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Parkinson Disease

Parkinson Disease. 03/27/2014. By: Marlene Rhodes Amna Alramadhani Madona Guirgis. Spontaneous motor impulses is an essential facet of control linked to frontal-basal ganglia circuitry. Basal ganglia dysfunction caused by Parkinson’s disease disrupts proficiency. Sings and Symptoms:.

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Parkinson Disease

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  1. Parkinson Disease 03/27/2014 By: Marlene Rhodes AmnaAlramadhani Madona Guirgis

  2. Spontaneous motor impulses is an essential facet of control linked to frontal-basal ganglia circuitry. Basal ganglia dysfunction caused by Parkinson’s disease disrupts proficiency.

  3. Sings and Symptoms: • Tremor • Rigidity • Akinesia and Bradykinesia • Postural Instability

  4. Myth/Misconception • Parkinson’s Disease only affects movement, movement-related (motor) symptoms such as tremor, stiffness and slowness. Reality • Many symptoms are unrelated to movement. Nonmotor.

  5. Cognitive changes • One cause is a drop in the level of dopamine, the neurotransmitter that is involved in regulating the body’s movements.

  6. Myth/Misconception • Parkinson’s Disease has spontaneous “exacerbations” and can “flare up” unexpectedly. Reality • Although symptoms may fluctuate throughout the day, the progression of Parkinson’s Disease is very slow.

  7. Instability and falls Falls occur in 40–70% of patient.

  8. Step training and strength training improve gait characteristic.

  9. Oral Care

  10. Oral Manifestations: • Dysphagia • Salivary dysfunction • Burning mouth • Change in taste and smell • Dry mouth • Difficulty speaking • Angular chelitis

  11. Caries and Periodontal disease: • Study investigates the oral health of patients with PD compared to healthy patients. • Result: patient with Parkinson’s disease has poorer oral hygiene. • Gingival recession • Mobility • Xerostomia

  12. Recommendations for Dental appointment • Schedule patient for short appointment between 60-90 minutes. • Calm the patient down. • Semi supine position. • The patient arrive with her/his caregiver for interpretation • Good nutrients that contains vitamin B and iron to treat burning mouth syndrome. • Place a blanket over patient with comorbid shy-drager disease.

  13. How to manage dental appointment: • The use of powered scaling device and air polishing are NOTrecommended. • Use of Bite block and suctioning more often. • No need for antibiotic, consult with physician. • Recall for every 3 -4 months • Apply fluoride varnish every visit.

  14. Medications:

  15. How to overcome Xerostomia: • Sipping water frequently. • Consuming sugar-free hard candies. • Chew on sugar-free xylitol containing gum. • salivary substitutes or pharmaceutical drug such as pilocarpine and cevimelineHCl.

  16. HOME CARE

  17. Therapeutic Agents • Toothbrushes • Floss • Mouth rinses • Fluoride

  18. Toothbrushes 1) Manual • Velcro strap • Bicycle handle grasp • Soft rubber ball • Styrofoam balls 2) Electric

  19. surround toothbrush https://www.google.com/search?q=surround+toothbrush&espv=210&es_sm=93&source=lnms&tbm=isch&sa=X&ei=cWgzU8jLN6GwygHsvICAAg&ved=0CAkQ_AUoAg&biw=1097&bih=560#imgdii=_

  20. Floss • Floss holders

  21. Mouth Rinse and Fluoride Antimicrobial Agents: • Liquid mouth rinse is NOT recommended • Chlorohexidine gel Fluoride: • OTC Fluoride gel

  22. Caregivers • Their importance • Help patients with home care (medications, food, shower, & brushing) • Their feelings about their tasks • Stress, anxiety, and burden • Less stress when PD is managed with subthalamic deep brain stimulation (STN-DBS)

  23. References 1. S.A. Wylie, D.O. Claassen, H.M. Huizenga, K.D. Schewel, K.R. Ridderinkhof, T.R. Bashore, and W.P.M. van den Wildenberg. Dopamine Agonists and the Suppression of Impulsive Motor Actions in Parkinson’s Disease. J CognNeurosci. 2012 August; 24(8): 1709–1724. 2. Melissa J. Nirenberg, M.D., Ph.D. Understanding Parkinson’s, Secrets, Myths & Misconceptions [Internet]. www.pdf.org PDF News & Review, Winter 2010 [updated 2011; cited 2014 March 18]. Available from: http://www.pdf.org/pdf/fs_parkinson_secrets_myths_10[1].pdf 3. Alexander Tröster, Ph.D. Understanding Parkinson’s, Cognition and Parkinson’s [Internet]. www.pdf.org PDF News & Review; 2012 [updated 2012; cited 2014 March 18]. Available from: http://www.pdf.org/pdf/fs_cognitive_changes_12.pdf 4. Roy G. Elbers, MSc, Erwin E. H. van Wegen, PhD, John Verhoef, PhD and GertKwakkel, PhD. Is gait speed a valid measure to predict community ambulation in patients with Parkinson’s disease? Journal of Rehabilitation Medicine 2013; 45: 370–375. 5. Xia Shen, MPT, Margaret K.Y. Mak, PhD. Repetitive Step Training with Preparatory Signals Improves Stability Limits in Patients with Parkinson’s Disease. J Rehabil Med 2012; 44: 944–949. 6. Grover S, RhodusNl. Dental implications of Parkinson’s disease. Journal of the Minnesota Dental Association. 7. Muller T, Palluch R, Jackowski J. Caries and periodontal disease in patients with parkinson’s disease. Special Care Denistry Association and Wiley Periodicals 2011; 31(5): 178-181. 8. Burgess J, Editor C, Meyers AD. Management of the dental patient with neurological Disease. Medscape 2013. 9. Yarnall A, Archibald N, Burn D. Parkinson’s disease. Medicine 2012.

  24. 10. DeBowes SL, Tolle SL, Bruhn AM. Parkinson’s disease: considerations for dental hygienist. International Journal of Dental Hygiene 2013; 15-12. 11. Yamanishi T, Tachibana H, Oguru M, Matsui K, Toda K, Okuda B, Oka N. Anxiety and depression in patients with parkinson’s disease. Internal Medicine 2013; 52: 539-545. 12. Al-Omari FA,  Al Moaleem MM, Al-Qahtani SS, Al Garni AS, Sadatullah S, Luqman M. Oral rehabilitation of parkinson’s disease patient: A Review and Case Report. Case Reports in Dentistry 2014; (2014): 4. 13. Katyayan PA, Katyayan MK, Nugala B. Dental management of parkinson's disease. New York State Dental Journal 2013; 79(5):33-9. 14. Wilkins, EM. Clinical practice of the dental hygienist. 11th ed. Philadelphia: Lippincott Williams and Wilkins; 2013. 1147 p. 15. Tew EH,  Naismith SL., Pereira M,  Lewis SJ. Quality of life in parkinson's disease caregivers: the contribution of personality traits. BioMed Research International 2013; (2013): 6. 16. Dotchina CL, Paddicka SM, Longdona AR, Kisolia A, GrayaWK, Dewhursta F, Chaotea P, Dewhursta M and Walker RW. A comparison of caregiver burden in older persons and persons with parkinson's disease or dementia in sub-Saharan Africa. International Psychogeriatric Association 2014; 26(04): 687-692. 17. Lewis CJ, Maiera F, Eggersa C, Pelzera EA, Maaroufb M, Moroc M, Zurowskid M, Kuhne J, Woopenf C, Timmermanna L. Parkinson's disease patients with subthalamic stimulation and carers judge quality of life differently. Elsevier B.V 2014; (2014): 1-6.

  25. Thank you

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