Depression in PD

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Depression in PD

• Sad mood, diminished ability to enjoy things
• Poor appetite,sleeping, reduced energy levels
• Slowed movement, poor concentration
• Usually diagnosed when symptoms present every day
  for at least two weeks
• Leading factor contributing to reduced QOL

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Oral Problems and Parkinsons Disease

• Xerostomia and root caries
• Dysphagia and drooling
• Muscle control and dentures
• Maintenance and oral hygiene
• Burning sensation

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PD diagnosis and management in primary and
secondary careKey priorities for implementation

• Referral to expert for accurate diagnosis
• Diagnosis and expert review
• Regular access to specialist nursing care
• Access to physiotherapy
• Access to occupational therapy
• Access to speech and language therapy
• Palliative care

NICE 2006
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Assessing health related QOL in patients with PD
in a prospective longitudinal study
This study did not consider the impact of dental
health on quality of life.
Reuther et al. Parkinsonism and Related Disorders
200713108-114
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An innovative education programme for people with
PD and their carers
This study did not include any advice on dental
health
Simons et al. Parkinsonism and related disorders.
200612478-485
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The dental awareness and needs of a PD population.
Dental problems were reported often. Xerostomia
and burning sensation at least twice that of
general population. Satisfaction with dental care
was high. Reduced satisfaction in those with
loose dentures and burning sensation.
Clifford and Finnerty. Gerodontolgy 1995 12
99-103
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PD Common Dental Complaints

• Xerostomia 51
• Dysphagia 48
• Loose dentures 31
• Poor denture control 28
• Sore gums 23
• Ulcers 17
• Bleeding gums 11.5
• Burning sensation 9.7
• Loose teeth 8
• Sore teeth 5

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Recommendations

• Dentists need to be made aware of the needs of PD
  patients
• Dentists should be involved early in the
  management of PD patients
• Dental health educators should establish contact
  with PD groups
• Dentists should target PD groups for dental
  health awareness

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Prosthetic need in Greek patients with
Parkinsons Disease

• Chewing problems 39
• Swallowing difficulty 29
• Nausea 14
• Occlusion difficult to evaluate 24
• Preference for soft diet
• Oral hygiene 57
• Brush dentures 12

Anastassiadu et al Eur J Prosthodont Rest Dent
2002 10 63-68
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Burning Mouth in PD
Clifford et al. Gerodontology 1998 15 73-78
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Burning Mouth in PD

• Burning mouth affected 24 of PD
• Females more than males
• None reported burning before onset of PD
• 96 of BM taking levodopa
• No relationship with dental status

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Complete dentures for PD patients
Oral rehabilitation of the edentulous mandible in
PD is particularly challenging to the clinician
when the orofacial musculature is unable to
stabilize the prosthesis. When voluntary and
involuntary muscle control of the
oro-facial-pharyngeal muscles are compromised,
difficulty in mastication, dysphagia and tremor
of the mouth and chin may be encountered.
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Treatment considerations for edentulous
Parkinsons patients

• Copy technique
• Rebase or reline dentures
• Conventional technique
• Implants
• Aftercare

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Treatment considerations for PD

• Time of day to treat
• Wheelchair access
• Domiciliary visit
• Chair position

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Complete Denture Design

• Denture bearing area
• Jaw relationship
• Polished surfaces
• Tooth position

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Factors Influencing Denture Success

• Reason for edentulousness
• Previous prosthetic experience
• Medical history
• Education
• Age
• Personality
• Psychological - depression