| Bell's Palsy
Oral Effects
Bell's palsy is a temporary paralysis of certain facial muscles. It comes on
very quickly, sometimes overnight, and usually affects only one side
of the face. Food particles are more likely to accumulate on the paralyzed
side of your mouth, so frequent and careful dental hygiene is important.
If you wear dentures, they should be cleaned daily. You may also experience
reduced saliva secretion and a loss or decrease in the sense of taste
on the paralyzed side of your mouth.
At the Dentist
If you have Bell's Palsy, visit a dental or medical specialist to see if the
cause can be identified. Causes can include herpes simplex virus 1 reactivation,
Lyme disease, herpes zoster, and certain tumors in the ear.
If possible, you should reschedule elective dental treatment until the
paralysis has disappeared. If you need to visit the dentist, your dentist
will use special retractors to control the paralyzed parts of your mouth
and tongue. If your eyelids cannot close properly, you also should see an
eye doctor. Sometimes the eye needs to be protected with lubricating eye
drops, ointment or a patch. You should wear protective eyewear during dental
treatment to keep foreign material out of your eyes.
Epilepsy
Oral Effects
If you are taking phenytoin (Dilantin) or other anti-seizure medications for
epilepsy, your gums may overgrow. This effect occurs in about half of people
taking phenytoin. Good
oral hygiene can help prevent the overgrowth or reduce its severity. Some
people with severe overgrowth will need a type of gum surgery called gingivectomy. Overgrown
gum tissue that is not treated can cause changes in the bone supporting your
teeth and may lead to tooth loss. If you stop taking the medication, your gums
should recede somewhat, but some people may still need gum surgery.
Children take phenytoin as a chewable tablet or a syrup. Both forms are
high in sugar, so parents should pay special attention to good oral hygiene.
People taking carbamazepine (Tegretol or Carbatrol) may have dry mouth,
bleeding of the gums, and osteoporosis.
At the Dentist
Routine dental treatment for people with well controlled epilepsy is no different
than for people without epilepsy. Routine use of sedation is not necessary
and doses of anti-seizure medications do not need to be increased before a
dental visit. If you have seizures frequently, you may be referred to a hospital-based
dental practice.
Your dentist should be familiar with your medical history. Tell your dentist
how often you have seizures and about any known triggers of your seizures.
Your dentist should know the medications you are taking because many drugs
can interact with anti-seizure medications and affect the way they work.
Multiple Sclerosis
Oral Effects
Because multiple sclerosis affects muscle control, it may be more difficult for
you to maintain a good oral-hygiene routine. You might want to consider toothbrushes
that are adapted to make them easier to hold, as well as other adaptive dental
care appliances.
Multiple sclerosis also may cause complete or partial paralysis of the
face. Associated nerve diseases can affect your face and mouth and cause
severe tooth, jaw, chin or lip pain or numbness. Inadequate oral hygiene
and difficulty swallowing can lead to tooth
decay and gum disease.
If you have dentures, they may become difficult or impossible to wear as
your multiple sclerosis gets worse. Small partial dentures may be dislodged
and swallowed. Larger dentures may fall out more often or simply not fit
properly anymore.
Some people with multiple sclerosis can no longer use their hands; instead,
they use their mouths for holding objects. Oral health is particularly important
for these people because if they lose their teeth, they lose this ability
as well. Special mouth-held appliances are manufactured that do not harm
the oral tissues, gums or bone.
At the Dentist
Try to keep your dental appointments to a comfortable length of time to avoid
stress, which can aggravate your multiple sclerosis. It also may be difficult
for you to sit in the dental chair throughout an appointment. If you are paraplegic
or quadriplegic, your dentist may use padding in the dentist's chair and change
your body position frequently to avoid pressure sores and pain. Your dentist
probably will have an assistant help you get in and out of the chair and assist
with dental procedures. If it is difficult or impossible for you to be moved
from your wheelchair, your dentist may be able to treat you while you are in
your wheelchair.
It may be difficult for you to hold your mouth open for long periods of
time and to control your tongue movements and swallowing. Your dentist has
special devices that can help. A bite block, or mouth prop, is made of rubber
and is placed between your teeth to keep your mouth open, reducing the stress
on your muscles. A tongue retractor keeps your tongue in one place. A rubber
dam can be stretched over your teeth to prevent you from inhaling foreign
materials or substances.
Be aware that if your dentist needs to prescribe medications with a sedating
effect, they can worsen your muscle control. Tell your dentist about all
medications you are taking, including those by injection. Some medicines
used to treat multiple sclerosis significantly affect blood cells. If you
are under active treatment, give your dentist copies of your most recent
blood tests. Also, tell your dentist how to get in touch with your doctor
so they can coordinate dental and medical treatment if needed.
Cerebral Palsy
Oral Effects
Cerebral palsy refers to a group of body movement (motor) disorders that result
from brain injury and do not worsen over time.
Children with cerebral palsy have more defects in their tooth enamel, although
the cause of this is not known. The permanent teeth of children with cerebral
palsy may come in late and be stained a greenish color.
People with cerebral palsy may experience:
- Malocclusion (upper and lower teeth that do not come together
properly)
- Severe grinding of teeth (bruxism),
which wears them down and requires repair
- Damage to front
teeth resulting from falls
- Difficulties
controlling plaque and in swallowing and chewing food, which can increase
the risk of tooth
decay and periodontal
(gum) disease
- Difficulty with oral, facial or neck muscle control, which can result
in excessive salivation or drooling
- Underdeveloped tooth structure (enamel hypoplasia)
Some people with cerebral palsy take anti-seizure medication, which can
cause gum overgrowth. Good oral hygiene can help prevent the overgrowth or
reduce its severity. Some people with severe overgrowth will need a type
of gum surgery called gingivectomy. Overgrown gum tissue that is not treated
can cause changes in the bone supporting your teeth and may lead to tooth
loss. If you stop taking the medication, your gums should recede somewhat,
but some people may still need gum surgery.
At the Dentist
If you have cerebral palsy, you may need help getting into the dental chair.
You also may need, or want, pillows or other stabilizers to keep you comfortable.
If you cannot get in and out of your wheelchair, your dentist may be able to
treat you while you are in your wheelchair. People with severe cerebral palsy
may need to be treated in a hospital.
Your dentist may have an assistant to help keep you relaxed and comfortable
during dental procedures. It may be difficult for you to hold your mouth
open for long periods of time and to control your tongue movements. Your
dentist has special devices that can help. A bite block, or mouth prop, is
made of rubber and is placed between your teeth to keep your mouth open,
reducing the stress on your muscles. A tongue retractor keeps your tongue
in one place. A rubber dam can be stretched over your teeth to prevent you
from inhaling foreign materials or substances.
Muscular Dystrophy
Oral Effects
Muscular dystrophy is a genetic disease that causes severe and progressive muscle
weakness. There are different types of muscular dystrophy, categorized by their
genetics and symptoms. In specific types of muscular dystrophy, the muscles
in the face can be affected, as well as the muscles of the head, neck and hand.
For example, people with myotonic dystrophy may have trouble chewing, moving
their lips and turning their head. Other types usually do not involve facial
muscles.
In some people with muscular dystrophy, the upper and lower teeth don't
meet properly. This can be caused by muscle weakness, and by the tongue pushing
theteeth out toward the lips. Some people with muscular dystrophy also have
problems with their jaw joints (temporomandibular
joint), which can lead to difficulty chewing, clicking of the joints,
headaches or muscle tenderness.
Many people with muscular dystrophy have trouble brushing, flossing or
rinsing. Power-assisted brushes and tools to help with flossing are available.
At the Dentist
If you have muscular dystrophy, your treatment at the dentist will depend on
the type and severity of your condition. Bring a complete list of all medications
and doses. Tell your dentist how to contact your physician. They will work
as a team to coordinate your dental and medical treatment.
Try to keep your dental appointments to a comfortable length of time, especially
if stress worsens your condition. It also may be difficult for you to sit
in the dental chair throughout an appointment. If you are paraplegic or quadriplegic,
your dentist may use padding in the treatment chair and change your body
position frequently to avoid pressure sores and pain. Your dentist may have
an assistant present to help you get in and out of the chair and assist with
dental procedures. If it is difficult or impossible for you to be moved from
your wheelchair, your dentist may be able to treat you while you are in your
wheelchair. If your condition is severe, it may be best for you to be treated
in a hospital setting.
It may be difficult for you to hold your mouth open for long periods of
time and to control your tongue movements and swallowing. Your dentist has
special devices that can help. A bite block, or mouth prop, is made of rubber
and is placed between your teeth to keep your mouth open, reducing the stress
on your muscles. A tongue retractor keeps your tongue in one place. A rubber
dam can be stretched over your teeth to prevent you from inhaling foreign
materials or substances.
Be aware that if you require any medications with sedating effects, they
can worsen your muscular control.
Parkinson's Disease
Oral Effects
Parkinson's disease mainly affects adults in middle to late life. It apparently
is caused by progressive degeneration of the brain-stem neurons, leading to
a decrease in dopamine, a chemical that transmits messages between cells. People
with Parkinson's disease have involuntary muscle tremors and stiffness.
Many people with Parkinson's disease are older adults, who may be less
likely to seek dental treatment except in an emergency. Older adults experience
other barriers to dental care, including transportation problems and chronic
diseases.
If you have dentures, they may become difficult or impossible to wear as
your disease worsens. Small partial dentures could be dislodged and swallowed.
Larger dentures may fall out more often, fracture from sudden movements,
or not fit properly anymore.
Some medications taken by people with Parkinson's disease can cause dry
mouth (xerostomia).
This can increase your risk of tooth
decay, because there is less saliva in your mouth to wash away food particles
and bacteria. If you have this condition, your dentist can prescribe a topical
fluoride treatment
or an artificial saliva solution to help protect your teeth from decay.
At the Dentist
Because anxiety can aggravate symptoms, it is important for people with Parkinson's
disease to be calm and reassured during a dental appointment. The environment
at your dentist's office should be low stress. It also helps to keep your appointments
as short as possible.
The tremors associated with Parkinson's disease can make dental treatment
challenging. Depending on the severity of your disease, you may need to have
treatment in a hospital setting or receive sedation in your dental office.
It may be difficult for you to hold your mouth open for long periods of
time and to control your tongue movements and swallowing. Your dentist has
special devices that can help. A bite block, or mouth prop, is made of rubber
and is placed between your teeth to keep your mouth open, reducing the stress
on your muscles. A tongue retractor keeps your tongue in one place. A rubber
dam can be stretched over your teeth to prevent you from inhaling foreign
materials or substances.
People taking levodopa/carbidopa (Sinemet), which is a treatment for Parkinson's
disease, should be careful when getting up from the dental chair. This medicine
can reduce blood pressure and lead to light-headedness or fainting if you
move too quickly from a lying to a sitting or standing position.
Huntington's Disease
Oral Effects
People with Huntington's disease have involuntary muscle movements, including
muscles in the face and tongue. They can have trouble swallowing as well. It
can be difficult for people with Huntington’s disease to practice good
oral hygiene. Preventive dental treatment (regular dental visits) is crucial
for people with Huntington's disease and those at risk of it. Dental care should
be thorough and frequent. If you become unable to take care of your mouth and
teeth yourself, a family member or caregiver should help you. A proper diet
is also important in reducing the risk of decay.
Good
oral hygiene is important in order to minimize infection and tooth
loss. It can be difficult for people with Huntington's disease to adapt
to dentures. The sudden and violent facial movements associated with the
disease can lead to denture fracture. Patients with Huntington’s
disease must be careful to avoid accidentally swallowing, dislodging or
ejecting dentures from the mouth.
At the Dentist
Dental treatment of patients with advanced Huntington's disease can be difficult,
because they may not be able to open their mouths very wide or sit still for
long periods. Dental appointments should be kept to a comfortable length of
time. Your dentist can use mouth props and tongue retractors to ease some of
the strain on your muscles.
Myasthenia Gravis
Oral Effects
People with myasthenia gravis may have expressionless faces because they cannot
move their facial muscles. Some people have difficulty chewing food. Their
muscles may be so tired that they cannot keep their mouths closed after eating.
They may also have weakened tongue and palate muscles.
If you have myasthenia gravis, you may not be able to keep complete dentures
in your mouth because your muscles may be too weak. Ill-fitting dentures
may make it more difficult to close your mouth and may result in dry mouth,
tongue fatigue, a tight upper lip, and difficulty speaking, chewing or swallowing.
As much as you can, choose foods that maximize dental health and reduce
the risk of decay. If weakness prevents you from regular dental care, consider
using a power-assisted brush or other aids. A family member or caregiver
can help you with dental care.
Several medications used by people with myasthenia gravis may have oral
effects. Tell your dentist about any medication you are taking.
At the Dentist
Your dental appointments should be early in the day and should be kept to a comfortable
length of time. You may find it most comfortable to receive dental care an
hour or two after taking your anticholinesterase medications. Your dentist
and physician can work as a team and talk about modifying your medication schedule
to allow you to take your medication in advance of your dental appointment.
Some people have such poor muscle control that there is concern about maintaining
proper breathing during dental procedures. Some of these people are treated
in the hospital.
During your appointment, a dental assistant may observe you and monitor
your vital signs. Your dentist may use a mouth prop, or bite block, to reduce
the strain on your jaw muscles, and may also use a tongue retractor and rubber
dam. Let your dentist know if you feel like you are tipped too far back in
the dental chair. Ask for rest periods during treatment if you think that
would help you.
Be aware that if you require medications with a sedating effect, they can
worsen your muscular control.
If you have problems keeping your teeth clean, there are modified brushes
and other appliances that can help. Your dentist or dental hygienist can
tell you about them. If you take medicines that weaken your immune system
and your ability to fight off infection, be sure your dentist is aware. It's
best to bring updated medical records to each dental appointment so your
dentist is aware of the medications you are taking and their doses.
Tell your dentist how to contact your physician. They may work together
to coordinate your medical and dental needs.
Spina Bifida
Oral Effects
People with spina bifida have no unusual dental problems. However, if your arms
or chest are paralyzed, it may be difficult for you to brush and floss without
assistance. There are many adaptive dental aids and techniques to help you
maintain good dental care and a family member or caregiver can help you.
Some people with spina bifida may take medications that cause oral side
effects (for example, gum overgrowth).
At the Dentist
Try to limit your dental appointments to a comfortable length of time. It also
may be difficult for you to sit in the dental chair throughout an appointment.
Your dentist may use padding in the treatment chair and change your body position
frequently to avoid pressure sores and pain. Your dentist will probably have
an assistant present to help you get in and out of the chair and assist with
dental procedures. If it is difficult or impossible for you to be moved from
your wheelchair, your dentist may be able to treat you while you are in your
wheelchair.
It may be difficult for you to hold your mouth open for long periods of
time and to control your tongue movements and swallowing. Your dentist has
special devices that can help. A bite block, or mouth prop, is made of rubber
and is placed between your teeth to keep your mouth open, reducing the stress
on your muscles. A tongue retractor keeps your tongue in one place. A rubber
dam can be stretched over your teeth to prevent you from inhaling foreign
materials or substances.
Infants with spina bifida are at a high risk of developing a latex allergy
because they are exposed to it during multiple medical procedures. The dentist
should ask about any allergies and avoid exposing infants to latex products.
If you have a surgically placed plastic tube or shunt, you may receive
premedication with antibiotics before any dental treatment that might introduce
bacteria into your bloodstream. Discuss these shunts with your physician
and dentist prior to treatment. Also bring a copy of any paperwork that may
explain the type of shunt. Tell your dentist about all medications you are
taking. Also. tell your dentist how to get in touch with your physician so
they can coordinate dental and medical treatment if necessary.
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