Management of orofacial manifestations of parkinson's Disease with splint therapy: A case report

Abstract

Patients with Parkinson's Disease display a number of orofacial manifestations. These manifestations are secondary to motor and sensory deficits, resulting in bradykinesia, muscle rigidity and tremor, and difficulties with speech, swallowing, proprioception, tactile sensitivity, and hard- and soft-tissue trauma. This case describes the use of a bruxism splint which benefited a PD patient by diminishing the occurrence of orofacial pain secondary to muscle tremor and rigidity while reducing the cumulative damage to the oral structures common with the disease. The impact of therapy on sleep, speech, and swallowing difficulties is also discussed.

Behavioral and neurophysiological correlates of striatal dopamine depletion: A rodent model of Parkinson's disease

“…Swallowing impairments in PD are usually attributed to movement dysfunction of affected bulbar structures and include: lingual tremor, repetitive lingual pumping, anterior bolus leakage, slow or impaired mastication, mandible rigidity, reduced and delayed pharyngeal constrictor contraction, slow and reduced laryngeal excursion, slowing of true vocal fold closure, reduced epiglottic range of movement, reduced and delayed opening of the esophageal sphincter's, abnormal esophageal motility, and esophageal bolus redirection (Chou, Evatt, Hinson, & Kompoliti, 2007; Durham, Hodges, Henry, Geasland, & Straub, 1993; Leopold & Kagel, 1996, 1997; Nagaya, Kachi, Yamada, & Igata, 1998). These bulbar movement abnormalities may contribute to functional swallowing deficits that include: poor oral bolus control, ineffective oral transit, increased oral transit time, oral buccal residue, premature spillage of the bolus into the valleculae, delay in the execution of the swallow reflex, stasis in the valleculae or pyriforms, penetration and/or aspiration, and gastroesophageal reflux (Pitts, Bolser, Rosenbek, Troche, & Sapienza, 2008; Troche, Sapienza, & Rosenbek, 2008; Troche, Huebner, Rosenbek, Okun, & Sapienza, 2010; Troche, Okun, et al, 2010).…”

Oral Splints: the Crutches for Temporomandibular Disorders and Bruxism?

“…Introduced by Karolyi in 1901 (see Ramfjord and Ash, 1994) for the treatment of bruxism, it is striking to see the versatility of their current applications. Other than their use in the prevention of dental injuries and oral soft-tissue trauma potentially induced by bruxism, sports, cheek biting (Walker and Rogers, 1992), and electroconvulsive therapy (Minneman, 1995), oral splints of various designs have been prescribed in the management of diverse disorders including: (a) motor disorders such as Parkinson's disease (Durham et al, 1993) and oral tardive dyskinesia (Kai et al, 1994); (b) sleep disorders such as snoring (George, 1993) and sleep apnea (George, 1993;Athanasiou et al, 1994;Lowe, 1994;Yoshida, 1994;Osseiran, 1995); (c) sensitive teeth related to chronic sinusitis (Dawson, 1974); (d) various headaches, from the tension-type to migraine (Ouayle et al, 1990;Lamey and Steele, 1996); and (e) all subgroups of TMD, e.g., myofascial pain, disc displacement disorders, and the arthritides (Table 1).It is also surprising to see the wide acceptance of oral splints and their "multi-purpose usage", while little is known about the mechanisms by which they exert their effect. For the TMD, a survey of 10,000 members of the American Dental Association identified oral splints as being, by far, the treatment most commonly used by both general practitioners and dental specialists (Glass et al, 1991(Glass et al, , 1993.…”

Synaptic organization of monosynaptic connections from mesencephalic trigeminal nucleus neurons to hypoglossal motoneurons in the rat

“…Increased trigeminal proprioceptive stimulation (sensory cueing) could improve oral motor dysfunction and decrease orofacial muscle pain. This effect was noted by clinical observation (Durham et al, 1993) and supported by behavioral studies on Parkinson's disease patients (Maitra and Telage, 2002). Numerous studies have shown that proprioceptive afferents play a critical role in the perception of body orientation and visual, auditory, and vestibular coordination (Goodwin et al, 1972;Devanne and Maton, 1998;Abelew et al, 2000;Adamovich et al, 2001;Schmuckler and Fairhall, 2001;Karnath et al, 2002).…”