Oral Self-care

It is common for patients diagnosed with PD to have impaired fine motor skills and manual dexterity.1-4 They may also experience muscle rigidity, cognitive problems, dementia, depression, and apathy.1-4,61 Collectively, this compromises their ability to perform oral self-care. Figure 6 provides a list of homecare aids that may be helpful for individuals who need help with oral self-care. It is important for dental providers to recognize that a patient’s ability to practice oral self-care can vary throughout the day and from one day to another because of the nature of PD and a patient’s response to medications.64 In addition to providing instructions on “what and how” to practice oral self-care, a patient may need help determining “when” the most optimal times are to practice oral self-care.

Figure 6. Homecare aids.
  • Prescription home fluoride (5000 parts per million)

  • Power toothbrush

  • Collis-curve toothbrush

  • Power flosser

  • Extend or enlarge toothbrush handle

  • Written instructions for caregivers

  • Artificial salivary products

  • Toothbrush dipped in Chlorhexadine

Nearly half of all people diagnosed with PD have difficulty with their daily oral self-care regimen.6 Dental providers must be cognizant that it is important for people diagnosed with PD to preserve their independence in activities of daily living whenever possible.64 Finding a balance between maintaining independence and effective oral self-care can be challenging. At times it may be necessary for dental providers to collaborate with the patient’s occupational therapist to identify adaptive techniques that are effective and allow the patient to maintain their independence.64 Dental providers should offer simple advice. Instructions should be provided in writing and explained to the caregiver as well as to the patient.7 Dental providers should suggest patients sit down to brush and floss their teeth. Sitting reduces the risk of falling and helps conserve energy. A shower or commode chair works well for this. It can also be helpful to leave the doors underneath the sink open to make room for the patient’s knees. If a patient’s shoulders tire, it may be helpful for the patient to prop his or her elbows on the vanity or sink when brushing their teeth. A mechanical toothbrush may also be beneficial.24 As PD progresses, tremors, bradykinesia, and dyskinesia may increase to a point where the patient can no longer perform his or her own oral self-care. When this happens, it is important for a family member or caretaker to be instructed on how to offer assistance.