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

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.

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.

Investigating the Connection between Chronic Periodontitis and Parkinson's Disease: Findings from a Korean National Cohort Study

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.

Oral health experiences of people living with Parkinson's disease: a scoping review

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.

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.

An Interactive Workshop on Managing Dysphagia in Older Adults With Dementia

Introduction

Nearly six million American adults live with dementia, and dysphagia is a common comorbidity impacting their nutrition and quality of life. There is a shortfall in the number of geriatricians available to care for older adults. Thus, primary care physicians should be equipped with the knowledge to adequately care for the geriatric population. Modified diets are routinely prescribed for patients with dementia despite limited evidence that they protect patients from the sequelae of dysphagia and some suggestion of poor side-effect profiles.

Methods

We created a onetime, interactive, case-based session to educate medical residents on how to evaluate and treat dementia-associated dysphagia and address the discrepancy between the limited evidence for dietary modifications and their routine use. The session had a mixture of small-group discussion and didactic learning as well as a participatory component during which learners were able to sample thickened liquids.

Results

The session was implemented in an established primary care curriculum. Based on survey responses, which were obtained from 15 out of 17 participants, the session significantly improved participants' knowledge of dysphagia-associated dementia and increased their comfort with caring for patients with dysphagia.

Discussion

Dementia-associated dysphagia, although an increasingly common clinical problem, remains an underexamined area of medicine. We successfully implemented a session on this topic for internal medicine residents on the primary care track. Limitations included generalizability due to the small number of residents in the course and inability to gather sufficient data to see if knowledge learned was sustained over time.

Oral Factors That Impact the Oral Microbiota in Parkinson's Disease

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.

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.