Keeping teeth and gums healthy can be more difficult if you have Parkinson’s disease. Motor symptoms, such as bradykinesia and rigidity, may hamper good daily oral hygiene care. Parkinson’s disease can also effect the orofacial muscular system, causing difficulties in swallowing, chewing and controlling dentures. In addition, the oral environmental balance and the quality of the saliva can be influenced by medication.

The paragraphs below illustrate the most common problems related to the mouth in people with Parkinson’s.

Increased decay of teeth (caries)

Caries (known as decay or cavities) is caused by bacteria in teeth plaque. These bacteria change sugar into acid, which damages the teeth. To prevent caries, it is therefore important to limit the frequency and amount of sugar intake and to remove teeth plaque from teeth surface. Fluoride in toothpaste can contribute to stronger teeth. Recent research demonstrates that people with Parkinson’s tend to have more dental caries than other people.

Advice to prevent caries includes:

• Try to limit sugary food to mealtimes only, and no more than four times a day.
• Limit sugary drinks to mealtimes only. Tea or coffee should be taken without sugar between meals.
• Do not rinse your mouth after brushing your teeth. This allows fluoride to continue to work to protect your teeth.
• Try to avoid eating or drinking for 30 minutes after brushing your teeth.

Increased inflammation of the gums and periodontal disease

Due to the presence of teeth plaque and tartar, gums can become inflamed. The gums look red, bleed easily (e.g. when brushing the teeth), and can feel painful. When the plaque is removed, the gums mostly recover. However, when not only the gums are infected, but also the underlying alveolar bone (the part of the jaw which hold the teeth), it is called periodontal disease. When you suffer from periodontal disease, the alveolar bone weakens, and as a result teeth can become loose and eventually fall out. This process is irreversible. Inflammation of the gums and periodontal disease can be prevented by good oral hygiene and regular professional teeth cleaning. Smoking has a strongly negative effect on the gums and the periodontal system.

Difficulty swallowing (dysphagia)

Swallowing difficulties (dysphagia) are very common in Parkinson’s because motor impairment can also effect the orofacial system. Reduced control of mouth, tongue and throat muscles, especially in the later stages in Parkinson’s, can make swallowing slower and less effective. People suffering from dysphagia are more vulnerable to aspiration and to developing pneumonia.

To improve swallowing movements, your doctor may refer you to a speech and language therapist for advice, preferably one who has experience of Parkinson’s. Treatment is vital to prevent serious problems, such as aspiration, pneumonia and choking.

Dysphagia can cause drooling.

A speech and language therapist can help by:

• Advising on techniques to help with eating and exercises to strengthen the orofacial muscles.
• Providing advice on diet to make sure you eat and drink enough, including tips on the consistency and texture of foods that are easier to eat.
• Identifying specific areas of difficulty with saliva control – for example poor posture, lip seal, tongue or swallowing problems.

See also: Eating, swallowing and saliva control.

Dry or burning mouth 

Some people with Parkinson’s experience a dry mouth. This may be caused by some Parkinson’s medicines, particularly anticholinergic medications. The lack of lubrication can result in a sore or dry mouth, which can make talking, eating and retaining dentures uncomfortable.

As saliva has a buffering and lubricating effect in the oral environment, a dry mouth can increase the risk of tooth decay and inflammation of the gums. People with Parkinson’s sometimes report a loss of taste or a burning sensation in the mouth.

Tell your doctor if you have a dry mouth, because they may be able to adjust your medication. Make your dentist aware too and, together with your doctor or pharmacist, they should be able to advise you. For example, taking frequent sips of water or using suitable saliva substitutes may help. A lip salve or balm can also help to keep lips moist. Caffeine, soft drinks, alcohol and tobacco, which all dry the mouth, are best avoided.

Drooling 

We all produce about one litre of saliva each day, which we usually swallow without thinking. Because swallowing is a motor function, this mechanism can be disrupted by Parkinson’s (see also dysphagia). Saliva may then build up in the mouth and, as the muscles which seal the lips also become weaker, it can escape, causing dribbling or drooling (sialorrhoea). The stooped posture associated with Parkinson’s disease, with head forwards and chin pointing downwards, can add to poor saliva control.

Inhaling excessive saliva by mistake is a risk for aspiration pneumonia. Good saliva control is therefore important both for your personal safety and for good quality of life and comfort.

A speech and language therapist can advise you when you have problems with swallowing and saliva control.

See also: Eating, swallowing and saliva control.

Difficulty controlling dentures

Controlling dentures can be difficult, because the orofacial muscular system can be impaired by Parkinson’s. Dry mouth or pools of saliva building up in the mouth can make it harder to keep a denture in place. Poor denture control may lead to ulcers or blisters in the mouth, which can be very painful. Difficulties in eating and speaking may also occur.

It is of course important that dentures fit well; your dentist can help you with this. A speech and language therapist can advise you on how to improve denture control.

There are several professionals who can help with dental issues and oral hygiene.

Dentist

A dentist can help you maintain your mouth healthy. You should visit a dentist regularly for check-ups, preferably one who has experience of Parkinson's. When you have oral problems, he or she will, together with you, look for an appropriate treatment.

It is important to seek advice on any dental problems promptly so that they can be treated quickly to prevent them getting worse.

Ask your dentist for advice on cleaning techniques and aids, such as interdental cleaners. Always tell your dentist about any medications you take.

Dental hygienist 

Dental hygienists are trained in oral care and hygiene and can provide practical advice for day-to-day care of your teeth. They can also clean the teeth thoroughly by removing plaque and tartar.

Doctor 

Always seek advice from your doctor, as well as your dentist, on any dental problems you experience. In some cases, your doctor may be able to adjust your medications to resolve problems.

Speech and language therapist

A speech and language therapist can provide you with advice and exercises to strengthen the orofacial muscles, in order to have less difficulties eating, swallowing and controlling dentures, as well as to prevent drooling.

Dietician 

A dietician will be able to offer advice on a healthy, well-balanced diet that minimises the risk of harming your teeth and gums.

Try to establish a regular and fixed dental routine, ensuring that all tooth surfaces are cleaned twice a day. If you find it hard to clean all your teeth thoroughly in one go, you may prefer to concentrate on one half of your mouth in the morning and the other half at night. Clean systematically from one side to the other and from front to back, remembering that each tooth has multiple surfaces that must all be cleaned. Your carer can also help you with brushing and interdental cleaning.

Tremor and reduced hand-to-mouth mobility can make accurate and thorough brushing more difficult, which may lead to increased decay. Some people with Parkinson’s find it difficult to hold a toothbrush. Ways of overcoming this include:

• Slipping the brush into a velcro sleeve you strap to your hand
• Cutting an opening in a tennis ball and inserting the brush handle to give you something larger to grip
• Inserting the brush into a bicycle handlebar grip so it slips less in your hand
• Using an electric toothbrush as the extra weight can help reduce tremor in your hand or arm.

It is important to be mindful of the number of meals you eat during the day - many people with Parkinson's are unable to eat three large meals a day and instead eat a number of smaller meals or snacks. Your mouth would usually use the time between meals to ‘recover’, so greater care should be taken to keep your mouth clean if you eat more regularly. A dental hygienist can advise you on this.

Dentures

If you have dentures, you need to clean them thoroughly as plaque can still build up, which can cause irritation or infection in your mouth.

You may find it helpful to:

• Clean dentures over a sink with a towel in it so that they do not break if you drop them.
• Clean your dentures with simple soap and water. Use a special brush for dentures. Do not use normal toothpaste as is too abrasive and will damage dentures.
• Never use bleach to clean them. Ask your dentist to remove stubborn stains.

We would like to thank Dr Marjolein A.E. van Stiphout (Foundation for Oral Health and Parkinson’s Disease, The Netherlands) for her help in reviewing this information.

Our thanks to Parkinson's UK for permission to use the following source(s) in compiling this information:

• Dental health.

• Parkinson disease: systemic and orofacial manifestations, medical and dental management. Friedlander AH, Mahler M, Norman KM, Ettinger RL. J Am Dent Assoc. 2009 Jun. Vol. 140(6); 658-69. Review. - Read article
• Oral Health of Parkinson's Disease Patients: A Case-Control Study. Van Stiphout MAE, Marinus J, van Hilten JJ, Lobbezoo F, de Baat C. Parkinsons Dis. 2018 May 8;2018:9315285. doi: 10.1155/2018/9315285. eCollection 2018. - Read article