Surgical Treatments

Individuals who are experiencing advanced PD symptoms that significantly interfere with activities of daily living and cannot be adequately controlled with medication are candidates for surgical interventions. Two options are available; selective “destruction of target cells” and selective “stimulation of target cells.” Both options take place in areas of the brain that control movement (thalamus, internal globus pallidus, and/or subthalamic nucleus). Pallidotomy, thalamotomy, and subthalamotomy are surgical procedures that destruct target cells by inserting a heated probe into specific areas of the brain to destroy tissue. Destructive procedures are irreversible and very seldom used. Selective stimulation of target cells is achieved by a relatively new surgical procedure called “deep brain stimulation” (DBS). Selective stimulation requires two surgeries. The first surgery, guided by a computerized guidance system or image guided intervention, places lead(s) in specific areas of the brain that control movement. A small hole is placed in the skull for the procedure. The second surgery places a neurostimulator (similar to a pacemaker) or implantable pulse generator, under the skin near the collarbone. This device contains a battery and computer which generates electrical pulses. The two objects are connected by a thin insulated wire. Together they stimulate specific areas of the brain. Deep brain stimulation is completely reversible. Stimulation of target cells can be modified after surgery to achieve optimal results. Dental providers should not use handpieces, ultrasonic scalers, or dental instruments near the patient’s neurostimulator or implantable pulse generator, connecting wire, or implant site (on the head) because this equipment could adversely affect the DBS system. Additionally dental providers should not deliver heat to tissue using diathermy (therapeutic ultrasound) because the diathermy’s energy can be emitted through the system and cause tissue damage resulting in severe injury or death.54,55 Dental radiographs can be taken as needed.1,52,53