Dental Health

Maintaining dental health is important for people with Parkinson’s disease (PD), as symptoms can complicate dental care. People living with PD can face serious consequences from oral ailments. Quickly addressing dental difficulties can help you continue to live well.

Dental Risks Related to Parkinson’s

Knowing about these PD-related dental challenges can help prevent future complications.

Parkinson’s can alter face and tongue muscle function, affecting speech and chewing. Missing teeth can further hinder those abilities and may contribute to depression and unhealthy dietary adjustments.
Swallowing problems can accompany Parkinson’s. Healthy teeth allow less labored and more effective chewing. Poorly chewed food can increase the risk of choking and aspiration, which can contribute to life-threatening pneumonia.
Inflamed gums can signal periodontal disease, which destroys the bone supporting teeth. A cavity is a breeding ground for bacteria that can easily infiltrate the bloodstream and harm other parts of the body.
Infected teeth and gums can harbor bacteria that may infect devices, such as deep brain stimulation electrodes, prosthetic hips and knees, vascular stents and grafts.
PD-related rigidity, tremor and dyskinesia can make it hard to brush one’s teeth. These symptoms can also cause cracked teeth, tooth wear, changes in the fit and wear of dentures and tooth grinding.
Symptoms such as fatigue, anxiety and tremor can make the commute to appointments, sitting still in the dentist’s chair or opening the mouth wide challenging.
Too much saliva can lead to a fungal infection at the corners of the mouth. By contrast, too little saliva or dry mouth increases the risk of cavities.

Immune-Suppressing Medications

A suppressed immune system can allow the easy spread of bacterial infections. Some people with Parkinson’s take immune-suppressing medications for unrelated diseases, such as rheumatoid arthritis. Others take clozapine for PD-related psychosis. These medicines can significantly reduce white blood cells, a natural defense against infections, increasing the risk for bacteria-causing dental diseases to spread elsewhere.

If you take a medicine with a warning to tell your doctor about infections, make sure to report cavities, loose teeth or inflamed gums.

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Tips for Preventing Dental Problems

Consistent dental maintenance helps prevent cavities and gum disease, but Parkinson’s movement symptoms can sometimes interfere with maintaining oral hygiene.

- Use a toothbrush with a large-handled grip and soft bristles. A small brush head reaches the corners better. To make the toothbrush easier to grasp, place the handle inside a bike handlebar grip or tennis ball or use an electric toothbrush.
- Aim to brush after every meal for two minutes, also brushing the tongue. It is best to brush one-handed, using the stronger side of the body. If it is not possible to brush after a meal, simply rinsing the mouth with water will help.
- Floss. This may mean getting help from a caregiver. For fluoride rinses, if swishing and spitting are difficult, the dentist may recommend a brush or sponge applicator. Antimicrobial mouth rinses can also be applied with a brush.
- Waterpiks or pre-threaded flossing aids may be also helpful options for some.
- Remove dentures after each meal, brush and rinse them.
- Brush or clean them in a solution at night.
- Handle, insert or remove dentures over a soft surface or water-filled sink so they will not break if dropped.
- Suck on sugar-free hard candy or use artificial saliva substitutes to help regulate saliva production. Saliva aids denture retention.
- Discuss the benefits of implants with your dentist.
- Avoid alcohol, tobacco, spicy and acidic foods.
- Tell your dental office of your PD symptoms. This will help the dentist and the staff provide better treatment.
- Schedule wisely. Plan short dental appointments for the time of day your symptoms are most effectively controlled.
- Give the dentist the details of your overall health. Someone on staff should record vital signs upon arrival.
- Tell the dentist if you are taking monoamine oxidase-B (MAO-B) inhibitors (rasagiline and selegiline), as these may interact with anesthetics.
- Consider replacing old fillings, crowns and bridges and ill-fitting dentures or mouth guards during the early stages of PD. Dental visits may become more difficult as PD progresses.

Costs and Resources

The best way to control the cost of dental care is to prevent problems from developing. Regular care can help.

Some commercial health plans have a dental benefit.
Medicare does not cover dental care, although some Medicare Advantage plans offer a limited benefit.
Dental coverage for adult Medicaid recipients varies by state.
Most Federally Qualified Health Centers have a dental department. Fees are adjusted based on income for those who qualify.
Free dental care is available in some areas. The Donated Dental Services program is offered through the nonprofit Dental Lifeline Network.

Portions of content provided by the Dental Lifeline Network.

Page reviewed by Dr. Bhavana Patel, Movement Disorders Neurologist at the University of Florida, a Parkinson’s Foundation Center of Excellence.