June 24, 2013
by Kahaliah Richards
Parkinson’s is one of those growing issues in an aging community. The incidence of this disease rises from 17.4 per 100,000 between ages 50 and 59 to 93.1 in 100,000 between ages 70 and 79. Unlike other neurodegenerative diseases such as Alzheimers, Parkinson’s patients remain in the community for a long period. The typical onset of Parkinson’s disease is insidious, with peak age at 55-65 years. It progresses slowly with a mean duration of fifteen years. Many Parkinson’s patients show little disability for twenty years. Others may be severely disabled after ten years.
Chances are most dental practices have at least one Parkinson’s patient, and will have more in the foreseeable future. And strategically, there is an even greater chance that one of your older adult patients knows of, or provides care to someone with Parkinson’s.
A recent study in Germanyfound Parkinson’s patients at the local hospital had significantly more oral disease and a significantly lower frequency of tooth brushing and level of salivary flow than healthy older adults (Table 1).
Parkinson’s patients recruited from in-patients at the local hospital
-Mean age 66 years-
-Mean age 71 years-
2.90 ± 6.64
0.67 ± 2.04
6.97 ± 8.34
2.12 ± 2.73
17.38 ± 31.06
3.65 ± 4.96
19.70 ± 36.52
1.69 ± 0.83
2.08 ± 0.80
2.69 ± 0.94
3.56 ± 1.11
1.94 ± 1.49
1.21 ± 0.60
So how do we best manage the professional dental care of these patients? A recent study on the appropriate hygiene protocols for Parkinson’s patients, published in the International Journal of Dental Hygiene, recommended some simple adjustments in appointment scheduling, patient communication, and handling of the patient in the dental chair.
But is this sufficient given the pronounced risks to oral health reported in Table 1?
The reality is that these patients are very sick and need more aggressive prevention not just encouragement, empathy and accommodation.
How far can we go in delivering more prevention? Let’s look at the Prevora data from controlled clinical trials. In patients with very poor oral hygiene and with 3 cavities at the start of the treatment plan, this new coating reduced more cavities by 70% versus no treatment over one year.
And so what if we offer more preventive care to these patients? Start with this premise: you are a caregiver of a Parkinson’s patient. Accordingly, you are very attentive to any healthcare services which might be helpful to forestalling the decline of your patient. So you notice the following advertisement in the community newspaper. What would you do? And how would you adjust the purchase of your own dental services?
Patient surveys show that more than 6 out of 10 adults are interested in reading about more preventive care offered by the Partners in Prevention. I expect the caregivers of Parkinson’s patients are even more interested.
Sourced: Ross Perry
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