Oral Health Disorders in Parkinson’s Disease: More than Meets the Eye

Abstract

Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.

Facts and controversies regarding oral health in Parkinson's disease: A case-control study in Spanish patients

“…The oral health of these patients has been previously analysed but the results are heterogeneous ( 3 , 7 ). There is not a consensus on the most prevalent orofacial pathologies in patients with PD ( 4 ). Therefore, a thorough discussion, focussing only on the studies that performed a complete oral clinical examination, is needed ( 6 , 8 - 20 ).…”

“…The frequent appearance of dysphagia (80% of patients with PD) highlights its role as a progressive motor nerve impairment indicator ( 28 ). PD patients also reported a greater difficulty in performing regular chewing ( 4 ), probably due to motor impairment.…”

“…These patients also present non-motor symptoms including cognitive impairment and autonomic and psychiatric disorders ( 2 ). The oral pathology of patients with PD has previously been analysed but with limited and, in many cases, controversial results, due to poor methodological design such as absence of a control group, little collection of data with questionnaires and lack of professional oral examination ( 3 , 4 ). To date, some cross-sectional case-control studies have been conducted, but none on Spanish PD patients.…”

Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

“…Dysphagia severity has also been identified as a predictive factor for poor outcomes in patients with late-stage PD (Fabbri et al, 2019). A recent review has highlighted the considerable direct and indirect impact that PD can have on oral health and hygiene and the importance of considering oral health as a part of PD management since it is 10.3389/fnagi.2022.979826 a critical component of overall health, well-being and quality of life for patients (Auffret et al, 2021). Oral health has also been shown to be a predictive factor for the risk of aspiration pneumonia in PD (Noguchi et al, 2018).…”

Self-reported periodontitis and C-reactive protein in Parkinson’s disease: a cross-sectional study of two American cohorts

“…In the advanced stages, beyond the debilitating and interfering impact of motor and non-motor symptoms (NMS) on everyday-life activities, PD also has a major detrimental effect on patients’ overall quality of life 5 , 8 . Oral health is no exception and may be deteriorated in PD resulting from impaired oral hygiene and lack of oral care 9 – 17 .…”