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The dentist has a large role in geriatric health care for the ever increasing elder population with associated physical and neurological disorders. The Parkinson disease is progressive neurological disorder with resting tremor, bradykinesia, akinesia, and postural instability. The psychological components of disease include depression, anxiety, and...
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... Conventional removable prosthetic restorations (full dentures and partial dentures) can improve masticatory performance and quality of life of the patient with PD. 35 However, in PD xerostomia and thick saliva, mobility problems (decreased muscle control and involuntary movements), weight loss as well as depression, mental decline and apathy lead to problems in the successful construction (since there are difficulties in every stage of the restorative treatment, such as impressions etc.), retention and use of the dentures (4,7,36,37). Good knowledge and strict application of the construction protocols of full dentures are required, as well as various modifications, such as merging of stages and less visits, use of fast setting impression materials, the double impression technique (use of putty-light/wash material at the same time) with a polyvinylsiloxane impression material to reduce working time and preventing fatigue of the patient. ...
... Good knowledge and strict application of the construction protocols of full dentures are required, as well as various modifications, such as merging of stages and less visits, use of fast setting impression materials, the double impression technique (use of putty-light/wash material at the same time) with a polyvinylsiloxane impression material to reduce working time and preventing fatigue of the patient. Teeth without anatomical and/or flat cusps are selected in order not to displace the full denture from the atypical moves of the lower jaw (36,(38)(39)(40). ...
... After the construction of the restoration, the patient is encouraged to saturate continuously his mouth with water throughout the day, to use artificial saliva as well as retention paste for better retention, to remove the denture during night and to enroll in a frequent recall program (eg every 3 months) to re-evaluate and timely correct the full denture (36,38). Fixed restorations with dental bridges or dental implants can be considered wherever possible (2). ...
Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. This disease affects about 1 in 1000 people in the general population and 1% of the over 60 age group. The main features of the disease are: resting tremor, bradykinesia, postural instability, muscle rigidity and inexpressible face (mask-like face). People with PD face a series of pathological manifestations from the oromaxillofacial region related to the disease, while some of the drugs used to treat PD also lead to adverse effects from the oral cavity. Purpose: The dentist should be able to recognize the basic signs and symptoms of the disease, its basic oral manifestations and the basic dental management protocols of patients with PD. This review aims to contribute in this direction. Method: In pubmed database we searched with keywords “dental and Parkinson’s disease”, “Parkinson disease and dental management”, ‘Parkinson and periodontal’, “oral hygiene and Parkinson disease’, “periodontitis and Parkinson’s disease”. We concluded that 141 papers were to be used in our review. We also used Little’s and Scully’s books on the medically compromised patient, as well as Dougall’s series of articles for disabled patients. Last, we used few website links of official dental sites. Conclusion: PD patients may suffer from a multitude of pathological manifestations from the oral-maxillofacial area, while they need special dental management due to motor, mental and autonomic neural system disorders. The insufficient experience and training of the majority of dentists in treating patients with PD is given. The dental community in collaboration with the medical community and the State is important to contribute to the improvement of the oral health of PD patients, by educating patients and dentists.
... Patients who have systemic diseases like Parkinson's, dementia, and physical frailty are considered the most at-risk patients. The prosthodontist has to understand that the adaptability of elderly denture wearers is also influenced by their neuromuscular coordination, the health of the supporting tissues, and their desire to learn new skills [4,5]. ...
Background: Digital technology has been introduced in prosthodontics, and it has been widely used in denture duplication instead of a conventional denture duplication technique. However, research comparing different denture duplication techniques and how they affect the fitting accuracy of the denture base is scarce. Objectives: The aim was to assess the impact of duplication techniques on the accuracy of the fitting surface of computer-aided design and manufacturing (CAD-CAM) milled, 3D-printed, and injection-molded complete denture bases (CDBs). Methodology: This study involved fabricating a mandibular complete denture base with three marked dimples as reference marks (A, B, and C at the incisive papilla, right molar, and left molar areas) using a conventional compression molded technique. This denture was then scanned to generate a standard tessellation language (STL) file; after that, it was duplicated using three different techniques (milling, 3D printing, and injection molding) and five denture base resin materials—two milled CAD-CAM materials (AvaDent and IvoBase), two 3D-printed materials (NextDent and HARZ Labs), and one injection-molded material (iFlextm). Based on the denture base type, the study divided them into five groups (each with n = 10). An evaluation of duplication accuracy was conducted on the fitting surface of each complete denture base (CDB) using two assessment methods. The first method was a two-dimensional evaluation, which entailed linear measurements of the distances (A–B, A–C, and B–C) between reference points on both the scanned reference mandibular denture and the duplicated dentures. Additionally, a three-dimensional superimposition technique was employed, involving the overlay of the STL files of the dentures onto the reference denture’s STL file. The collected data underwent statistical analysis using a one-way analysis of variance and Tukey’s pairwise post hoc tests. Results: Both evaluation techniques showed significant differences in fitting surface accuracy between the tested CDBs (p ˂ 0.001), as indicated by one-way ANOVA. In addition, the milled CDBs (AvaDent and IvoBase) had significantly higher fitting surface accuracy than the other groups (p ˂ 0.001) and were followed by 3D-printed CDBs (NextDent and HARZ Labs), while the injection-molded (iFlextm) CDBs had the lowest accuracy (p ˂ 0.001). Conclusions: The duplication technique of complete dentures using a CAD-CAM milling system produced superior fitting surface accuracy compared to the 3D-printing and injection-molded techniques.
... Retention of denture in these patients is further compromised due to thick ropy consistency of saliva, dry mouth condition, and decreased muscles tone [4]. The psychological problems like depression, slowness and cognitive problems further jeopardize the successful fabrication of complete denture [5]. This case report describes the complete denture rehabilitation strategy and procedure involved in a patient with Parkinson's disease. ...
Parkinson’s disease is mostly seen in adults in their late middle or old age. It presents with major four cardinal signs -resting tremor, bradykinesia, akinesia, and postural instability. The patient affected with PD shows uncontrolled movements of the body along with stiffness of muscles. Tremors and marked rigidity in orofacial musculature can make dental treatments more challenging. The psychological symptoms like depression, cognitive problems may further affect the successful fabrication of prosthesis. This case report describes the complete denture rehabilitation strategies and procedures involved in a patient with Parkinson’s disease.
... The aged community is rapidly growing, and their dental complications are likewise increasing. 1 Many factors can complicate the treatment plan and/ or fabrication of a complete denture prosthesis. These problems may arise following the insertion of complete dentures and, if not well handled, they may lead to serious oral conditions that could result in the patient being unable to tolerate dentures. ...
... A poorly fitted prosthesis can lead to complications such as pain, discomfort with mastication, and speech, in addition to tissue abuse. 2 One of the most common tissue reactions to a persistently poorly fitted denture is the occurrence of tissue hyperplasia along the denture borders. 1 Denture induced hyperplasia (DIH) is tumor-like hyperplasia of fibrous connective tissue affecting the soft tissues of the vestibular sulcus produced by poorly adapted dentures. 3 Complete denture fabrication in such clinically compromised conditions is a challenging task for the dentist. 1 DIH can be treated conservatively or by surgical excision. ...
Introduction: The objective of a complete denture prosthesis is restoring aesthetics, comfort, and function by the replacement of missing dental and alveolar structures employing a stable prosthesis. Case Report: Many conditions can complicate the treatment plan and fabrication of a complete denture prosthesis. Complete denture fabrication in clinically compromised conditions is a challenging task for the dentist. In this clinical report, we present comprehensive management of a patient with denture-induced hyperplasia, flabby ridge, and severely resorbed edentulous ridge. The three-part strategy for management of the above-mentioned challenges can provide high-quality complete dentures, based on recognized prosthodontic principles. This first part will discuss the management of denture induced hyperplasia by elimination of the inflammation and excision of the lesion. Part two will cover management of the flabby ridge using a modified window technique for the impression of maxillary flabby tissues for an improved and controlled application of the impression material that is usually obtainable in dental practice. Part three highlights the rehabilitation procedure of the resorbed mandibular ridge using a functional impression technique with minimum soft tissue displacement and neutral zone arrangement of teeth to improve stability of the denture. Conclusion: rehabilitation of a patient with denture induced hyperplasia, flabby ridge, and severely resorbed edentulous ridges was successful.
... Higher number of dental caries and higher tooth loss frequency is seen with patients with Parkinson's disease than in the control group 1 . The number of Parkinson's patients visiting dental clinics to be treated with complete dentures is increasing 11 . Previous report showed that the number of tooth loss was positively correlated with a higher risk of development of newly onset Parkinson's disease in a longitudinal study setting 12 . ...
... Previous report showed that the number of tooth loss was positively correlated with a higher risk of development of newly onset Parkinson's disease in a longitudinal study setting 12 . Increased susceptibility to periodontitis in Parkinson's disease is reported in the individuals with Parkinson's disease 11 www.nature.com/scientificreports/ significant differences were observed between patients with Parkinson's disease and a control group in probing depth, bleeding on probing, gingival index, and plaque index 13 . ...
... People with Parkinson's disease pose a challenge to dentists because the degenerative disease causes problems in patients accessing dental care and maintaining adequate oral health 38 . It has been widely shown that the psychological components of Parkinson's disease include cognitive deficiency and that there is a great need to encourage dental plaque control 1,9,11,13 . Increased cooperation from dentists and physicians is needed to ensure optimal screening, treatment, and prevention of periodontitis and Parkinson's disease 22 . ...
The objective of this study was to examine the association between periodontitis and risk of incident Parkinson’s disease using large-scale cohort data on the entire population of South Korea. Health checkup data from 6,856,180 participants aged 40 and older were provided by the National Health Insurance Service of South Korea between January 1, 2009, and December 31, 2009, and the data were followed until December 31, 2017. The hazard ratio (HR) of Parkinson’s disease and 95% confidence interval (CI) were estimated using a Cox proportional hazards model adjusted for potential confounders. The incidence probability of Parkinson’s disease was positively correlated with the presence of periodontitis. The HR of Parkinson’s disease for the participants without the need of further dentist visits was 0.96 (95% CI 0.921–1.002); the HR of Parkinson’s disease increased to 1.142 (95% CI 1.094–1.193) for the individuals who needed further dentist visits. Compared to individuals without periodontitis and without metabolic syndrome, the HR of incident Parkinson’s disease gradually increased for individuals with periodontitis, with metabolic syndrome, and with both periodontitis and metabolic syndrome. People with periodontitis and metabolic syndrome had the highest HR of incident Parkinson’s disease, at 1.167 (95% CI 1.118–1.219). In conclusion, a weak association between periodontitis and Parkinson’s disease was suggested after adjusting for confounding factors from the population-based large-scale cohort of the entire South Korean population.
... 2,[16][17][18] But this contrasts with other authors, who suggested LGO or MPO would be ideal for patients having parafunctional habits, when complete denture opposes a removable partial denture and in uncontrolled diabetes. 4,19,20 It has been further emphasized by Haralur et al that MPO should be preferred in patients with severe neuromuscular disorders and in patient with poor muscular control as it accommodates for irregular mandibular movement. 21 Moreover, Rangarajan et al believed that there is no balancing contact on non-working side during mastication hence the forces distributed on both sides are uneven 4 . ...
... 6,22 The principles of teeth set-up in LGO, according to various authors includes placing the maxillary lingual cusps in articulation with the central fossa of the mandibular teeth, with the buccal cusps kept out of occlusion. 4,19,20 In addition, it offers multiple advantages that include cross-arch stabilization and improved patient comfort, as only lingual cusps are kept in contact which reduces the potentially damaging lateral forces. 2 This scheme also allows the vertical forces to be centered on the mandibular ridge, hence, providing improved denture stability and help maintains soft and hard tissues. 9,15 According to resources LGO has better masticatory efficiency, improved patient comfort and increased chewing efficiency when compared to BBO. 23 At the same time researchers found that patients preferred it due to increased masticatory efficiency and improved esthetic in comparison to MPO. 24 LGO. ...
Objectives: To assess the concepts of complete denture occlusion among dental fraternity. Study Design And Setting: Cross-sectional study conducted at various dental hospitals and institutes of Karachi, for a period of six months, from 1st June’2019 to 30th November’2019 Methodology: Total 849 dental practitioners who are currently practising were included. A well-structured and validated questionnaire was used for data collection. SPSS version 25 was used. Results: Bilateral balanced occlusion was an ideal occlusion by majority subjects i.e, 530(62.4%) in patients with wellformed ridges, followed by 464(54.7%) candidates with skeletal class 1, total 376(44.3%) chose it with uncontrolled diabetes mellitus, 365(43%) in single complete denture cases, 339(39.9%) with increased inter-arch space, 298(35.1%) with parafunction habits, 296(34.9%) in patients with history of neuromuscular disorder and 271(31.9%) where a complete denture opposes a removable partial denture. Furthermore, Lingualized occlusion was preferred by 341(40.25%) participants for patients with skeletal class 3. Total 316(37.2%) candidates chose it for patients with displaceable supporting tissue followed by 264(31.1%) who chose it for skeletal 2 and 260(30.6%) for cases of highly resorbed ridges. Lastly, 311(36.6%) chose canine guided occlusion with highly resorbed ridges accompanied by high aesthetic demand A significant difference between education level and knowledge of occlusal schemes was also found. Chi-square (73.87), df 6, p-value =0.000. Conclusion: Dental practitioners lack adequate knowledge of occlusal schemes in terms of prescription in complete denture patients. A significant difference between the education level and knowledge of occlusal schemes was found. Therefore, awareness of various occlusal schemes should be increased at undergraduate level.
... Magnets can also be used for easy placement of the dentures. [20][21][22] For removable partial dentures, the major connectors of smaller design should be avoided to prevent the risk of aspiration and choking. Flexible removable partial dentures can be used to obtain good retention and stability.Due to the absence of the required stable movement for insertion of a prosthesis precision attachments aren't advocated in these patients. ...
Aim: The present paper aims to highlights the prosthodontic management of patients with some common systemic disorders. Background: The increase in life expectancy, more desire for improved standard of life and increased importance to esthetics has resulted in many ambulatory patients with systemic health disorders walking into the dental clinics. Results: Systemic diseases can have a local manifestation with no apparent systemic symptoms or may present with both local as well as systemic reactions. Accordingly, the assessment of medical risks and its relationship to oral health becomes a major area of concern. Conclusion: Dental specialists have a responsibility to contribute to overall health by subsequent maintenance of the oral health. Clinical significance: As certain systemic disorders may produce a pernicious effect on the oral health, it is incumbent for the dental specialists to be aware of the several systemic conditions and also to consider them in the treatment plan.
... For dental clinicians, PD patients are a challenge, as PD symptoms complicate treatment plans, execution, and outcome [1, 18,86,108,109]. Akinesia, hypokinesia, bradykinesia, gait disorders, orthostatic hypotension, postural deformities [103,110], and muscle related problems (spasms, rigidity, tremors, and dyskinesia) cause difficulties in getting in and out of the dental chair and staying still during dental treatment [18,86]. Because of motor and nonmotor fluctuations, patients' behavior can change from minute to minute and may require stopping dental procedures [18,83], while anxiety and stress worsen motor symptoms [111]. ...
... Because of motor and nonmotor fluctuations, patients' behavior can change from minute to minute and may require stopping dental procedures [18,83], while anxiety and stress worsen motor symptoms [111]. Muscle rigidity, poor muscle control (lips, jaw, tongue), oral festination [57], facial dystonia [56], orolingual tremor [34,35,[112][113][114], dyskinesia (flycatcher tongue), impaired neck and head posture, or dysphagia (saliva accumulation) lead to difficulties in dental examination and oral rehabilitation [30,48,83,102,108,109], and can even compel the use of general anesthesia [102]. ...
... The supine position during dental procedures may increase the risk of aspiration and ingestion of dental instruments, adding to the already existing risk factors related to PD [26,115]. Fatigue, urinary [116] and bowel issues may require treatment cessation, preventing extensive treatment plans which require extended chair time [18,83,86,106,108]. ...
... 19 However, a significant number of patients with PD still require complete dentures (CDs) 20 and/or removable partial dentures (RPDs) 21 for esthetic, psychological, and masticatory rehabilitation. 22 The success of masticatory rehabilitation with CDs in patients with PD largely depends on their ability to control the prosthesis with their oral musculature and on the presence of an adequate quantity and quality of saliva. 19 For RPDs, the outcome depends on an accurate indication and design and on appropriate follow-up with the patient. ...
Statement of problem:
Parkinson disease (PD) symptoms, such as muscle rigidity, tremors in the lips and tongue, and involuntary mandibular movements, may cause oral health-related problems, mastication difficulties, and denture discomfort because of the difficulty in controlling a prosthesis with the oral musculature.
Purpose:
The purpose of this observational clinical study was to evaluate the influence of oral rehabilitation with a removable prosthesis on oral health-related quality of life (OHRQoL) and masticatory efficiency (ME) in elders with PD.
Material and methods:
Thirty-four elders with PD (n=17, mean age 69.4 ±4.7 years) or without PD (n=17, mean age 70.7 ±4.7 years) were recruited. All participants first underwent OHRQoL and ME evaluations. Two months after the insertion of new removable prostheses, the participants were reassessed. The OHRQoL was measured with the Oral Health Impact Profile (OHIP-49). ME was evaluated by determining the percentage weight of the comminuted silicone-based artificial material that passed through a 2.8 mm sieve. For each group, data were compared between baseline and after insertion of new removable prostheses by paired t test or Wilcoxon sign test/signed-rank test. Group differences were assessed at each time point by t test (α=.05).
Results:
After the insertion of removable prostheses, elders with PD showed improved OHRQoL and ME. Controls also showed improvements on both measures after insertion of removable prostheses. At baseline, elders with PD had lower OHRQoL and ME compared with the controls (P<.05). After removable prosthesis insertion, the elders with PD continued to show lower ME values than the controls, but their OHRQoL was similar.
Conclusions:
Oral rehabilitation with new removable dental prostheses improved the OHRQoL and ME in elders with and without PD, although ME did not reach control levels in elders with PD.
... It is genetically linked disease, with the mean age of onset around 57 years. 3 Parkinson's disease is divided into mild/early, moderate, advanced and severe stages according to Hoehn and Yahr. 4 In stage 1 only one side of the body is affected, usually with minimal or no functional impairment; and in stage 2 both sides of the body are affected, but posture and balance remain normal; in stage 3 both sides of the body are affected and there is mild imbalance when standing or walking; in stage 4 both sides of the body are affected and there is disabling instability while standing or walking, i.e. the person requires substantial help and cannot live alone; and in stage 5 fully developed disease is present, i.e. the person is often cachectic and restricted to bed or a wheelchair unless aided. ...
... The denture retention and control in PD patients is further compromised due to thick ropy saliva, xerostomia, and rigid muscles. 3 ...
Parkinson's disease is seen in adults in their late middle or old age. It has four cardinal signs-resting tremor, bradykinesia, akinesia, and postural instability. Patient's gait is often slow, shuffling with a stooped posture and they tend to walk faster with shorter steps. The affected patients have uncontrolled movements of the body along with stiffness of muscles. Tremors in orofacial musculature caused by Parkinson's disease can make dental treatments, a challenge. The psychological component like depression, cognitive problems, and apathy further jeopardise the successful fabrication and utilisation of complete denture. This case series presents completely edentulous patients with Parkinson's disease successfully treated with complete dentures in a sympathetic and caring approach. Some modification of techniques and materials were adopted to suit the special situations.
