Parkinson disease: systemic and orofacial manifestations, medical and dental management. J Am Dent Assoc. 2009;140:658-669. [PMID: 19491161 DOI: 10.14219/jada.archive.2009.0251]

Motor deficits and brain pathology in the Parkinson's disease mouse model hA53Ttg

Background

Parkinson's disease (PD) is a debilitating neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons and the accumulation of α-synuclein (α-syn) aggregates. The A53T missense point mutation occurs in autosomal dominant familial PD and has been found to promote the aggregation of α-syn. To investigate the role of the A53T mutation in PD, researchers have developed various mouse models with this mutation.

Objective

We therefore conducted a comprehensive characterization of the tg(THY1-SNCA*A53T)M53Sud mouse model (hA53Ttg mice) for its motor and pathological features.

Methods

hA53Ttg mice were tested for motor impairments in a series of motor tests at 2, 4 or 6 months of age. Human α-syn and α-syn pSer129, as well as GFAP and Iba1 signal were labeled and quantified in the cortex, hippocampus, and brainstem. Neurofilament light chain (NF-L) levels were measured in the cerebrospinal fluid (CSF) and plasma. Ex vivo analyses were performed at the age of 2, 4, 6, and 10 months.

Results

Behavioral tests revealed early muscle weakness and motor impairments that progressed with age. Immunohistochemical analyses demonstrated elevated levels of human α-syn and α-syn pSer129 in all evaluated brain regions. α-syn pSer129 labeling further revealed fiber-like structures in the cortex of older animals. Neuroinflammation was observed in an age-dependent manner. Biochemical evaluation revealed elevated NF-L levels in the plasma and CSF. Overall, our findings highlight the value of hA53Ttg mice in modeling PD-associated pathologies that closely resemble those observed in PD patients.

Conclusion

Our results thus suggest that hA53Ttg mice are a useful tool for studying the underlying mechanisms of PD.

Feasibility of interprofessional partnerships between neurologists and dentists for oral health management of Parkinson's disease

This dental student-led study aimed to explore the extent to which an interprofessional intervention can be incorporated within the management of Parkinson's Disease (PD) to address the oral health needs of those living with the condition. Existing integrated or interprofessional (IP) care models lack the inclusion of oral health to improve clinical outcomes. We conducted key informant interviews with five neurologists and four dentists to ascertain their willingness, and the process needed, to facilitate collaborative referral management for patients with PD. We conducted a focus group composed of eight patients living with PD to understand their oral health needs and perspective on an integrated oral health management care team. Both neurologists and dentists were receptive IP the idea of integrating oral health into the overall management of patients, with the expectation of improved communication and collaboration. Patients commonly expressed a need for their oral health to be addressed by both neurologists and dentists. These results reveal an opportunity for an IP care model that includes oral health management in the care for patients with PD. It also provides clues on how to incorporate care for PD into a dental education curriculum.

An Alternative Approach for the Rehabilitation of a Complete Denture Patient With Parkinson's Disease

Parkinson's disease (PD) affects one to two out of every 1,000 individuals. PD, being age-related, is affecting a percentage of those over and around the sixth decade. Lewy bodies containing α-synuclein and a reduction in dopaminergic neurons in the substantia nigra, which impairs the region's capacity to promote voluntary movements, are the main neuropathological findings. The three main symptoms of PD are stiffness, bradykinesia, and tremor. Treatment of edentulous conditions in patients with PD becomes a challenge due to decreased neuromuscular coordination and decreased mobility. This case report outlines a 64-year-old male patient with complete edentulism suffering from PD. Complete denture fabrication was done using the concepts of the neutral zone and denture characterization. Significantly, it not only improves the stability of the dentures but also establishes good denture aesthetics.

Expert consensus on endodontic therapy for patients with systemic conditions

The overall health condition of patients significantly affects the diagnosis, treatment, and prognosis of endodontic diseases. A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy, as well as selecting appropriate therapeutic approaches. This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence, aiming to provide general guidance on clinical procedures, improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

Clinical Report on an Implant-Supported Overdenture in a Parkinson's Patient

Speaking, chewing, and swallowing difficulties can result from Parkinson's disease (PD), which frequently affects the oro-pharyngeal muscles. The reduction in food and hydration intake that is unavoidable leads to a worsening of neurological symptoms. Patients with Parkinson's disease experience significant challenges when adjusting to wearing entire dentures. Each of these problems presents a considerable challenge for the doctor in terms of prosthodontic rehabilitation. This case study describes how a patient with Parkinson's disease was able to employ flexible removable partial dentures supported by implants to replace both their full and partial set of missing teeth. A well-made prosthesis will help the patient with their psychological, functional, and aesthetic impairments.

Parkinson's disease - The dentist's role as part of the healthcare team

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.

An Integrated Computational Approaches for Designing of Potential Piperidine based Inhibitors of Alzheimer Disease by Targeting Cholinesterase and Monoamine Oxidases Isoenzymes

The study aimed to evaluate the potential of piperidine-based 2H chromen-2-one derivatives against targeted enzymes, i.e., cholinesterase's and monoamine oxidase enzymes. The compounds were divided into three groups, i.e., 4a-m ((3,4-dimethyl-7-((1-methylpiperidin-4-yl)oxy)-2H-chromen-2-one derivatives), 5a-e (3,4-dimethyl-7-((1-methypipridin-3-yl)methoxy)-2H-chromen-2-one derivatives), and 7a-b (7-(3-(3,4-dihydroisoquinolin-2(1H)-yl)propoxy)-3,4-dimethyl-2H-chromen-2-one derivatives) with slight difference in the basic structure. The comprehensive computational investigations were conducted including density functional theories studies (DFTs), 2D-QSAR studies, molecular docking, and molecular dynamics simulations. The QSAR equation revealed that the activity of selected chromen-2-one-based piperidine derivatives is being affected by the six descriptors, i.e., Nitrogens Count, SdssCcount, SssOE-Index, T-2-2-7, ChiV6chain, and SssCH2E-Index. These descriptor values were further used for the preparation of chromen-2-one based piperidine derivatives. Based on this, 83 new derivatives were created from 7 selected parent compounds. The QSAR model predicted their IC50 values, with compound 4 k and 4kk as the most potent multi-targeted derivative. Molecular docking results exhibited these compounds as the best inhibitors; however, 4kk exhibited greater activity than the parent compounds. The results were further validated by molecular dynamic simulation studies along with the suitable physicochemical properties. These results prove to be an essential guide for the further design and development of new piperidine based chromen-2-one derivatives having better activity against neurodegenerative disorder.

Management for the patients with severe Parkinson's disease during dental treatments and tooth extractions: A retrospective observational study

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.

Brainstem Modulates Parkinsonism-Induced Orofacial Sensorimotor Dysfunctions

Parkinson's Disease (PD), treated with the dopamine precursor l-3,4-dihydroxyphenylalanine (L-DOPA), displays motor and non-motor orofacial manifestations. We investigated the pathophysiologic mechanisms of the lateral pterygoid muscles (LPMs) and the trigeminal system related to PD-induced orofacial manifestations. A PD rat model was produced by unilateral injection of 6-hydroxydopamine into the medial forebrain bundle. Abnormal involuntary movements (dyskinesia) and nociceptive responses were determined. We analyzed the immunodetection of Fos-B and microglia/astrocytes in trigeminal and facial nuclei and morphological markers in the LPMs. Hyperalgesia response was increased in hemiparkinsonian and dyskinetic rats. Hemiparkinsonism increased slow skeletal myosin fibers in the LPMs, while in the dyskinetic ones, these fibers decreased in the contralateral side of the lesion. Bilateral increased glycolytic metabolism and an inflammatory muscle profile were detected in dyskinetic rats. There was increased Fos-B expression in the spinal nucleus of lesioned rats and in the motor and facial nucleus in L-DOPA-induced dyskinetic rats in the contralateral side of the lesion. Glial cells were increased in the facial nucleus on the contralateral side of the lesion. Overall, spinal trigeminal nucleus activation may be associated with orofacial sensorial impairment in Parkinsonian rats, while a fatigue profile on LPMs is suggested in L-DOPA-induced dyskinesia when the motor and facial nucleus are activated.

Orofacial pain and dysfunction in patients with Parkinson's disease: A scoping review

BACKGROUND

Parkinson's disease (PD) is commonly known as a disorder that affects the smooth performance of body movements. In addition to the motor impairments, patients with PD often experience pain. Both motor impairments and pain can occur throughout the body, hence including the orofacial region. However, currently, there is a lack of knowledge on the orofacial manifestations. Since orofacial pain and dysfunction can, amongst others, reduce the quality of life of patients with PD, it is important to explore the prevalence of these symptoms in the PD population.

OBJECTIVE

To provide a broad overview of the relevant literature on orofacial pain and dysfunction in patients with PD. Furthermore, we aim to generate hypotheses for future research on this topic.

DATABASES AND DATA TREATMENT

A literature search (in PubMed, Embase.com, Web of Science [Core collection], and Cochrane Library) was performed on 20 January 2022, in collaboration with a medical librarian. In total, 7180 articles were found, of which 50 were finally included in this scoping review.

RESULTS

In the included studies, pain (e.g. orofacial pain (N = 2) and temporomandibular disorder pain (N = 2)), orofacial motor dysfunction (e.g. limited jaw movements (N = 10), reduced maximum muscle output (N = 3), chewing difficulties (N = 9), unspecified TMD (N = 3), sensory disturbances (N = 1)), and bruxism (N = 3) were observed more often in patients with PD than in healthy controls.

CONCLUSION

Patients with PD experience more pain in the orofacial area and more dysfunction of the masticatory system than their healthy peers.

SIGNIFICANCE

This scoping review can increase health care providers' awareness of the problems that can be encountered in the orofacial area of PD patients, especially pain syndromes also occur in the orofacial region and not only in the extremities. Besides, dysfunction of the orofacial area is elaborated in this scoping review, which helps to understand that this limits PD patients' quality of life. Further, the outcomes of this scoping review can assist in encouraging collaboration between medicine and dentistry. Finally, this scoping review suggests new research areas, based on the gaps identified in the current literature on this topic. Ultimately, this will improve individualized strategies for reducing orofacial pain and/or dysfunction in PD patients.

Barriers and Motivations to Provide Dental Care to Adult Patients with Movement Disorders

Patients with movement disorders, like Parkinson's and Huntington's diseases, tend to have poor oral health. Although contributing factors have been proposed, the willingness and ability of dentists to treat this patient population are still unknown. Our objective is to understand the current barriers and motivations of dentists to treat this patient population as a path to improved care and quality of life. A total of 176 dentists in Texas were surveyed through a structured questionnaire which contained both closed and open-ended questions. Nearly 30% of participants reported having no barriers to treating these patients and 26.7% reported that no such patients have visited their practice. Barriers reported included lack of education on the topic (17.6%) and longer appointments than average (14.8%). A main motivation to treat these patients was more training and education on the subject (38.6%). Poor oral health in patients with movement disorders may not be due to barriers encountered by dentists, but rather encountered by patients, such as access to and use of dental treatment. General dentists are willing to provide care for adult patients with movement disorders and continuing education for these providers is preferred over referral to a specialist.

Management of Medically Compromised Prosthodontic Patients

The medical evaluation of patients considering prosthodontic treatment is a vital step in the treatment planning. The prosthodontist should be able to assess the inherent risks associated with the treatment of patients with systemic conditions. Many factors are associated with evaluating the patient's health status and risk including the patient's current and past medical and dental history, current and past use of medications, type of treatment, length of treatment, invasiveness of treatment, and degree of urgency of treatment. In this article, some of the systemic diseases like arthritis, cardiovascular diseases, endocrine disorders, hematologic and oncologic disease, neurologic disorders, bone disorders, pulmonary diseases, liver diseases, and chronic kidney disease that commonly affect aged individuals are reviewed. The prosthodontic considerations that should be taken care of while managing patients with these systemic conditions will also be discussed.

Common Medical and Dental Problems of Older Adults: A Narrative Review

The advancement of medicine has reduced the rate of mortality and older adult population is increasing. Among the 7,700,000,000 world population in 2019, 1 in 11 people were at the age of 65 or more. The population is expected to increase to 1 in 6 people by 2050. Older adults have degenerative changes that become more severe with age. This study used the World Health Organization’s websites and PubMed and Google Scholar databases to review current global oral and systemic health issues. Studies generally reported that many older adults have no regular dental checkup. Common oral diseases such as dental caries particularly root caries and periodontal disease are highly prevalent among them. These oral diseases are often interrelated with their systemic problems. A meta-analysis reported diabetes increases the incidence and progression of periodontitis by 86%. A decrease in salivary output is common among older adults having polypharmacy. A review reported the caries risk in older adults increases by 60% with low resting pH and low stimulated salivary flow rate. Many older adults suffer from dementia and depression which complicates the delivery of dental treatment. Proper oral hygiene practice and dental care at supine position are often difficult to be carried out if they have rheumatoid arthritis. With the increasing need of elderly dental care, dentists and other dental personnel should understand interlaced oral and general health in order to provide a successful dental care plan for older adults. The aim of this study is to give an overview of the common medical conditions and dental problems and their impacts on older adults.

Oral Health Disorders in Parkinson's Disease: More than Meets the Eye

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.

Effect of orofacial physiotherapeutic and hygiene interventions on oral health-related quality of life in patients with Parkinson's disease: A randomised controlled trial

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.

Factors associated with bite force in people with Parkinson's disease

ABSTRACT Purpose: to assess the bite force in people with Parkinson’s disease and correlate it with age, sex, stage and time of the disease, dentures use, presence of temporomandibular disorder, side of symptom onset, and masticatory preference. Methods: the Research Diagnostic Criteria for Temporomandibular Disorders and the Hoehn & Yahr Parkinson’s disease scale were used, and the participants’ oral cavity was clinically examined. Then, the bite force was measured with an analog dynamometer, whose bar was adapted for mouth grip. The bite force results and their correlation with the variables were analyzed with the independent t-test (p<0.05). Results: the sample comprised 42 parkinsonians at a mean age of 64 years, 67% of whom were males. No difference was observed in the correlation with age, temporomandibular disorder, stage and time of Parkinson's disease; or between the sides, symptom onset and masticatory preference. However, there was a significant association between the sexes (males and females) for both sides (right - p=0.002; left - p=0.04) and denture use for bite force on the right side (p=0.03). Conclusion: being a female and using dentures are factors associated with decreased bite force in people with Parkinson’s disease.

Is YouTube a useful tool for oral care in patients with Parkinson's disease?

INTRODUCTION

To analyze the quality of YouTube videos offering information about oral care in patients with Parkinson's disease (PD).

BACKGROUND

Regular oral and dental care is essential for good general health and well-being. In this regard, the motor and/or cognitive problems of people with PD can complicate correct daily hygiene.

MATERIALS AND METHODS

A systematic review was made of YouTube videos for the terms "Parkinson's disease," "dental education," "oral care," "dental care," "oral disease," "oral status," and "oral health." The videos were assessed for content, duration, number of viewings, days since upload, and likes and dislikes. The interaction index and viewing rate were also evaluated. Video quality was rated using a 5-point Likert scale based on the global quality score (GQS).

RESULTS

The search identified 620 videos, of which 42 were included in the analysis. The sources of the uploads were universities (n = 15), television channels (n = 8), and other sources (n = 19). Significant differences were recorded according to the source of information in terms of the duration of the videos (P = .021), the number of views (P = .025), viewing rate (P = .028), days since upload (P = .018), likes (P = .048), and dislikes (P = 0.008).

CONCLUSIONS

GQS is higher for University videos; YouTube videos are an accessible, effective, informative, and educative tool for improving oral quality of life of patients with PD.

RELEVANCE TO CLINICAL PRACTICE

YouTube is increasingly used by patients with chronic disorders, for many reasons, including the desire for a second opinion, the search for support, and a wish to increase personal knowledge of the disease. Likewise, there is a growing interest in the search for information about oral care and coping skills.

A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration

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.

Orofacial Functions and Chewing Effiency in Elderly Patients with Parkinson’s Disease Rehabilitated with Removable Prostheses

Background:

Parkinson’s Disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease. It is one of the movement disorders that can affect oro-facial conditions. It is more common in the elderly, having an average age of onset of around 60 years.

Objective:

The aim was to study orofacial functions in patients suffering from PD with partial or total edentulism, wearing removable prostheses.

Methods:

Forty-eight (48) elders, rehabilitated with removable dentures, were included: 24 patients suffering from Parkinson's disease constitute the Study Group (SG), and 24 subjects not suffering from Parkinson's disease or neurological degenerative diseases represent the Control Group (CG).

In SG, the severity of Parkinson's disease was assessed according to the Unified Parkinson's Disease Rating objective motor scale III, and oro-facial dysfunctions were evaluated using Nordic Orofacial Test-Screening (NOT-S). The duration of the use of dental prostheses expressed in years has been reported. In both the groups, the subjective chewing index for the analysis of masticatory ability and the two-color chewing gum test for the analysis of masticatory efficiency were conducted .

Results:

There was a statistically significant difference between the SG and CG compared to the NOT-S (P = 0.001).

Analyzing the study group, a statistically significant correlation was found between the masticatory efficiency and prosthetic years of use (rs = 0.436; P <0.05); instead, no statistically significant correlation was found between the masticatory efficiency and the severity of Parkinson's disease.

Conclusion:

In our study, we did not find differences between SG and CG in terms of the degree of masticatory efficiency; therefore, only a correlation between the duration of use of dental prostheses and the degree of masticatory efficiency was found.

Sicca Symptoms in Parkinson's Disease: Association with Other Nonmotor Symptoms and Health-Related Quality of Life

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.

Parkinson's Disease Oral Health Module: Interprofessional Coordination of Care

Introduction

Patients with Parkinson's disease (PD) suffer progressive neurodegeneration and experience motor and nonmotor symptoms. Oropharyngeal dysfunctions are increasingly recognized as nonmotor PD symptoms that negatively impact a patient's quality of life. This module was primarily created to update dental health professionals and educate dental students on the oral health needs of patients with PD, with an emphasis on interprofessional collaboration and evidence-based dentistry. The module may also benefit other health professionals from different disciplines working with patients with PD.

Methods

The module was developed to be delivered in one 55-minute large-group session followed by a short assessment and case study discussion. Associated materials include PowerPoint slides with transcript, a narrated video version of the PowerPoint lecture, a quiz, and the case study. Thirty-four first-year dental students were invited to watch the narrated presentation, complete a pre-/postsurvey, and take the quiz.

Results

All participants agreed dental schools should provide education regarding oral health in patients with neurological disorders, as only 29% of them had previously taken a related class. After watching the presentation, students reported that most of the information was new content and that the difficulty level met their expectations. All students reported that the lecture increased their interest in interprofessional collaboration. In a quiz taken immediately after the presentation, the class average grade was 82.7, with 94% of the class passing the quiz with a grade of 70 or more.

Discussion

Educating dental professionals regarding care of patients with PD must emphasize interprofessional collaborations among health care providers.

Oral health and implant therapy in Parkinson's patients: review

Parkinson's Disease (PD) is one of the most frequent neurodegenerative diseases, second only to Alzheimer's disease. It is a progressive disease that inevitably leads the patient to death, in most cases for pneumonia ab ingestis. It affects 120 people out of 100,000 and more frequently affects men than women. The main symptoms are divided into motor, non-motor and behavioral ones. The main motors symptoms are tremor, bradykinesia and postural instability. Non-motor symptoms include autonomic nervous dysfunction (orthostatic hypotension, cardiac arrhythmia, sexual dysfunction, excessive sweating due to hypothalamic dysfunction, constipation), insomnia, OSAS, and olfactory dysfunction. Behavioral symptoms are depression, dementia and psychosis. The purpose of this study is to evaluate, through a systematic review of literature, the oral health status of the Parkinson's patient compared with the general population with particular reference to the incidence of caries and periodontal disease, the patient's management during dental interventions and the possibility of rehabilitating the patient with implanted therapy.

Periodontal surgery in a stage II Parkinson’s disease patient: Report of a case with special considerations

Parkinson’s disease (PD) is an idiopathic progressive neurological disorder characterised by resting tremor, restrictions in mobility and muscular rigidity that can lead to problems in maintaining oral health. Here we report a case where crown lengthening surgeries were successfully performed in a PD patient for complete oral rehabilitation. Certain special considerations that are required before and during periodontal surgery in such patients are also elucidated. Often dentists and PD patients are reluctant to embark on complex dental procedures resulting in a compromised outcome. However, early intervention along with proper education and motivation of these patients can aid in achieving satisfactory results.

Influence of a removable prosthesis on oral health-related quality of life and mastication in elders with Parkinson disease

STATEMENT OF PROBLEM

Parkinson disease (PD) symptoms, such as muscle rigidity, tremors in the lips and tongue, and involuntary mandibular movements, may cause oral health-related problems, mastication difficulties, and denture discomfort because of the difficulty in controlling a prosthesis with the oral musculature.

PURPOSE

The purpose of this observational clinical study was to evaluate the influence of oral rehabilitation with a removable prosthesis on oral health-related quality of life (OHRQoL) and masticatory efficiency (ME) in elders with PD.

MATERIAL AND METHODS

Thirty-four elders with PD (n=17, mean age 69.4 ±4.7 years) or without PD (n=17, mean age 70.7 ±4.7 years) were recruited. All participants first underwent OHRQoL and ME evaluations. Two months after the insertion of new removable prostheses, the participants were reassessed. The OHRQoL was measured with the Oral Health Impact Profile (OHIP-49). ME was evaluated by determining the percentage weight of the comminuted silicone-based artificial material that passed through a 2.8 mm sieve. For each group, data were compared between baseline and after insertion of new removable prostheses by paired t test or Wilcoxon sign test/signed-rank test. Group differences were assessed at each time point by t test (α=.05).

RESULTS

After the insertion of removable prostheses, elders with PD showed improved OHRQoL and ME. Controls also showed improvements on both measures after insertion of removable prostheses. At baseline, elders with PD had lower OHRQoL and ME compared with the controls (P<.05). After removable prosthesis insertion, the elders with PD continued to show lower ME values than the controls, but their OHRQoL was similar.

CONCLUSIONS

Oral rehabilitation with new removable dental prostheses improved the OHRQoL and ME in elders with and without PD, although ME did not reach control levels in elders with PD.

Oral Health in Elders with Parkinson's Disease

Abstract This study aimed to evaluate objectively and subjectively the oral health of elders with Parkinson's disease (PD), using clinical oral assessments and the General Oral Health Assessment Index (GOHAI). Subjects included 37 removable prosthesis wearers, 17 with PD (mean age 69.59±5.09 years) and 20 without PD (mean age 72.00±5.69 years). The objective assessment included an evaluation of oral characteristics, including the number of remaining teeth, decayed, missing and filled teeth (DMFT), visible plaque index (VPI), salivary flow rate and removable prosthesis conditions. The subjective assessment included self-perception of oral health collected using the GOHAI index. The number of remaining teeth, DMFT, VPI, salivary flow rate and GOHAI data were compared between the groups using t-tests. Removable prosthesis conditions were analyzed using χ2 tests (p<0.05). There were no group differences in the number of remaining teeth, DMFT, VPI or salivary flow rate (p>0.05). Greater maxillary prosthesis defects were observed in the control group (p=0.037). GOHAI scores were low for the PD group and moderate for controls, yielding a group difference (p=0.04). In conclusion, elders with PD have similar oral health to controls. Although all elders had few remaining teeth, high DMFT and high VPI, PD elders had more negative self-perceptions of their oral health than did the controls.

Clinical strategies for complete denture rehabilitation in a patient with Parkinson disease and reduced neuromuscular control

The dentist has a large role in geriatric health care for the ever increasing elder population with associated physical and neurological disorders. The Parkinson disease is progressive neurological disorder with resting tremor, bradykinesia, akinesia, and postural instability. The psychological components of disease include depression, anxiety, and cognitive deficiency. Poor oral hygiene, increased susceptibility for dental caries, and periodontal diseases predispose them to early edentulism. The number of Parkinson affected patients visiting dental clinic seeking complete denture is growing. This case report explains the steps involved in the complete denture rehabilitation of Parkinson patient. The effective prosthesis will help in alleviating functional, aesthetic, and psychological disabilities of the patient.

Disorders of the oral cavity in Parkinson's disease and parkinsonian syndromes

Awareness of nonmotor symptoms of Parkinson's disease is growing during the last decade. Among these, oral cavity disorders are, although prevalent, often neglected by the patients, their caregivers, and physicians. Some of these disorders include increased prevalence of caries and periodontal disease, sialorrhea and drooling, xerostomia, orofacial pain, bruxism, and taste impairment. Though many of these disorders are not fully understood yet and relatively few controlled trials have been published regarding their treatment, physicians should be aware of the body of evidence that does exist on these topics. This paper reviews current knowledge regarding the epidemiology, pathophysiology, and treatment options of disorders of the oral cavity in Parkinson's disease patients.

Oral rehabilitation of Parkinson's disease patient: a review and case report

Parkinson's disease is usually seen in adults in their middle and late ages. Most people with this disease are less likely to opt for dental treatments unless it is an acute condition. Tremors caused by Parkinson's disease can make dental appointments, especially prolonged treatments, a challenge. The case presented here was successfully treated with an immediate denture for the partially edentulous maxillary and mandibular arches. Early morning brief appointments were given for the procedure. Patient was instructed to take the prescribed parkinsonism medications 60 to 90 minutes before the appointment to utilize the advantage of its peak response. Sympathetic and caring approach towards the patient was employed to reduce his anxiety during the procedures. Some modification of technics and materials was adopted to suit the special situation.

Neuroprotective effect of kaempferol against a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced mouse model of Parkinson's disease

In the present study, we investigated the neuroprotective effects of kaempferol in the mouse model of Parkinson's disease, which was induced by neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). We confirmed that MPTP led to behavioral deficits, depletion of dopamine and its metabolites, reduction in superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) activity, and the elevation of malondialdehyde (MDA) levels in the substantia nigra. When administered prior to MPTP, kaempferol improved motor coordination, raised striatal dopamine and its metabolite levels, increased SOD and GSH-PX activity, and reduced the content of MDA compared with mice treated with MPTP alone. Immunohistochemical studies using anti-tyrosine hydroxylase (TH) antibody showed that medication of kaempferol could prevent the loss of TH-positive neurons induced by MPTP. Taken together, we propose that kaempferol has shown anti-parkinsonian properties in our studies. More work is needed to explore detailed mechanisms of action.

Phenotypic disruption to orofacial movement topography in conditional mutants with generalized CamKIIa/Cre D1Tox versus striatal-specific DARPP-32/Cre D1Tox ablation of D1 dopamine receptor-expressing cells

Orofacial movements were quantified in (a) DARPP-32/Cre D1Tox mutants, having progressive loss of D1 dopamine receptor expressing striatal medium spiny neurons and (b) CamKIIa/Cre D1Tox mutants, having progressive, generalized loss of forebrain D1 receptor expressing cells. Horizontal jaw movements and tongue protrusions were reduced in DARPP-32/Cre but not in CamKIIa/Cre mutants; head and vibrissae movements were increased in DARPP-32/Cre but decreased in CamKIIa/Cre mutants. In drug challenge studies, tongue protrusions were increased in CamKIIa/Cre mutants following vehicle, suggesting a stress-related phenotype. These findings indicate that mice with progressive loss of striatal-specific D1 receptor expressing cells have an orofacial phenotype that may be modulated by the loss of extrastriatal D1 receptor expressing cells. As progressive loss of D1 dopamine receptor-expressing cells is a hallmark feature of Huntington's disease (HD), these findings may inform the functional role of loss of this cell population in the overall pathobiology of HD.