Do your bit for Parkinson’s diseaseNews
Posted by: The Probe 12th May 2020
Each year during the month of April, Parkinson’s Awareness Week takes place to spread awareness and help those affected by one of the world’s most degenerative and debilitating diseases. This serves as a reminder to us all that there is always more that can be done to assist those living with Parkinson’s disease (PD), which, today, is thought to be in the region of 145,000 people. By 2030, that number is set to increase by a fifth to 172,000, with those aged 70 and above likely to be the most affected.[i]
But what is PD and what do you need to know about it? PD is a progressive neurological disorder in which part of the brain becomes increasingly more damaged over time due to cells not working properly. It’s when the brain is no longer able to make enough dopamine (the chemical produced by healthy cells) that symptoms start to appear. These symptoms typically include tremors, slowness of movement and muscle stiffness, as well as non-motor manifestations such as bladder and bowel complications, eye issues, dizziness, fatigue, pain, restless leg syndrome, problems with sleeping and speech and communication difficulties.
Sadly, PD patients are also extremely prone to experiencing Mild Cognitive Impairment (MCI), which can later progress into dementia. Indeed, a recent study suggests that 25% of PD patients with normal cognition become cognitively impaired within just three years, and 20% of those with MCI develop dementia.[ii] Naturally, this can be very distressing and as such, it’s not uncommon for people with PD to suffer from anxiety and depression. When that happens, mundane tasks such as oral hygiene can get pushed to the wayside, resulting in a number of oral complications, which – given that PD patients’ oral health status is already compromised to begin with – is not ideal.
Indeed, a big challenge for many people living with PD is managing oral care, as tremors and rigidity make it difficult to use a toothbrush effectively. Many also suffer from impaired chewing, swallowing and poor denture control due to weakening of the muscles in the jaw and face – all of which can have a negative impact on an individual’s oral health. One of the main problems associated with PD is periodontal disease caused by a build-up of plaque and tartar as a result of poor and less frequent oral hygiene and decreased attendance to the dentist.[iii] Interestingly, research shows that the relationship between both diseases is two way – patients with periodontal disease are thought to be at higher risk of developing PD.[iv] This is worth bearing in mind as early intervention might help with preventing future diagnoses.
Caries is the other big issue in PD patients. Again, this is largely due to poor oral hygiene, but xerostomia brought on by medication is also thought to increase the risk and severity of decay.[v] So, if you have a patient with PD suffering from a dry mouth, it might be worth discussing their medication as it might be that they need referring to their doctor for a drugs review. Medication to watch out for include procyclidine and trihexyphenidyl, which are anticholinergics. Be aware, however, that a change in medicine might not be possible, as it may be that their prescription is the best option for controlling the symptoms of their condition. If that’s the case, all you can do is treat the oral manifestations and make sure the patient is doing the best they can in terms of hygiene and diet to prevent or minimise the potential risks.
Diet in particular can make all the difference, so advise them to avoid foods and drinks high in sugar, carbohydrates and acid, including sweet treats, carbonated drinks, bread, pasta and citrus fruits. Whilst on the topic of nutrition, it may also be worth letting your patients know that certain food products – for instance, canned fruits and vegetables, soda, fried foods, beef, ice cream and cheese – can also increase the progression of PD.[vi] Foods found to potentially reduce progression include fresh fruit and vegetables, nuts and seeds, non-fried fish, olive and coconut oil, fresh herbs and spices,vi and – most recently – yoghurt containing the probiotic bacillus subtilis.[vii]
As for oral hygiene, why not make PD patients’ lives easier by recommending an electric toothbrush. With small heads and larger, easy to hold handles, electric toothbrushes are ideal adjuncts for helping overcome barriers such as tremors and stiffness, and encouraging daily cleaning. For maximum results, suggest the Hydrosonic Easy toothbrush by leading oral healthcare specialist Curaprox. Boasting hydrodynamic technology, extra-soft CUREN® filaments and three settings capable of delivering up to 42,000 movements per minute, the Hydrosonic Easy ensures a safe, gentle and atraumatic clean for all users. The popular Curaprox creation is also supplied with a CHS 200 sensitive brush head for sonic toothbrush beginners, which is ideal for PD patients that might be new to the technology.
Until there’s a cure, Parkinson’s disease is going to remain a problem for a number of your patients. However, with your help and guidance, patients need not suffer from oral complications that can hinder quality of life.
Author Dawn Woodward National Sales manager Curaprox UK
[i] Parkinson’s UK. Statistics for Journalists. Accessed online 15 January 2020 at https://www.parkinsons.org.uk/about-us/statistics-journalists
[ii] Saredakis D, Collins-Praino LE, Gutteridge DS, Stephan BCM, Keage HAD. Conversion to MCI and dementia in Parkinson’s disease: a systematic review and meta-analysis. Parkinsonism and Related Disorders. 2019; 65: 20-31. Accessed online 16 January 2020 at https://www.sciencedirect.com/science/article/abs/pii/S1353802019302159
[iii] Müller T, Palluch R, Jackowski J. Caries and periodontal disease in patients with Parkinson’s disease. Spec Care Dentist. 2011; 31 (5): 178-81. Accessed online 16 January 2020 at http://www.ncbi.nlm.nih.gov/pubmed/21950532
[iv] Chen C-K, Wu Y-T, Chang Y-C. Periodontal inflammatory disease is associated with the risk of Parkinson’s disease: a population-based retrospective matched-cohort study. PeerJ. 2017; 5: e3647. Accessed online 16 January 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5554596/
[v] Su N, Marek CL, Ching V, Grushka M. Caries prevention for patients with dry mouth. J Can Dent Assoc. 2011; 77:85. Accessed online April 2016 at http://www.ncbi.nlm.nih.gov/pubmed/21774875
[vi] Lange KW, Nakamura Y, Chen N, Guo J, Kanaya S, Lange KM, Li S. Diet and medical foods in Parkinson’s disease. Food Science and Human Wellness. 2019; 8(2): 83-95. Accessed online 16 January 2020 at https://www.sciencedirect.com/science/article/pii/S2213453019300230
[vii] Parkinson’s UK. Gut Bacteria Could Guard Against Parkinson’s. Published 14 January 2020. Accessed online 16 January 2020 at https://www.parkinsons.org.uk/news/gut-bacteria-could-guard-against-parkinsons
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