Teeth and oral health

Dental and oral care is important for general good health and for self-esteem. A good oral hygiene routine, together with a well-balanced diet and regular visits to the dentist, vital to maintaining healthy teeth and gums. Keeping your mouth healthy is essential for tasting, chewing, swallowing and speaking and will enable you to eat foods you like rather than those you are simply able to eat.

To keep your mouth healthy you should:

  • Brush your teeth twice a day with a fluoride toothpaste.
  • Brush last thing at night and one other time during the day.
  • Try not to rinse your mouth after spitting out toothpaste so that fluoride continues to work.
  • Use a fluoride wash daily and, if you eat lots of small meals, between meals.
  • Limit sugary food and drinks to mealtimes only and no more than four times a day.
  • Visit your dentist regularly.

How might Parkinson's affect teeth and oral health?

Keeping teeth and gums healthy can be more difficult if you have Parkinson's, both because of symptoms that make caring for your teeth harder and because some Parkinson’s medications can affect dental health.

Click on the headings below to read about the most common problems related to the teeth and mouth in Parkinson’s and how to manage these.

Difficulty swallowing (dysphagia)

Swallowing difficulties are common in Parkinson’s because swallowing is a motor function. Reduced control of your mouth, tongue and throat muscles, especially in later stages of the condition, can make eating and swallowing slower and more effort may be required.

If teeth are missing or poorly looked after you may find it difficult to chew food properly in preparation for swallowing. Inflamed or bleeding gums, decayed fillings or faulty dental fittings, such as bridges or dentures, can cause you distress and make eating and swallowing uncomfortable and painful.

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 from occurring, such as aspiration (which can lead to chest infections) and choking. A speech and language therapist can help by:

  • advising on techniques to help with eating
  • suggesting exercises to strengthen muscles used for eating
  • suggesting strategies to reduce the risks of asphyxiation and aspiration
  • 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. He or she can suggest exercises and also devices to achieve good lip seal

See also: Eating, swallowing and saliva control.

Dry mouth 

Some people with Parkinson’s experience a dry mouth because they swallow repeatedly, which removes saliva from the mouth. The lack of lubrication can result in a sore or dry throat, which can make talking and eating uncomfortable.

Dry mouth may also be caused by some Parkinson’s medicines, particularly anticholinergic medications.

As saliva contains antibodies that fight infection, a dry mouth can increase the chance of tooth decay and gum disease. A dry mouth may lead to dentures fitting poorly so that eating becomes more difficult and uncomfortable. You may also experience 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 on suitable saliva substitutes. Rinsing with mouthwash, taking frequent sips of water, sucking on ice chips , chewing gum or using a mouth spray 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.

Burning mouth

If you experience a burning mouth sensation then talk to your doctor or dentist. This can be related to a dry mouth or to levodopa.

Drooling 

We all produce about one litre of saliva each day, which we usually swallow without thinking. But because swallowing is a motor function, this mechanism can be disrupted by Parkinson’s. 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, with head forwards and chin pointing downwards, can add to poor saliva control, as it causes saliva to pool in the front of the mouth.

If you experience drooling you may feel embarrassed in social situations. Your clothes may become stained and your breath may be stale as saliva pools in your mouth. This may make the skin around your mouth sore.

If you inhale excessive saliva by mistake you may experience aspiration pneumonia. Good saliva control is therefore important both for your personal safety and for good quality of life.

The following suggestions may help you to control excessive saliva:

  • Take sips of drink more often so that saliva is ‘washed down’ with fluids
  • Swallow saliva often, and make a conscious effort to do so before eating
  • Practice closing your lips as tightly as possible and hold for a count of four, relax, then repeat five times
  • Stretch your lips in a wide smile and hold for a count of four, then relax
  • Keep your head up so that saliva flows to the back of your throat to make swallowing easier.
  • Dairy products can cause an increase in mucous in some people, so consider reducing dairy in your diet. However, note that milk provides calcium and other nutrients, which are beneficial to health.

See also: Eating, swallowing and saliva control.

Difficulty controlling dentures

This can occur because of loss of muscle tone, difficulty in controlling your facial muscles, dry mouth, pools of saliva building up in your mouth, or poorly fitting/old dentures. A build-up of plaque can also accelerate changes in the structure of your mouth and this can lead to dentures not fitting properly. If you have poor control of your dentures they may rub parts of your mouth and cause ulcers or blisters. These can be painful and may lead to difficulties eating and speaking.

Your dentist should be able to advise on ways to improve control and minimise any problems with dentures.

Increased decay

Decay is caused by the bacteria in plaque which change sugar into acid which then attacks your teeth. It is therefore important to limit the frequency and amount of sugar you eat and to brush teeth well, twice a day, using a fluoride toothpaste.

  • Try to limit sugary food and drinks to mealtimes only and no more than four times a day
  • Snack between meals should be sugar free, such as vegetables or cheese
  • Limit sugary drinks to mealtimes only. Tea or coffee should be 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.

Who can help?

There are many professionals who can help with dental issues and oral hygiene:

Dentist

You should visit a dentist regularly, preferably one who has experience of Parkinson's. Normally visits should be made every six months, or earlier if you have a new problem, but your dentist will be able to advise you if you need to visit more often.

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 floss, an angled or electric toothbrush, and on other ways of preventing disease from developing in your mouth. If possible find a dentist with specially trained nurses, rather like dental hygienists. They will be more experienced in explaining and managing oral hygiene. If it is difficult to get to the dentist, ask your doctor if they can recommend a dentist who will visit your home.

Always tell your dentist about any medications you take.

Dental hygienist 

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 calculus.

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.

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.

How can I help myself?

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 flossing.

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.

Squeezing a tube of toothpaste can be difficult and you may find it easier to use a pump dispenser. Flossing can be tricky and there are special floss holders available to make it easier. Ask your dentist or dental hygienist about different products you could try.

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. If you eat throughout the day it is not necessary to brush your teeth every time - too much rubbing is a risk for the teeth - so instead you should rinse with water or mouthwash or chew special gums.

Keeping your lips moist can help you to smile and speak more easily. Try using a lip balm if your lips feel dry. 

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:

  • Soak dentures overnight then brush them gently under water.
  • Clean dentures over a full sink of water or in a bowl so that they do not break if you drop them.
  • Use special denture paste to clean them. Simple soap and water applied with a nailbrush has been shown to be equally effective. Do not use normal toothpaste as is too abrasive and will damage dentures.
  • Follow instructions carefully if you use a special solution for soaking dentures. This should ensure they are not damaged.
  • Never use bleach to clean them. Ask your dentist to remove stubborn stains.

Acknowledgement

Our thanks to Parkinson's UK for permission to use the following source(s) in compiling this information: Parkinson’s UK – Dental and oral health

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