Ask the experts: Q and A with two dentists
Dr Shafaq Ali is a dentist working in Wakefield and was diagnosed with Parkinson’s 5 years ago.
Jessie Tebbutt is an Academic Clinical Fellow in Special Care Dentistry at the University of Sheffield.
Here, they both answer some key questions about Parkinson’s and mouth and dental care.
I'm worried that my Parkinson's symptoms will make it difficult for me to have dental treatment. What should I do?
Generally, your dental treatment will not change if you have Parkinson’s.
If you have any worries, let your dental practice know about these before your appointment. Taking a friend or family member along to the appointment might help, as well as arranging your appointment for a time of day when your symptoms are best controlled.
If your regular dentist can’t provide your dental treatment, they may refer you to the Community Dental Service. These teams work with people with different medical conditions who may need adjustments to receive treatment.
The Community Dental Service also has access to specialised equipment, including hoists to move people from a wheelchair to the dental chair. If you use a wheelchair, they can use a wheelchair tipper to help you receive treatment without getting out of it.
My mouth feels very dry sometimes. Why is this and what can help?
Dry mouth is a side effect of some Parkinson’s medications. Your specialist may be able to prescribe you different medication to reduce this.
Sometimes, you may simply be dehydrated, and sipping water more frequently might help.
Rinsing your mouth with a teaspoon of coconut oil can help to keep your mouth moist.
Saliva substitutes can also help prevent a dry mouth. These can come as a spray, gel or lozenge. Discuss these with your dentist or pharmacist, as some brands may not be suitable for people with natural teeth.
The corners of my mouth are sore because my Parkinson’s makes it hard for me to control my saliva. What can help with this?
Leaking saliva at the corners of your mouth can cause the skin barrier to break down, and result in an infection similar to oral thrush. Wiping away saliva to keep the corners of your mouth dry can help, as well as applying petroleum jelly or lip balm with SPF.
Your dentist can prescribe antibiotic or antifungal creams to clear this, but these won’t address the cause of the issue.
Your medical team should make sure you’re getting all the vitamins you need, such as iron, folic acid and vitamins B12 and D. Not getting enough of these can make soreness around your mouth worse.
Speech and language therapists can suggest exercises to improve your lip muscle strength and help you hold saliva in your mouth.
I struggle with holding my toothbrush. What tips do you have?
An electric toothbrush can be easier to use than a manual toothbrush, and can have chunkier handles which are easier to grip. Most come with timers and pressure indicators, so you know when you have brushed for 2 minutes and if you are brushing too hard. This is common for people with Parkinson’s.
Electric toothbrushes are sometimes a bit heavier and may be difficult to hold. Your dental team could add silicone putty to the brush handle to improve its grip. You could also buy a strap to attach to the toothbrush to help hold it, or try using your other hand if it is stronger.
Take breaks when brushing if needed. Just remember to start your brushing at a different point in your mouth each time so you don’t miss anywhere.
Flossing is also important, but dental floss can be fiddly.
You could try:
- floss sticks or flossettes
- waterflossers to remove debris from between your teeth
- interdental brushes: these have longer handles making it easier to clean between back teeth
- a higher fluoride toothpaste and mouthwash
- a 3-sided or 360 toothbrush, which brushes each side of your mouth simultaneously
- asking for a scale and polish every 3 months.
If you wear dentures, take them out twice a day to clean them, and don’t wear them overnight.
To boost protection for your teeth, your dentist might apply a fluoride varnish on your teeth or prescribe a high fluoride toothpaste.
They’ll probably advise that you keep sugary foods to mealtimes, such as a dessert after your main meal. They may recommend that, if you eat between meals to keep your energy up, you rinse your mouth with water or a fluoride mouthwash afterwards.
I have a tremor in my jaw and feel that my bite has changed since my Parkinson’s diagnosis. How could my dentist help me?
Your dental team can check whether you’re grinding your teeth or have gum disease. These are 2 common reasons for your bite to feel different.
If you’re worried about your tremor during dental treatment, the dentist may use a jaw prop. This is a tool to rest your teeth on during treatment and helps relax your muscles, even when your jaw is open.
If necessary, your dentist may suggest local anaesthetic or intravenous sedation. This is a drug to relax your nerves and muscles and is given through the back of your hand or arm. Sedation is particularly good if you have persistent tremors.
If your tremor is made worse by anxiety, your dentist might suggest breathing exercises or mindfulness to put you at ease.
My partner experiences apathy around cleaning their teeth. How might I help them?
Parkinson’s can cause a shortage of the hormone serotonin, which can lead to apathy and low mood. Apathy is when you have little interest or enthusiasm to do anything.
Why not try:
- turning brushing into a social activity by brushing your teeth together and picking the best time of day for them
- setting reminders and giving gentle prompts
- brushing in another room if the bathroom is inconvenient
- trying brushing while sat down
- combining brushing with other personal care to create a routine
- identifying a personal and meaningful reason why they might want to keep their teeth clean.
You may consider providing your partner’s oral hygiene yourself. The idea of brushing someone else’s teeth can be overwhelming for both of you.
The brushmyteeth.ie website has some useful information. Your dental team can also give you tips and check your technique.
Your partner’s specialist may be able to offer more support around apathy and low mood.
If your tremor is made worse by anxiety, your dentist might suggest breathing exercises or mindfulness to put you at ease.