I recently had a visit to the dentist. It is never a pleasure and as the disease progresses it becomes more and more difficult.
My dentist had MSA in the family, so he knows what to look out for.
Regular visits to the dentist are important for all of us. For people with multisystem atrophy, dental care is especially important because the health of the mouth, teeth and jaws can be affected by the disease and make dental care more difficult. Poor dental care can affect nutrition and increase the risk for stroke, cognitive impairment and weight loss. People of all ages with multisystem atrophy face similar challenges, but in the elderly, the problems can be particularly severe.
Because of the physical effects of multisystem atrophy, such as stiffness and tremor, nearly half of all MSA patients have difficulty with daily oral hygiene. These symptoms also make going to the dentist more difficult and uncomfortable. A weakened ability to swallow can increase the risk of choking during treatment. In addition, people with MSA who have been taking medications such as levodopa for several years may begin to develop dyskinesia (involuntary movements) that can affect the jaw causing teeth grinding. This can cause problems during dental exams and at home. A weakened ability to swallow may increase the risk of aspiration (swallowing) during treatment.
Difficulty swallowing saliva can lead to a fungal infection in the corners of the mouth, which is easily treated. On the other hand, people with MSA may suffer from dry mouth, which increases the risk of tooth decay and can lead to difficulty chewing and with dentures. In fact, MSA patients clean their dentures less frequently than others in their age group.
Non-motor symptoms such as apathy, depression and forgetfulness may cause people with MSA to pay less attention to their daily dental care. Other behavioral changes may affect diet. People with MSA require a higher caloric intake than people without, but in turn, some people have less appetite. Combined with poor dental hygiene, this often leads to a tendency to devour nutrient-dense foods like vegetables without chewing. Some people also develop a preference for sweets, putting them at higher risk for tooth decay.
People who suffer from cognitive changes are also more likely to miss dental appointments and less likely to report toothaches to their care partners or dentist, leaving problems untreated for too long.
Try using a toothbrush with a large handle and soft bristles. A smaller brush head will reach the corners better. To get a better grip on the toothbrush, it is recommended to put the handle in a tennis ball.
Another recommended option is to use an electric toothbrush, which uses fine, repetitive movements to best protect the teeth.
Brush for two minutes after each meal, and brush the tongue as well. To be thorough, you should be consistent when brushing. Start on one surface and go from right to left or vice versa. If it is not possible to brush after a meal, it helps to rinse your mouth with water. Flossing is important, but may require the help of a care partner.
Mouthwashes are not recommended for MSA because of the risk of choking and swallowing disturbances. A fluoridated toothpaste or rinse may be used. Fluoride helps increase the teeth’s resistance to the harmful effects of bacteria.
If you wear dentures, take them out after each meal and then brush and rinse them.
There are several ways to optimize dental visits, starting with strategic scheduling. Schedule visits when wait times are shorter. Take levodopa 60 to 90 minutes before the dental visit to have the best comfort you can.
Caution with Surgery/Anesthesia. If dental/surgical procedures are planned for an MSA patient, local anesthesia should be preferred if possible. However, some local anesthetics contain epinephrine, which can adversely affect blood pressure. Make sure the dentist or surgeon and the anesthesiologist know that MSA affects the autonomic nervous system. The MSA patient must be well hydrated via IV before and during surgery to maintain a safe blood pressure. The recovery process should also be attended.
It is helpful to inform the practice about MSA and your symptoms when you make an appointment. It is difficult and dangerous for dentists working with drills and other sharp instruments to perform procedures on a moving target, which can be caused by uncontrolled tremors.
It is also challenging for dentists when people have difficulty sitting in a dental chair or holding their mouth open for extended periods of time, or when there is a risk of choking or swallowing if they have difficulty swallowing.
There should be someone in the office to take vital signs upon arrival. Inform the dentist if you are taking an MA0 inhibitor, as there may be interactions with anesthetics.
As the disease progresses, the time period in which a person responds optimally to medications becomes shorter and shorter. For this reason, it may be helpful to schedule a series of shorter visits to the dentist’s office rather than one longer visit. Replacement of old fillings, crowns and bridges, and ill-fitting dentures should also be scheduled in the early stages of the disease. In particular, if invasive procedures such as dental rehabilitation are needed, they should be done as early as possible in the course of the disease to minimize risk. And if you’re not sure whether the risks outweigh the benefits for a particular procedure, your neurologist may be able to help.
TIPS
- Use an electric toothbrush.
- Try strategies that allow you to use the stronger side of your body.
- Try alcohol-free mouthwashes with chlorhexidine or baking soda.
- Schedule dental appointments, approximately 60-90 minutes after a levodopa dose.
- Ask that the dental chair be placed more upright to facilitate swallowing.
- Schedule multiple, shorter dental visits rather than fewer, longer visits.
- Go for checkups every 3-6 months.
- If you wear dentures, ask the dentist to check for oral cancer and assess the fit of the dentures as part of the routine visit.