Parkinson's disease

Oral health effects

• Drooling (sialorrhea)

  Affects an estimated 70-80% of PD patients; saliva pools in the mouth/oropharynx and can cause perioral skin irritation and increased caries/candidiasis risk from chronic mucosal wetting.

  Mechanism: Caused primarily by reduced swallowing frequency and impaired oral-motor/pharyngeal control, not by increased salivary gland output; actual saliva production is often normal or reduced.

  Clinical management: Botulinum toxin injection into salivary glands, short-term anticholinergics, and speech/orofacial motor therapy to improve swallow frequency.

• Swallowing difficulty (dysphagia)

  Impaired swallowing is common as PD progresses and increases the risk of aspirating saliva, food, blood, or dental irrigants/debris, including silent aspiration that can progress to aspiration pneumonia.

  Mechanism: Progressive loss of pharyngeal and esophageal motor control and reduced airway protective reflexes.

  Clinical management: High-volume suction and rubber dam isolation during procedures; favor fixed prostheses over removable dentures in advanced disease; coordinate with speech-language pathology.

• Tremor affecting oral hygiene and in-chair treatment

  Resting tremor of the hands, and sometimes tongue, lips, and jaw, makes effective toothbrushing/flossing difficult and can interfere with a stable field during clinical procedures.

  Clinical management: Adaptive aids (powered toothbrushes, built-up handles, floss holders), caregiver assistance with hygiene, and scheduling dental appointments to coincide with peak antiparkinsonian medication effect.

• Xerostomia from anticholinergic/dopaminergic medications

  Dry mouth is a common side effect of anticholinergic agents, dopaminergic drugs, tricyclic antidepressants, and antipsychotics used in PD management.

  Mechanism: Anticholinergic and other PD-related medications reduce salivary flow.

  Clinical management: Salivary substitutes, sugar-free sialogogues where not contraindicated, topical fluoride, and routine medication review with the patient's physician.

• Gum disease (periodontitis)

  People with Parkinson's have deeper pockets, more attachment loss and more plaque than controls, largely because rigidity, slowness and tremor make cleaning hard.

  Clinical management: Recommend a powered toothbrush or adapted handles and floss holders, involve caregivers, schedule shorter, more frequent recall visits during 'on' medication periods, and consider chlorhexidine or fluoride adjuncts.

• Dizziness or fainting when sitting up (orthostatic hypotension)

  About one in three people with Parkinson's has orthostatic hypotension from autonomic dysfunction and dopaminergic medication, so blood pressure can drop sharply when the chair is raised.

  Clinical management: Raise the chair slowly in stages, have the patient sit upright for a minute or two before standing, assist them out of the chair, and check blood pressure if they report light-headedness.