Oral & Health Care Basics: Neuromuscular

Oral & Health Care Basics: Neuromuscular
4/26/2005
Colgate World of Care

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 HuntingtonÌs 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 HuntingtonÌs 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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