Some people with Parkinson’s may have problems with their dental and oral health.
Why is it important to look after my teeth and mouth?
A healthy mouth will help you to chew, taste, swallow and speak properly. It means you can eat the foods you like, rather than the ones your teeth allow you to.
To keep up good oral health, you should:
- brush your teeth twice a day with a toothpaste containing fluoride. Ask your dentist if you are not sure about the level of fluoride in your toothpaste
- use a daily fluoride mouthwash at a different time to brushing
- brush last thing at night and one other time during the day
- try not to rinse your mouth after spitting out your toothpaste
- reduce the amount of sugary food and drinks you have – limit them to meal times and no more than 4 times a day
- visit your dentist regularly
What oral and dental problems are common for people with Parkinson’s?
Having Parkinson’s doesn’t mean that you will have problems with your dental health.
But the nature of Parkinson’s, and some of the medication used to treat the condition, may mean that you have more uncommon problems. Parkinson’s symptoms can also make cleaning your teeth more difficult.
The main dental problems you could see are:
- difficulty swallowing
- dry mouth
- increase in tooth decay
- difficulty in controlling dentures
Parkinson’s can cause the muscles in your jaw and face to weaken, which affects the control you have over chewing and swallowing.
Find out more about eating, swallowing and saliva control.
Parkinson’s drugs can sometimes reduce the flow of saliva to your mouth. They can also lead to taste disturbances. Saliva is key to oral health.
It is needed for eating, taste and to lubricate food to assist swallowing. It has antibacterial properties and enzymes to help digest food.
A dry mouth can lead to higher rates of tooth decay and gum disease. It can also lead to an increased risk of getting decay in the exposed roots of teeth. It may also cause dentures to become loose and hard to control.
A dry mouth can also increase the harmful effects of sugar on teeth, making it more important to watch what you eat and when you eat.
Tell your dentist that you have a dry mouth. They may ask you what drugs you take, so you may find it helpful to take a list of your medication to your appointments.
You should also mention having a dry mouth to your GP, specialist or Parkinson’s nurse as there may be other treatments that doesn’t cause this problem. Saliva substitutes are also available – ask your GP, dentist or local pharmacist about this.
The following tips may help reduce dry mouth.
- try to take frequent sips of water
- chew sugar free gum
- use lip salve or Vaseline to keep your lips moist
- remove dentures at night to give your mouth a chance to recover
- eat a healthy diet. If you are thinking about changing your diet, a dietitian will be able to help you
- smoke – it makes the dryness worse
- use mouthwashes that have not been prescribed by your dentist or doctor. They may contain alcohol, which can increase dryness
- suck sweets to increase saliva – this will increase decay and other oral problems
- sip sugary drinks between meals. This will also increase decay and other oral problems
- use your teeth to open bottles or bite or chew hard objects
Some people with Parkinson’s complain of a burning mouth feeling. This can be due to a dry mouth and or taking levodopa. If you are affected, speak to your dentist or doctor.
Increase in tooth decay
The bacteria in plaque changes sugar into acid, which attacks your teeth. This leads to cavities and tooth decay.
How often sugar is in contact with your teeth can be more damaging than the amount of sugar you eat.
To stop tooth decay from happening you can try the following:
- Try not to eat or drink sugary things more than 4 times a day.
- Snacks between meals should be sugar free, for example cheese or vegetables.
- Sugary drinks should be restricted to meal times. Try drinking water or sugar-free tea or coffee between meals.
- Brush your teeth twice a day with a fluoride toothpaste (your dentist may prescribe a highly concentrated one). After spitting your toothpaste out, don’t rinse your mouth and avoid having anything to eat or drink for 30 minutes.
- Your dentist may also advise a fluoride mouth rinse to use at times other than when brushing. This is important if you have a dry mouth as you are more likely to get tooth decay. They may also apply a fluoride varnish to your teeth.
Drooling is common for people with Parkinson’s and may be due to people with the condition not being able to swallow as well as they used to.
If you swallow less, saliva pools in your mouth and instead of being swallowed it overflows from the corners of your mouth. This may happen when you’re concentrating on other things, such as watching TV or doing day-to-day activities.
Drooling or dribbling can also lead to sores and cracks developing at the corners of your mouth. This can make some everyday activities, such as talking, eating meals or having a drink, difficult or cause embarrassment. It may also lead to lip infections.
Some people with Parkinson’s can also find that their posture adds to the problem. Those who have a stooped, head-down position can find it hard to seal their lips. This can make it harder to control saliva flowing from the mouth.
You can also try these simple exercises at home in front of a mirror to try help prevent drooling. They’ll help you become more aware of what your lips are doing and how tight you need to hold them closed to keep saliva in.
- Close your lips as tightly as possible and hold for a count of 4, relax, then repeat 5 times.
- Smack your lips together as if puffing on a pipe.
- Stretch your lips in a wide smile, hold for a count of 4 and relax.
In addition, you can try aids to help you to remember to swallow, for example a timed bleeper brooch that uses sound to prompt you to swallow. Your speech and language therapist may also be able to help.
Find out more about saliva control.
Some people with Parkinson’s may have difficulty controlling their dentures because of the following:
- problems controlling facial muscles
- loss of muscle tone
- dry mouth
- pooling of saliva
- poorly designed dentures
- old and very worn dentures
- loose dentures that rub parts of the mouth and cause blisters or ulcers. They may also make it difficult to eat and can make speech worse.
Ask your dentist to check your dentures if you’re having problems controlling them – they can suggest ways to improve control.
Visiting the dentist
It is important to make sure that any dental problems you may have are dealt with in their early stages. Regular visits to a dentist will help identify and treat any problems quickly, and prevent them from getting worse.
How often you should visit your dentist depends on your individual needs, but as a general rule, you should consider visiting every 6 months (or earlier if you discover any new problem). Your dentist will advise you on how often you need to have a check-up.
Ask your dentist for advice on cleaning techniques or aids and what kind of toothbrush may be best for you to use. A dentist can also advise you on prevention of oral problems.
If you are unable to go to your dentist, ask if home visits may be possible. Many dentists will do this, but if they cannot they can either refer you onto a colleague who does, or give you information on where to seek help.
Will my Parkinson’s mean I need to see a specialist dentist?
It’s important to tell your dentist that you have Parkinson’s and how it can affect you.
Most dentists will be able to treat people in the early stages of Parkinson’s and many will be able to treat those in the more advanced stages of the condition.
If your dentist feels you need specialist care, they will refer you to a colleague on the General Dental Council’s ‘special care’ register.
You may find it helpful to tell your dentist if you think you may have physical difficulties during your appointments because of your symptoms.
Tips for people with natural teeth
It is important to clean all tooth surfaces, especially the area where the tooth leaves the gum. Don’t forget to clean both sides of your teeth as well as the biting surface.
You should use whichever technique you find easiest. Your dentist or hygienist may show you some aids to help you clean between your teeth.
If you find cleaning your teeth difficult or tiring, you could consider cleaning one part of your mouth in the morning and another part in the afternoon.
Your dentist may advise you on toothbrush handle adaptations which can help improve your grip. You may find it easier to use a 3-sided toothbrush or one with an angled head. A small head may also help you reach all of your teeth.
You could also consider an electric or battery-operated brush, as the extra weight may help to reduce hand and arm tremors.
If you have a carer who cleans your teeth, they may find it easier to stand behind you when brushing your teeth (dentists always clean patients’ teeth from behind). Or, if they are right-handed, they may clean your left side teeth from behind you and your right side teeth while standing in front of you.
Ask your dentist for help on choosing the best toothbrush for you. They will also be able to help you find the best way to clean your teeth and the gaps in-between.
Tips for people with dentures
If you have dentures, removing them will help you clean all surfaces more easily.
Plaque can build up on dentures, just as it does on natural teeth, causing irritation to the skin on the roof of your mouth, cheeks and gums. It may help you to do the following things.
- Always clean dentures over a sink full of water. That way, if you accidentally drop them, you can avoid breaking them.
- Soak your dentures overnight in water and then brush them gently under water.
- Never use toothpaste on dentures because it’s too abrasive – it’s similar to cleaning plastic with a Brillo pad. Denture pastes are available.
- Cleaning your dentures with a nailbrush and soap and water has been shown to be as effective as using commercial denture pastes or soaking solutions.
- If you do use a soaking solution for cleaning your dentures, follow the instructions carefully. Leaving dentures in the solution for too long can damage the plastic. Also make sure that the solution is not too hot, as heat can damage the denture plastic. Avoid using a soaking solution if you have metal dentures.
- Do not use bleach.
- If you find persistent stains, ask your dentist to remove them. It is vital that you get advice from a dentist about any specific problems.