding OHRQoL. The latter construct was assessed using the Dutch 14‐item version of the Oral Health Impact Profile (OHIP‐14). Data were analysed using independent samples t‐tests and univariate and multivariate linear regression analysis. Results The mean OHIP‐14 score was higher in PD patients (19.1 ± 6.7) than in historical controls (16.5 ± 4.4) (t(239) = 6.5; p < .001). OHRQoL in PD patients was statistically significant associated with motor aspects of experiences of daily living (B = 0.31; t(315) = 7.03; p < .001), worsening of the oral environment during disease course (B = 3.39; t(315) = 4.21; p < .001), being dentate (B = −5.60; t(315) = −4.5; p < .001), tooth wear (B = 2.25; t(315) = 3.29; p = .001), and possible burning mouth syndrome (B = 5.87; t(315) = 2.87; p = .004). Conclusion PD patients had a lower OHRQoL than historical controls. Besides, PD‐related variables and oral health‐related variables were associated with OHRQoL.
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Affiliation(s)
- Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Astrid M van Leeuwen
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie A Schuller
- TNO Child Health - Behavioral and Societal Sciences, Leiden, The Netherlands.,Center for Dentistry and Oral Hygiene, University Medical Center Groningen, Groningen, The Netherlands
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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19
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John TK, Vasanthy B, Madhavanpillai BR, Gomez MS, Kuriakose R. Does parkinsonism affect periodontal health? A cross-sectional study in a tertiary hospital. J Indian Soc Periodontol 2021; 25:538-543. [PMID: 34898921 PMCID: PMC8603805 DOI: 10.4103/jisp.jisp_749_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Muscular rigidity, tremors, and bradykinesia with diminished motor skills are the characteristic features of Parkinson's disease (PD). Aim: The study investigated the influence of reduced motor proficiency on the periodontal health of PD patients and compared it with controls. Setting and Design: A cross-sectional study was conducted on PD patients selected from outpatient section of a tertiary healthcare center and compared with age- and gender-matched controls. Materials and Methods: Oral health status of the subjects was graded based on decayed, missing, and filled teeth index, oral hygiene index (OHI), modified gingival index, probing pocket depth (PPD), clinical attachment level (CAL), tooth mobility, interproximal PPD, and interproximal CAL measurements. PD patients were categorized based on Hoehn and Yahr scale and duration to assess the influence of PD severity and progression. Statistical Analysis: Difference in the mean values of quantitative variables was analyzed by parametric t-test and Chi-square test for categorical variables. Results: In PD patients, 84.4% of subjects had moderate–severe gingivitis, while it was 2.4% in the control group. Mean number of interproximal sites with CAL >5 mm in PD patients and control subjects was 8.41 ± 6.37 and 1.12 ± 2.28, respectively (P < 0.05). The mean OHI was 2.90 ± 0.81 in patients with mild PD and increased to 3.77 ± 0.52 as PD severity exalted. Conclusion: PD patients had impaired oral condition with higher OHI and increased gingival inflammation with a likelihood of male predisposition. Substantial interproximal tissue destruction, debilitated periodontal health as PD progresses, suggests early attention toward their oral health.
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Affiliation(s)
- Tony Kurien John
- Department of Periodontics, Government Dental College, Kottayam, Kerala, India
| | - Beena Vasanthy
- Department of Neurology, Government Medical College, Kottayam, Kerala, India
| | | | - Mary Shimi Gomez
- Department of Public Health Dentistry, Government Dental College, Kottayam, Kerala, India
| | - Rene Kuriakose
- Department of Prosthodontics, Pushpagiri College of Dental Sciences, Tiruvalla, Kerala, India
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20
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Rozas NS, Tribble GD, Jeter CB. Oral Factors That Impact the Oral Microbiota in Parkinson's Disease. Microorganisms 2021; 9:microorganisms9081616. [PMID: 34442695 PMCID: PMC8402101 DOI: 10.3390/microorganisms9081616] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023] Open
Abstract
Patients with Parkinson’s disease (PD) are at increased risk of aspiration pneumonia, their primary cause of death. Their oral microbiota differs from healthy controls, exacerbating this risk. Our goal was to explore if poor oral health, poor oral hygiene, and dysphagia status affect the oral microbiota composition of these patients. In this cross-sectional case-control study, the oral microbiota from hard and soft tissues of patients with PD (n = 30) and age-, gender-, and education-matched healthy controls (n = 30) was compared using 16S rRNA gene sequencing for bacterial identification. Study participants completed dietary, oral hygiene, drooling, and dysphagia questionnaires, and an oral health screening. Significant differences in soft tissue beta-diversity (p < 0.005) were found, and a higher abundance of opportunistic oral pathogens was detected in patients with PD. Factors that significantly influenced soft tissue beta-diversity and microbiota composition include dysphagia, drooling (both p < 0.05), and salivary pH (p < 0.005). Thus, patients with PD show significant differences in their oral microbiota compared to the controls, which may be due, in part, to dysphagia, drooling, and salivary pH. Understanding factors that alter their oral microbiota could lead to the development of diagnostic and treatment strategies that improve the quality of life and survivability of these patients.
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Affiliation(s)
- Natalia S. Rozas
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
| | - Gena D. Tribble
- Department of Periodontics and Dental Hygiene, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBS-5318, Houston, TX 77054, USA;
| | - Cameron B. Jeter
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
- Correspondence: ; Tel.: +1-(713)-486-4427
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Auffret M, Meuric V, Boyer E, Bonnaure-Mallet M, Vérin M. Oral Health Disorders in Parkinson's Disease: More than Meets the Eye. JOURNAL OF PARKINSONS DISEASE 2021; 11:1507-1535. [PMID: 34250950 PMCID: PMC8609694 DOI: 10.3233/jpd-212605] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.
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Affiliation(s)
- Manon Auffret
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
| | - Vincent Meuric
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Emile Boyer
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Martine Bonnaure-Mallet
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Marc Vérin
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.,Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
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Baram S, Karlsborg M, Øzhayat EB, Bakke M. Effect of orofacial physiotherapeutic and hygiene interventions on oral health-related quality of life in patients with Parkinson's disease: A randomised controlled trial. J Oral Rehabil 2021; 48:1035-1043. [PMID: 34129743 PMCID: PMC8457132 DOI: 10.1111/joor.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022]
Abstract
Background Parkinson's disease (PD) has a negative effect on oral health and orofacial function, but the subjective experience of orofacial symptoms and their impact on the quality of life is not fully investigated. In addition, knowledge of how to improve the subjective oral symptoms is lacking. Objectives To assess the self‐reported orofacial function and oral health in patients with PD. Furthermore, to investigate the effect of interventions for improvement of oral hygiene and function on oral health–related quality of life (OHRQoL). Methods A randomised controlled study with delayed intervention was conducted in 29 patients with moderate to advanced PD. Patients were instructed in a standardised exercise programme for the jaw and orofacial muscles and given an individualised oral hygiene programme. The effect on self‐reported orofacial function and OHRQoL was measured after 2 and 4 months using the Nordic Orofacial Test—Screening (NOT‐S), the oral health impact profile (OHIP‐14), self‐reported drooling score and subjective mastication ability. Results Self‐reported oral health and function before the intervention was significantly correlated to the severity and duration of PD. The NOT‐S and drooling score were significantly improved by the interventions after 2 months and the OHIP‐14 after 4 months. Conclusion The interventions improve the self‐reported orofacial function and OHRQoL. These simple interventions can be implemented in the allied multidisciplinary health care surrounding the PD patient.
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Affiliation(s)
- Sara Baram
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Karlsborg
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Esben Boeskov Øzhayat
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Bakke
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bleiel D, Nitschke I, Noack MJ, Barbe AG. Impact of care level, setting and accommodation costs on a newly developed oral care nursing plan format for elderly patients with care needs - Results from a cross-sectional study. Int J Dent Hyg 2021; 20:543-552. [PMID: 34037316 DOI: 10.1111/idh.12525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 04/25/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A new oral care nursing plan format for improved communication among dentists, nursing staff and caregivers has been developed in Germany. We aimed to (1) describe this plan, (2) investigate the prevalence of oral health problems among elderly patients with care needs documented by the plan, outline the recommendations in the plans and (3) investigate whether the accommodation costs or care needs of patients influenced oral care quality or the need for oral hygiene support documented within the plan. METHODS In this cross-sectional trial, oral care nursing plans were collected from outpatient and inpatient care clinics. Items on the oral care nursing plan were divided into three areas (oral health, oral hygiene needs, and coordination needs and dental therapy) and were correlated with the care level and accommodation costs. RESULTS Oral care nursing plans were collected from seven dentists (N = 747; 94.5% from inpatient and 5.5% from outpatient care). The plans enabled documentation of well-known oral health and hygiene problems among elderly patients. In their current form, the plans provided recommendations for obvious oral hygiene tasks such as toothbrushing or fluoridating, rather than specialized tasks such as nutritional advice or dry mouth asymptomatic therapeutic approaches. Although accommodation costs were associated with the need for oral hygiene support (not with oral care condition), the care level influenced both measures. CONCLUSIONS The oral care nursing plan can facilitate documentation of oral health and hygiene among elderly individuals with care needs. Further clarification of the plan would help promote careful documentation by dentists.
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Affiliation(s)
- Dirk Bleiel
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Ina Nitschke
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zürich, Switzerland.,Department for Prosthodontics and Materials Science, University of Leipzig, Leipzig, Germany
| | - Michael J Noack
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Köln, Germany
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Impact of Progression of Parkinson's Disease on Swallowing Ability and Oral Environment. PARKINSONS DISEASE 2021; 2021:5571556. [PMID: 33981405 PMCID: PMC8088364 DOI: 10.1155/2021/5571556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023]
Abstract
This study investigated the impact of the severity and treatment of Parkinson's disease (PD) on the swallowing ability and oral environment of patients. Swallowing dysfunction increases the aspiration risk and may lead to poor oral health among patients with PD. We investigated the influences of PD progression and drug treatment on the swallowing ability and oral environment using simple noninvasive screening measurements. We recruited 87 patients with PD (mean age, 71.9 ± 8.0 years; mean Hoehn and Yahr score, 2.9 ± 0.9). The PD condition was assessed in each patient using the unified Parkinson's disease rating scale (UPDRS) part III, diet type and oropharyngeal function using the swallowing disturbances questionnaire (SDQ), maximum bite force (MBF), tongue pressure (TP), and oral bacterial count (OBC). Levodopa equivalent daily dose (LEDD) was also calculated for 56 participants. Based on an SDQ score of ≥11, 29.5% of patients were dysphagic, but almost all were still on a regular diet. The SDQ score was positively correlated with disease duration (rho = 0.228, p=0.047) and UPDRS part III score (rho = 0.307, p=0.007) but was negatively correlated with OBC (rho = -0.289, p=0.012). OBC was significantly higher among patients with an SDQ score of <11 (nondysphagic) (p=0.01), and the SDQ score was lower in patients with higher OBC requiring professional oral care (p=0.03). However, OBC was also negatively correlated with LEDD (rho = -0.411, p=0.004). These results indicated low self-awareness of dysphagia among the participants and an association between dysphagia and PD progression. Moreover, the oral environment could have deteriorated with swallowing dysfunction. Patients and clinicians should be aware that higher LEDD can increase xerostomia and associated deficits in oral health.
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Evidence-Based Recommendations for the Oral Health of Patients with Parkinson's Disease. Neurol Ther 2021; 10:391-400. [PMID: 33738711 PMCID: PMC8140025 DOI: 10.1007/s40120-021-00237-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Patients with Parkinson’s disease (PD) present a variety of oral disease that can be worsened by xerostomia and sialorrhea. The patients’ physical limitations, for example rigidity and tremor, add to the difficulty of oral care by the general dental surgeon. The objective of the present review was to organize a list of evidence-based recommendations for the oral care of patients with PD. Methods A systematic review of the literature was carried out by specialists who selected the relevant papers and created a list of recommendations based upon the literature. Results Fourteen papers (data reported in 16 articles) were included in this review. Patients with PD had reduced quality of oral health and hygiene, and high prevalence of gingival recession, periodontal disease, dental calculus, tooth decay, tooth mobility and loss, drooling, xerostomia, dysphagia and temporomandibular disorders. Most studies offered class IV evidence, while one paper had class II evidence. Conclusion Patients with PD present poor oral health with conditions that are mostly preventable. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00237-4.
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Nascimento D. Clinical features associated with drooling in Parkinson's disease. Neurol Sci 2021; 42:895-903. [PMID: 33443673 DOI: 10.1007/s10072-020-05005-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/16/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Drooling is characterized by an excessive pooling of saliva in the oral cavity. The exact pathophysiological mechanism of drooling in Parkinson's disease (PD) is not yet fully understood. OBJECTIVE To identify the relationship between drooling and other clinical features in people diagnosed with PD. METHOD Research on the topic was carried out on the PubMed and ScienceDirect electronic databases. Articles published between March 2015 and March 2020 were selected. Search terms and inclusion and exclusion criteria were previously defined. The articles included met those requirements. RESULTS Sixteen articles were included for analysis. The prevalence of drooling varies between 9.26 and 70% and can occur at any stage of the disease. Higher prevalence of drooling is related to disease duration, disease severity, older age, male, levodopa equivalent dose, hypomimia, dysphagia, dysarthria, cognition, sleep, non-dominant tremor, motor fluctuations, bradykinesia, more symmetric pattern, gastrointestinal and urinary problems, sexual dysfunction, obstipation, and orthostatic hypotension. However, it is not related to hallucinations, rapid eye movement sleep behavior disorder, akinetic-rigid PD, mixed, nor dyskinesias. CONCLUSION Drooling is not caused by a single factor; it is influenced and related to several clinical features. Some clinical factors participate in the onset of drooling while others are concomitant.
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Affiliation(s)
- David Nascimento
- Hospital de Egas Moniz - Centro Hospitalar Lisboa Ocidental, Rua da Junqueira n°126, 1349-019, Lisbon, Portugal.
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27
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Barbe AG, Javadian S, Rott T, Scharfenberg I, Deutscher HCD, Noack MJ, Derman SHM. Objective masticatory efficiency and subjective quality of masticatory function among patients with periodontal disease. J Clin Periodontol 2020; 47:1344-1353. [DOI: 10.1111/jcpe.13364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology University of Cologne Cologne Germany
| | - Simin Javadian
- Department of Operative Dentistry and Periodontology University of Cologne Cologne Germany
| | - Thea Rott
- Department of Operative Dentistry and Periodontology University of Cologne Cologne Germany
| | - Isabel Scharfenberg
- Department of Operative Dentistry and Periodontology University of Cologne Cologne Germany
| | | | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology University of Cologne Cologne Germany
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Legacy J, Herndon NE, Wheeler-Hegland K, Okun MS, Patel B. A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol 2020; 14:411-424. [PMID: 32657208 PMCID: PMC10405619 DOI: 10.1080/17474124.2020.1769475] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/12/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Bulbar dysfunction is common in Parkinson's disease (PD) with more than 80% of affected individuals developing dysphagia during the course of the disease. Symptoms can begin in the preclinical stage and individuals may remain clinically asymptomatic for years. Furthermore, patients may be unaware of swallowing changes, which contributes to the difference between the prevalence of self-reported dysphagia and deficits identified during instrumental evaluations. Dysphagia is underrecognized and contributes to the development of aspiration pneumonia which is the leading cause of death in PD. Dysphagia in PD is complex and not completely understood. Both dopaminergic and nondopaminergic pathways likely underpin dysphagia. AREAS COVERED This comprehensive review will cover the epidemiology, pathophysiology, clinical evaluation, and expert management of dysphagia and aspiration in patients with PD. EXPERT OPINION A multidisciplinary team approach is important to properly identify and manage PD dysphagia. Regular clinical screenings with objective instrumental assessments are necessary for early detection of dysphagia. Studies are needed to better understand the mechanism(s) involved in PD dysphagia, establish markers for early detection and progression, and develop evidence-based treatment options.
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Affiliation(s)
- Joseph Legacy
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Nicole E. Herndon
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Karen Wheeler-Hegland
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Michael S. Okun
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- Norman Fixel Institute for Neurological Diseases, Gainesville, FL
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Barbe AG, Spiritus S, Hagemeier A, Noack MJ, Röhrig G. [Oral health assessment of seniors under outpatient care by family doctors : Development and validation of the geriatric outpatient oral health screening]. Z Gerontol Geriatr 2020; 54:255-263. [PMID: 32350669 PMCID: PMC8096727 DOI: 10.1007/s00391-020-01730-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Einschränkungen der Mundgesundheit ambulant betreuter Senioren in Deutschland werden trotz hoher Prävalenz im hausärztlich-geriatrischen Bereich nicht routinemäßig erfasst. Da Senioren Hausärzte mit höherem Alter häufiger aufsuchen als Zahnärzte, stellt sich die Frage, ob reduzierte Mundgesundheit im Praxisalltag mit einem interdisziplinären Screeninginstrument identifiziert werden kann. Ziel der Arbeit Ziel der Arbeit ist, ein Screeninginstrument für reduzierte Mundgesundheit für Hausärzte zu entwickeln und dieses durch zahnmedizinische Befunde zu validieren. Material und Methoden Das geriatrische ambulante Mundgesundheits-Screening (GAMS) als subjektives Screeninginstrument wurde entwickelt, um für geriatrische Patienten relevante zahnmedizinische Aspekte wie Kauprobleme, Schmerzen, Parodontitis, Mundgeruch oder Mundtrockenheit in dichotomen Fragen abzubilden. Zudem erfolgt die Einschätzung der Dringlichkeit eines Zahnarztbesuches durch den Behandler. Es wurden n = 75 Patienten eingeschlossen und der GAMS sowie eine zahnärztliche Untersuchung zur Validierung durchgeführt. Ergebnisse Bei subjektiver Einschätzung als auch im zahnmedizinischen Befund zeigte sich reduzierte Mundgesundheit, insbesondere bei Risikofaktoren für die Entwicklung systemischer Komorbiditäten wie Dysphagie und Mangelernährung, wobei Mundgesundheitsprobleme durch die Patienten unterschätzt wurden. Einbisse, Kauschwierigkeiten und Mundtrockenheit zeigten ausreichende Übereinstimmung zwischen oralem Befund und subjektiver Einschätzung. Diskussion Der GAMS könnte beitragen, die Erwägung und Berücksichtigung von Mundgesundheitsproblemen bei geriatrischen Patienten im hausärztlichen Setting zu erleichtern und die Zusammenarbeit mit Zahnmedizinern im Sinne europäischer Handlungsempfehlungen fördern. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01730-5) enthalten.
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Affiliation(s)
- Anna Greta Barbe
- Fachbereich Parodontologie, AG Seniorenzahnmedizin, Poliklinik für Zahnerhaltung u. Parodontologie, Uniklinik Köln, Kerpener Str. 32, 50931 Köln, Deutschland
| | - Sabine Spiritus
- Fachbereich Parodontologie, AG Seniorenzahnmedizin, Poliklinik für Zahnerhaltung u. Parodontologie, Uniklinik Köln, Kerpener Str. 32, 50931 Köln, Deutschland
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, 50924 Köln, Deutschland
| | - Michael J. Noack
- Fachbereich Parodontologie, AG Seniorenzahnmedizin, Poliklinik für Zahnerhaltung u. Parodontologie, Uniklinik Köln, Kerpener Str. 32, 50931 Köln, Deutschland
| | - Gabriele Röhrig
- Zentrum für spezialisierte geriatrische Diagnostik, MVZ Medicum Köln Ost, Johann-Classen-Straße 68, 51103 Köln, Deutschland
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Flink H, Tegelberg Å, Arnetz JE, Birkhed D. Self-reported oral and general health related to xerostomia, hyposalivation, and quality of life among caries active younger adults. Acta Odontol Scand 2020; 78:229-235. [PMID: 31729277 DOI: 10.1080/00016357.2019.1690677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: The aim was to study prevalence of xerostomia, hyposalivation and quality of life among caries active younger adults.Materials and methods: A questionnaire regarding oral and general health, xerostomia and quality of life was mailed to 134 caries active (CA) and 40 caries inactive (CI) patients, 25-50 years of age (mean age 39.9 ± 6.2 years) treated at a Swedish Public Dental Service clinic, regarding oral and general health, xerostomia and quality of life. Caries data and unstimulated whole salivary flow rates were obtained from dental records.Results: The overall response rate was 69%. Dental records confirmed that CA patients had more decayed teeth over time than CI patients (p < .001). The CA group reported worse oral health (p < .001) and general health (p < .01), more xerostomia (p < .001) and lower salivary flow rate (p < .01) compared to CI patients. Xerostomia was inversely related to unstimulated whole salivary flow rates as well as to oral and general health (p < .01). There were no differences between groups in quality of life.Conclusion: Younger caries active adult patients reported significantly more xerostomia and hyposalivation compared to caries inactive patients. Xerostomia and hyposalivation were inversely related to perceptions of oral and general health, but not to quality of life.
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Affiliation(s)
- Håkan Flink
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
- Public Dental Clinic Sala, Public Dental Health Västmanland, Sala, Sweden
| | - Åke Tegelberg
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Sicca Symptoms in Parkinson's Disease: Association with Other Nonmotor Symptoms and Health-Related Quality of Life. PARKINSONS DISEASE 2020; 2020:2958635. [PMID: 32104559 PMCID: PMC7038154 DOI: 10.1155/2020/2958635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Background Frequently used nonmotor scales do not cover all aspects of dysautonomia in Parkinson's disease (PD). This study explores the association between autonomic symptoms and sicca symptoms with other nonmotor symptoms and health-related quality of life (QoL) in PD. Methods Autonomic symptoms (Survey of Autonomic Symptoms, SASs), motor function (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III, MDS-UPDRS III), nonmotor symptoms (nonmotor symptoms questionnaire, NMS-Quest), and QoL (PD Questionnaire-39, PDQ-39) were analysed in 93 PD patients without dementia. Multivariable and multivariate analyses were performed to study the association between clinical parameters and PDQ-39 domains. Results Among the autonomic symptoms, sicca symptoms (xerostomia and dry eyes) were the most commonly reported (69%), followed by sexual dysfunction in men, leaking of urine, vasomotor dysfunction, constipation, sudomotor dysfunction, and orthostatic symptoms. The autonomic symptom burden (SAS total) correlated with the NMS-Quest and Hoehn and Yahr stage, but not with age, levodopa equivalent daily dose, disease duration, and the MDS-UPDRS III. The SAS total score was an independent predictor of the PDQ-39 summary index and mainly affected the PDQ-39 cognition and emotional well-being domains. Sicca symptoms were not associated with age, MDS-UPDRS III, disease duration, Hoehn and Yahr stage, and levodopa equivalent daily dose but aggravated the PDQ-39 domains: cognition, emotional well-being, bodily discomfort, and mobility. Sicca symptoms frequently occur together with other nonmotor symptoms, namely, urine urgency, orthostatic problems, and concentration problems. Overall, 75% of the subjects took at least one drug that can cause sicca symptoms (anti-PD medication, antidepressant drugs, antihypertensive drugs, antipsychotic drugs, antimuscarinic drugs, and analgesic drugs). Conclusion Sicca symptoms are common in PD and negatively influence QoL. The observed association between sicca symptoms and other nonmotor symptoms provides further preliminary evidence for the growing recognition of different nonmotor clusters in PD.
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Quantitative metabolomics of saliva using proton NMR spectroscopy in patients with Parkinson's disease and healthy controls. Neurol Sci 2020; 41:1201-1210. [PMID: 31897951 DOI: 10.1007/s10072-019-04143-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a multisystem disorder of unknown etiology, highlights a broad array of symptoms and pathological features influencing organs throughout the body. The metabolic profile of saliva in patients with PD may be influenced by malabsorption in the gastroenteric tract, neurodegeneration, and mitochondrial dysfunction. In the present study, we apply a powerful NMR metabolomics approach for biomarker identification in PD using saliva, a non-invasive bio-fluid. METHODS Metabolic profiling of saliva were studied in patients with PD (n = 76) and healthy controls (HC, n = 37) were analyzed and differentiated PD from HC. A total of 40 metabolites including aromatic amino acids, short-chain fatty acids, branched chain amino acids, taurine, and N-acetylglutamate were identified. Spectral binned data and concentration of metabolites were estimated for analysis. RESULTS Increased concentration of phenylalanine, tyrosine, histidine, glycine, acetoacetate, taurine, TMAO, GABA, N-acetylglutamate, acetoin, acetate, alanine, fucose, propionate, isoleucine, and valine were observed in PD as compared to HC. Further, subgroup analysis among early PD, advanced PD, and HC groups, revealed increased metabolite concentration in early PD group as compared to advanced PD and HC group. DISCUSSION Analysis revealed potential biomarkers and their involvement in amino acid metabolism, energy metabolism, neurotransmitters metabolism, and microflora system. Patients with early PD exhibited higher metabolite concentration as compared to advanced PD group which might be associated with dopaminergic treatment. CONCLUSION The results of our data indicate that patients with PD might be characterized by metabolic imbalances like gut microflora system, energy metabolites, and neurotransmitters which may contribute to the PD pathogenesis.
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Jost WH, Friedman A, Michel O, Oehlwein C, Slawek J, Bogucki A, Ochudlo S, Banach M, Pagan F, Flatau-Baqué B, Dorsch U, Csikós J, Blitzer A. Long-term incobotulinumtoxinA treatment for chronic sialorrhea: Efficacy and safety over 64 weeks. Parkinsonism Relat Disord 2019; 70:23-30. [PMID: 31794936 DOI: 10.1016/j.parkreldis.2019.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking. This study investigated the efficacy and safety of repeated incobotulinumtoxinA injections for chronic sialorrhea over 64 weeks. METHODS Adults with sialorrhea were randomized (2:2:1) to incobotulinumtoxinA 75 U, incobotulinumtoxinA 100 U (n = 74 each), or placebo (n = 36) in the double-blind, placebo-controlled main period (NCT02091739). Eligible subjects entered the extension period and received dose-blinded incobotulinumtoxinA 75 or 100 U in three further 16±2-week injection cycles. Efficacy and safety assessments in subjects who received incobotulinumtoxinA throughout the study included unstimulated salivary flow rate (uSFR), subjects' Global Impression of Change Scale (GICS), Drooling Severity and Frequency Scale (DSFS), modified Radboud Oral Motor Inventory for Parkinson's Disease (mROMP) drooling, speech, and swallowing symptom scores, and incidence of adverse events (AEs). RESULTS In total, 173/184 subjects (94%) completed the main period and entered the extension period; 141 subjects received incobotulinumtoxinA 75 U (n = 69) or 100 U (n = 72) in both periods. Mean uSFR decreased consistently with repeated incobotulinumtoxinA 75 and 100 U treatment and by -0.16 and -0.17, respectively, at the end-of-study visit. Subjects' GICS, DSFS, and mROMP drooling scores also improved at all assessments. mROMP speech and swallowing scores remained stable. The most common treatment-related AEs during the extension period were dry mouth (4.4% and 11.1%) and dysphagia (1.5% and 4.2%). CONCLUSIONS Data support long-term efficacy and safety of repeated incobotulinumtoxinA treatment for sialorrhea, with no additional safety concerns reported over 64 weeks.
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Affiliation(s)
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.
| | - Olaf Michel
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany.
| | - Jaroslaw Slawek
- Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Gdansk, Poland.
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland.
| | - Stanislaw Ochudlo
- Department of Neurology and Stroke Unit, Medical University of Silesia, Katowice, Poland.
| | - Marta Banach
- Department of Neurology, Collegium Medicum, Jagiellonian University Medical College, Krakow, Poland.
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington DC, USA.
| | | | - Ulrike Dorsch
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - János Csikós
- Formerly of Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - Andrew Blitzer
- Department of Otolaryngology/Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA; NY Center for Voice and Swallowing Disorders, New York, NY, USA.
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Marchini L, Ettinger R, Hartshorn J. Personalized Dental Caries Management for Frail Older Adults and Persons with Special Needs. Dent Clin North Am 2019; 63:631-651. [PMID: 31470918 DOI: 10.1016/j.cden.2019.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Frail older adults and persons with special needs are at higher risk of oral diseases including dental caries. Considering the diverse background of the population, a personalized approach for each patient is mandatory to successfully manage their oral health needs. This article describes a succinct way to assess and categorize the risk of rapid oral health deterioration (ROHD) among this group. The procedures for assessing ROHD risk examine the ROHD risk categories, how risk factors impact treatment strategies, what techniques and materials exist for caries prevention and treatment, and how one effectively communicates caries management plans for this population.
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Affiliation(s)
- Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, N337-1 Dental Science, Iowa City, IA 52242, USA.
| | - Ronald Ettinger
- Department of Prosthodontics, The University of Iowa College of Dentistry and Dental Clinics, N-409 Dental Science, Iowa City, IA 52242, USA
| | - Jennifer Hartshorn
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, W327 Dental Science, Iowa City, IA 52242, USA
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Chen HJ, Chen JL, Chen CY, Lee M, Chang WH, Huang TT. Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2228. [PMID: 31238591 PMCID: PMC6617028 DOI: 10.3390/ijerph16122228] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =-2.69 to -1.25, Wald χ2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = -0.16 to 0.89, Wald χ2 = 1.86, p>0.05), MNA-SF (95% CI = -0.35 to 0.53, Wald χ2 =-0.17, p>0.05), and nasogastric tube removal (p>0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.
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Affiliation(s)
- Hsiao-Jung Chen
- Graduate Institute of Clinical Medical Sciences, Nursing, Chang Gung University, Taoyuan City 33378, Taiwan.
| | - Jean-Lon Chen
- Department of Physical Medicine & Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan.
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
| | - Chung-Yao Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Keelung, Keelung City 20401, Taiwan.
| | - Megan Lee
- Department of Biochemistry, University of Washington, Seattle, WA 98134, USA.
| | - Wei-Han Chang
- Department of Physical Medicine & Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan.
| | - Tzu-Ting Huang
- School of Nursing, Healthy Aging Research Center School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 33378, Taiwan.
- Department of Dementia Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan City 33378, Taiwan.
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Barbe AG, Ludwar L, Hamacher S, Noack MJ. Efficacy of a newly developed mouth gel for xerostomia relief-A randomized double-blind trial. Oral Dis 2019; 25:1519-1529. [PMID: 30972871 DOI: 10.1111/odi.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 04/04/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the efficacy of a new symptom-relieving mouth gel vs. a widely used control gel on xerostomic burden. MATERIALS AND METHODS This randomized, double-blind, crossover trial investigated the efficacy of the test gel (Dr. Wolff Gel) vs. control (Biotene) in participants with xerostomia (n = 32; mean age 60 years). Oral examinations were taken at baseline, and xerostomic visual analogue scales (xVAS), after-use questionnaires and willingness to pay were investigated before and after use. RESULTS Neither gel reduced xerostomic burden (xVAS) after 7-day application. There was some preference for the test gel regarding taste and healthy gum feeling. After 1-time application, there were differences favouring the test gel for symptom-relieving effects between test gel and water (p < 0.001), mucosal adhesion (p < 0.001) and taste persistence (p < 0.001). Overall symptomatic relief with the test gel lasted around 2 hr. CONCLUSIONS No mouth gel alleviated the overall xerostomic burden. Nevertheless, the test gel led to short-term perceived symptomatic relief and improved patient-centred outcomes as taste and perceived gum health. The gel will probably mainly be effective at moments that patients mostly suffer from xerostomia. Selection of a product will be based on perceived subjective differences and their value in the context of the overall xerostomic burden.
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Affiliation(s)
- Anna Greta Barbe
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Köln, Germany
| | - Lena Ludwar
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Köln, Germany
| | - Stefanie Hamacher
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Köln, Germany
| | - Michael Johannes Noack
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Köln, Germany
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Gosnell R, Lazear J, Hemphill JC, Dotson D. Development of guidelines for improving oral health in individuals with Parkinson’s disease. Gerodontology 2019; 36:229-235. [DOI: 10.1111/ger.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/04/2019] [Accepted: 02/08/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Roxanne Gosnell
- East Tennessee State University College of Nursing Johnson City Tennessee
| | - Janice Lazear
- East Tennessee State University College of Nursing Johnson City Tennessee
| | | | - Deborah Dotson
- Dental Hygiene program East Tennessee State University Johnson City Tennessee
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Muthumariappan S, Ng WC, Adine C, Ng KK, Davoodi P, Wang CH, Ferreira JN. Localized Delivery of Pilocarpine to Hypofunctional Salivary Glands through Electrospun Nanofiber Mats: An Ex Vivo and In Vivo Study. Int J Mol Sci 2019; 20:E541. [PMID: 30696017 PMCID: PMC6387464 DOI: 10.3390/ijms20030541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 01/12/2023] Open
Abstract
Dry mouth or xerostomia is a frequent medical condition among the polymedicated elderly population. Systemic pilocarpine is included in the first line of pharmacological therapies for xerostomia. However, the efficacy of existing pilocarpine formulations is limited due to its adverse side effects and multiple daily dosages. To overcome these drawbacks, a localized formulation of pilocarpine targeting the salivary glands (SG) was developed in the current study. The proposed formulation consisted of pilocarpine-loaded Poly(lactic-co-glycolic acid) (PLGA)/poly(ethylene glycol) (PEG) nanofiber mats via an electrospinning technique. The nanofiber mats were fully characterized for their size, mesh porosity, drug encapsulation efficiency, and in vitro drug release. Mat biocompatibility and efficacy was evaluated in the SG organ ex vivo, and the expression of proliferation and pro-apoptotic markers at the cellular level was determined. In vivo short-term studies were performed to evaluate the saliva secretion after acute SG treatment with pilocarpine-loaded nanofiber mats, and after systemic pilocarpine for comparison purposes. The outcomes demonstrated that the pilocarpine-loaded mats were uniformly distributed (diameter: 384 ± 124 nm) in a highly porous mesh, and possessed a high encapsulation efficiency (~81%). Drug release studies showed an initial pilocarpine release of 26% (4.5 h), followed by a gradual increase (~46%) over 15 d. Pilocarpine-loaded nanofiber mats supported SG growth with negligible cytotoxicity and normal cellular proliferation and homeostasis. Salivary secretion was significantly increased 4.5 h after intradermal SG treatment with drug-loaded nanofibers in vivo. Overall, this study highlights the strengths of PLGA/PEG nanofiber mats for the localized daily delivery of pilocarpine and reveals its potential for future clinical translation in patients with xerostomia.
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Affiliation(s)
- Sujatha Muthumariappan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore.
| | - Wei Cheng Ng
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
| | - Christabella Adine
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore.
| | - Kiaw Kiaw Ng
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore.
| | - Pooya Davoodi
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
| | - Chi-Hwa Wang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
| | - Joao N Ferreira
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore 119085, Singapore.
- Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand.
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892-4370, USA.
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Medication-Induced Xerostomia and Hyposalivation in the Elderly: Culprits, Complications, and Management. Drugs Aging 2018; 35:877-885. [PMID: 30187289 DOI: 10.1007/s40266-018-0588-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Medication-induced xerostomia and hyposalivation will increasingly become oral health issues for older and geriatric patients because of the likely high prevalence of medication intake and polypharmacy, with a complex negative impact on other symptoms such as dysphagia, caries incidence, malnutrition, and quality of life. All healthcare professionals are encouraged to investigate dry mouth symptoms among their patients, since diagnosis can easily be performed within daily clinical practice. This practical article also provides a review of available treatment options, which include medication changes towards products with fewer xerogenic side effects or dose reductions, if possible, as well as multidisciplinary, preventive care-oriented approaches that consider all influencing factors and treatment of the oral symptoms. In addition, several topical agents and saliva substitutes are discussed that may provide symptomatic relief but need to be carefully adapted to each patient's situation in terms of usability and practicability and in the knowledge that therapeutic success varies with each individual. Innovative methods such as intraoral electrostimulation or topical application of anticholinesterase on the oral mucosa are also discussed. The most commonly prescribed pharmaceutical treatment options for dry mouth are pilocarpine (a parasympathomimetic agent with potent muscarinic, cholinergic salivation-stimulating properties) and cevimeline (a quinuclidine analogue with therapeutic and side effects similar to those of pilocarpine). These pharmaceutic treatment options are described in the context of older patients, where the highly prevalent cholinergic side effects, which include nausea, emesis, bronchoconstriction, among others, need to be thoroughly supervised by the healthcare professionals involved. Providing these therapeutic options to patients with medication-induced dry mouth will help improve their oral health and therefore maintain a better quality of life, general health, and well-being.
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Hasby Saad M, Safwat O, El-Guindy D, Raafat R, Elgendy D, Hasby E. Biomolecular Changes and Cortical Neurodegenerative Lesions in Trichinella Spiralis Infected BALB/c Mice: A Preliminary Study Elucidating a Potential Relationship Between Systemic Helminthic Infections and Idiopathic Parkinson's. Helminthologia 2018; 55:261-274. [PMID: 31662657 PMCID: PMC6662001 DOI: 10.2478/helm-2018-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/28/2018] [Indexed: 02/05/2023] Open
Abstract
Idiopathic Parkinson's (IP) is a neurodegenerative disease that is suspected to be due to exposure to infections during early life. Toxoplasmosishas been the only suspected parasitic infection in IP (Celik et al., 2010). Recently, some non-central nervous system bacterial and viral infections have been incriminated in IP (Çamcı & Oğuz, 2016). So in the current study, we tried to explore if the systemic inflammatory reactions triggered by some helminths like Trichinella spiralis can induce Parkinsonian lesions in the brain, especially that the cerebral complications have been reported in 10-20% of Trichinella spiralis infected patients . An experimental study was designed to assess the neurodegenerative and biomolecular changes that may occur in Trichinella spiralis infected BALB/C mice in comparison to rotenone induced PD model and apparently healthy ones. The motor affection was significantly lesser in the Trichinella infected mice than the Parkinson's model, but when the catalepsy score was calculated (through the grid and bar tests) it was found to be significantly higher in the infected mice than in the healthy ones. A significant increase in the blood advanced oxidative protein products (AOPP), IFN-γ, TGF-β, and brain DNA fragmentation was also detected in the Trichinella spiralis infected mice. After histopathological examination, a significant increase in the cortical apoptotic neurons and Lewy's body were observed in the Trichinella infected and the rotenone induced Parkinson's model sections. A significant decrease in the immunohistochemical expression of the tyrosine hydroxylase expression in the brain sections and the ELISA measured dopamine level in the brain homogenate was also reported in the infected mice group. This study findings may collectively suggest that the systemic inflammatory reactions and the oxidative stresses associated with some systemic helminthic infections like trichinellosis are possible to precipitate neurodegenerative lesions and biomolecular changes in the brain , and manifest with IPD later in life.
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Affiliation(s)
- M. Hasby Saad
- Medical Parasitology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - O. Safwat
- Biochemistry, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - D. El-Guindy
- Pathology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - R. Raafat
- Biochemistry, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - D. Elgendy
- Medical Parasitology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - E. Hasby
- Pathology, Tanta University, Faculty of Medicine, Tanta, Egypt
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Barbe AG, Schmidt P, Bussmann M, Kunter H, Noack MJ, Röhrig G. Xerostomia and hyposalivation in orthogeriatric patients with fall history and impact on oral health-related quality of life. Clin Interv Aging 2018; 13:1971-1979. [PMID: 30349216 PMCID: PMC6188197 DOI: 10.2147/cia.s178370] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Falls are a common cause of morbidity and mortality in older people, and identification of risk indicators and risk factors to prevent falling is essential. Dry mouth (xerostomia and hyposalivation) can exacerbate conditions known to be fall risk indicators, such as nutritional status and sarcopenia. But there is little evidence regarding whether it is an independent risk factor for falling. We explored xerostomia prevalence and intensity and objective salivation rates in hospitalized geriatric patients to determine whether they were associated with an increased risk of falling. Patients and methods Hospitalized geriatric patients with and without a fall history were compared. We investigated several oral health issues including xerostomia, stimulated and unstimulated salivation rates, total number of teeth and prosthetics, periodontal status, and oral health-related quality of life. Results Forty patients were included, 28 in the fall history group and 12 in the control group. All patients had oral health issues that impacted on their oral health-related quality of life. However, there were no significant differences between the groups, including xerostomia and hyposalivation, apart from increased dysphagia and less flavor in food in patients with a fall history. Conclusion Dry mouth does not appear to be an independent risk factor for falling in this population, but oral health was impaired. Thus, it is important that dentists and geriatricians are aware of and investigate these conditions in their patients and that appropriate action is taken to reduce the consequences of impaired oral health, including a potential reduction in falls.
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Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Köln, Germany,
| | - Pia Schmidt
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Köln, Germany,
| | - Michael Bussmann
- Department of Orthogeriatrics, Evangelisches Krankenhaus Köln Kalk, Cologne, Germany
| | - Henning Kunter
- Department of Orthogeriatrics, Evangelisches Krankenhaus Köln Kalk, Cologne, Germany
| | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Köln, Germany,
| | - Gabriele Röhrig
- Geriatric Diagnostic Center, MVZ Medicum Köln Ost, Cologne, Germany
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Barbe AG, Ludwar L, Scharfenberg I, Hellmich M, Dano R, Barbe MT, Noack MJ. Circadian rhythms and influencing factors of xerostomia among Parkinson’s disease patients. Oral Dis 2018; 25:282-289. [DOI: 10.1111/odi.12942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Lena Ludwar
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Isabel Scharfenberg
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology University of Cologne Köln Germany
| | - Richard Dano
- Department of Neurology University of Cologne Köln Germany
| | | | - Michael Johannes Noack
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine University of Cologne Köln Germany
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Oral Health of Parkinson's Disease Patients: A Case-Control Study. PARKINSONS DISEASE 2018; 2018:9315285. [PMID: 29854385 PMCID: PMC5964533 DOI: 10.1155/2018/9315285] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/01/2018] [Indexed: 12/31/2022]
Abstract
The aim of the study was to examine the oral health status of Parkinson's disease (PD) patients, to compare their oral health status to that of a control group, and to relate it to the duration and severity of PD. Materials and Methods. 74 PD patients and 74 controls were interviewed and orally examined. Among PD patients, the duration and the Hoehn and Yahr stage (HY) of the disease were registered. Results. More PD patients than controls reported oral hygiene care support as well as chewing/biting problems, taste disturbance, tooth mobility, and xerostomia, whereas dentate patients had more teeth with carious lesions, tooth root remnants, and biofilm. Both longer duration and higher HY were associated with more chewing problems and, in dentates, more teeth with restorations. In dentates, longer duration of the disease was associated with higher number of mobile teeth. Higher HY was associated with more oral hygiene care support as well as biting problems and, in dentates, more teeth with carious lesions and tooth root remnants. Conclusions. Comparatively, PD patients had weakened oral health status and reduced oral hygiene care. Both duration and severity of the disease were associated with more oral health and hygiene care problems.
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Barbe AG, Deutscher DHC, Derman SHM, Hellmich M, Noack MJ. Subjective and objective halitosis among patients with Parkinson's disease. Gerodontology 2017; 34:460-468. [DOI: 10.1111/ger.12293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Greta Barbe
- Centre of Dental Medicine; Department of Operative Dentistry and Periodontology; University of Cologne; Köln Germany
| | - Deborah H. C. Deutscher
- Centre of Dental Medicine; Department of Operative Dentistry and Periodontology; University of Cologne; Köln Germany
| | - Sonja H. M. Derman
- Centre of Dental Medicine; Department of Operative Dentistry and Periodontology; University of Cologne; Köln Germany
| | - Martin Hellmich
- Institute of Medical Statistics; Informatics and Epidemiology; University of Cologne; Köln Germany
| | - Michael J. Noack
- Centre of Dental Medicine; Department of Operative Dentistry and Periodontology; University of Cologne; Köln Germany
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Chen CK, Wu YT, Chang YC. Periodontal inflammatory disease is associated with the risk of Parkinson's disease: a population-based retrospective matched-cohort study. PeerJ 2017; 5:e3647. [PMID: 28828251 PMCID: PMC5554596 DOI: 10.7717/peerj.3647] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background The cause−effect relation between periodontal inflammatory disease (PID) and Parkinson’s disease (PD) remains uncertain. The purpose of our study was to investigate the association between PID and PD. Methods We conducted a retrospective matched-cohort study by using Taiwan’s National Health Insurance Research Database. We identified 5,396 patients with newly diagnosed PID during 1997–2004 and 10,792 cases without PID by matching sex, age, index of year (occurrence of PID), and comorbidity. Cox proportional hazard regression was used to evaluate the risk of subsequent PD. Results At the final follow-up, a total of 176 (3.26%) and 275 (2.55%) individuals developed PD in the case and control groups, respectively. Patients with PID have a higher risk of developing PD (adjusted hazard ratio = 1.431, 95% CI [1.141–1.794], p = 0.002). Discussion Our results show that PID is associated with an increased risk of developing PD. Whilst these findings suggest that reducing PID may modify the risk of developing PD, further study will be needed.
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Affiliation(s)
- Chang-Kai Chen
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Section of Dentistry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chao Chang
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
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Abstract
Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.
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Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Barbe AG, Schmidt-Park Y, Hamacher S, Derman SHM, Noack MJ. Efficacy of GUM® Hydral versus Biotène® Oralbalance mouthwashes plus gels on symptoms of medication-induced xerostomia: a randomized, double-blind, crossover study. Clin Oral Investig 2017; 22:169-180. [PMID: 28353023 DOI: 10.1007/s00784-017-2096-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study is to determine the efficacy of GUM® Hydral versus Biotène® Oralbalance (both a mouthwash plus gel) on the subjective burden and clinical symptoms of patients with medication-induced xerostomia. MATERIALS AND METHODS Subjects (N = 40) with medication-induced xerostomia (minimum 4/10 mm visual analog scale [VAS]) were randomized to treatment with GUM Hydral or Biotène Oralbalance mouthwash, both with gel, for 28 days. Subjects then entered a 21-day wash-out period, before crossing over to the other treatment for 28 days. Outcomes measured included the VAS, German Oral Health Impact Profile (OHIPG)-14, Xerostomia Questionnaire (XQ), after-use questionnaire, and clinical parameters. RESULTS Both GUM Hydral and Biotène Oralbalance significantly (p < 0.05) reduced VAS, OHIPG-14 total score and single items, and XQ Part 1 (oral dryness, oral pain, taste loss) and Part 2 items. GUM Hydral also significantly reduced the XQ Part 1 dysphagia score, while Biotène Oralbalance significantly reduced the halitosis organoleptic score and plaque index. Significant increases in saliva secretion did not reach clinical relevance. No significant between-group differences were observed, apart from OHIPG-14 items "trouble pronouncing words" and "uncertainty" in favor of GUM Hydral. No adverse effects were reported. CONCLUSIONS Both products effectively improve oral health and xerostomia-related quality of life. However, they cannot completely substitute the continuous in-mouth secretion of saliva, and symptomatic relief is temporary. Product selection will be based on personal preference. CLINICAL RELEVANCE Both products diminish xerostomic burden and should be part of the management strategy. Affected patients should be informed of these treatments, since no adverse effects were reported.
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Affiliation(s)
- Anna Greta Barbe
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Kerpener Str. 32, 50931, Köln, Germany.
| | - Yasmin Schmidt-Park
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Kerpener Str. 32, 50931, Köln, Germany
| | - Stefanie Hamacher
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, 50924, Köln, Germany
| | - Sonja Henny Maria Derman
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Kerpener Str. 32, 50931, Köln, Germany
| | - Michael Johannes Noack
- Centre of Dental Medicine, Department of Operative Dentistry and Periodontology, University of Cologne, Kerpener Str. 32, 50931, Köln, Germany
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48
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Barbe AG, Heinzler A, Derman SHM, Hellmich M, Timmermann L, Noack MJ. Hyposalivation and xerostomia among Parkinson's disease patients and its impact on quality of life. Oral Dis 2017; 23:464-470. [DOI: 10.1111/odi.12622] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/14/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022]
Affiliation(s)
- AG Barbe
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - A Heinzler
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - SHM Derman
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Köln Germany
| | - L Timmermann
- Department of Neurology; University of Cologne; Köln Germany
| | - MJ Noack
- Department of Operative Dentistry and Periodontology; Centre of Dental Medicine; University of Cologne; Köln Germany
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49
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Pereira PAB, Aho VTE, Paulin L, Pekkonen E, Auvinen P, Scheperjans F. Oral and nasal microbiota in Parkinson's disease. Parkinsonism Relat Disord 2017; 38:61-67. [PMID: 28259623 DOI: 10.1016/j.parkreldis.2017.02.026] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/12/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is associated with neuropathological changes in olfactory and gastrointestinal tissues, and PD patients frequently suffer from hyposmia, hyposalivation, and dysphagia. Since hyposmia and gastrointestinal dysfunction are frequently premotor symptoms, it has been speculated that an external, for example microbial, agent could trigger the pathologic process in the corresponding organs, subsequently spreading to the central nervous system. We recently showed evidence for compositional differences between the fecal microbiota of PD patients and control subjects. In this study, our objective was to explore a possible connection between nasal and oral microbiota and PD. METHODS We compared the oral and nasal bacterial communities of PD patients (oral: n = 72, nasal: n = 69) and control subjects (oral: n = 76, nasal: n = 67) using a 16S rRNA gene amplicon sequencing approach. RESULTS Oral and nasal microbiota differed markedly from each other, with no notable similarity within subjects. Oral microbiota of PD patients and control subjects had differences in beta diversity and abundances of individual bacterial taxa. An increase in the abundance of opportunistic oral pathogens was detected in males, both with and without PD. Our data did not reveal convincing differences between the nasal microbiota of control subjects and PD patients. CONCLUSION The oral microbiome deserves additional research regarding its connection to PD and its biomarker potential. The higher abundance of oral pathogens in men underlines the importance of monitoring and promoting male dental health.
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Affiliation(s)
- Pedro A B Pereira
- Institute of Biotechnology, DNA Sequencing and Genomics Laboratory, University of Helsinki, Viikinkaari 5D, 00014, Finland
| | - Velma T E Aho
- Institute of Biotechnology, DNA Sequencing and Genomics Laboratory, University of Helsinki, Viikinkaari 5D, 00014, Finland
| | - Lars Paulin
- Institute of Biotechnology, DNA Sequencing and Genomics Laboratory, University of Helsinki, Viikinkaari 5D, 00014, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Petri Auvinen
- Institute of Biotechnology, DNA Sequencing and Genomics Laboratory, University of Helsinki, Viikinkaari 5D, 00014, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital, and Clinical Neurosciences, Neurology, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland.
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Dysphagia in Parkinson’s Disease. Dysphagia 2017. [DOI: 10.1007/174_2017_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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