Understanding Parkinson’s
Swallowing and Dental Challenges
Did you know that Parkinson’s disease (PD) can lead to difficulties swallowing and maintaining dental
health? These challenges are common in PD, and can interfere with important parts of life, such as the
ability to eat well. Most people with PD who have swallowing problems are not aware of them. The good
news is that being aware is the first step to taking charge. Here we outline the effects of PD on swallowing
and dental health and provide tips for staying safe, eating well and establishing a routine for dental care.
Parkinson’s and Swallowing
Because swallowing involves a very complex
sequence of movements, it is no surprise that PD
— a movement disorder — affects swallowing.
For example, the slowness of movement that often comes with PD may affect chewing, biting,
the ability to work the tongue and the ability to
get food or liquid down in one bite.
What are other signs of a problem? A person
with PD may lose food or liquid out of the mouth,
may swallow in small bites or sips or may have
difficulty with certain textures. He or she may
stop eating foods that are difficult to swallow,
may cough or have a wet or hoarse voice while
eating and drinking.
The term for swallowing difficulty is dysphagia. It affects the mechanics of swallowing and
quality of life. Many people become frustrated or
embarrassed and isolate themselves from social
activities like dining with friends or family.
More importantly, dysphagia can lead to malnutrition, dehydration and aspiration (when food
or liquid “goes down the wrong pipe”). Aspiration, which can sometimes be “silent,” meaning a
person does not cough or choke, can lead to aspiration pneumonia — the leading cause of death
in PD. Thus, it is important to ensure that people
with PD can swallow effectively and eat safely.
What Can Be Done? The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a
speech-language pathologist (SLP). This professional will take a medical history and interview
the person with PD about eating and swallowing.
This is typically followed by either a video x-ray
or an endoscopic examination, which allow the
medical specialist to observe the swallowing process as an individual sips liquid and eats food, as
these substances flow from the mouth, down the
throat and esophagus, to the stomach. With these
tests, it is possible to see where exactly the trouble is occurring, and to recommend therapies.
Follow the recommendations of the swallowing
specialist, which may include the following:
Exercise and Swallow Hard. Just as exercise
can ease other PD-related movement difficulties,
it can also help with swallowing. One technique
is the Lee Silverman Voice Technique® (LSVT®),
familiar to many people with PD as a therapy to
help people improve speech. It helps a person
to exaggerate speaking and swallowing. In addition, working with an SLP on an individualized
program can help the person to swallow hard
and move food from the mouth down the throat.
Expiratory Muscle Strength Training. This therapy strengthens respiratory muscles, improves
cough and swallowing and reduces aspiration.
Change the Food. Modifying liquids and solids can help. For people who find that liquids get
into the airway, liquid may need to be thickened
or avoided completely. Swallowing difficulties
can also be eased by taking bigger or smaller
(over please)
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bites or sips — or by pureeing the solid foods. The
best first step is to obtain an evaluation, so the SLP
can recommend how to modify food and liquid.
Parkinson’s and Dental Care
Regular visits to the dentist are important for
all of us. For a person who has PD, dental care
is even more critical because PD can impact the
health of the mouth, teeth and jaw and make dental care challenging. Rigidity or tremor may make
it difficult to brush one’s teeth. Symptoms such as
fatigue, anxiety and tremor can make it difficult to
commute to appointments, sit still in the dentist’s
chair or open the mouth wide.
Common PD symptoms and side effects such
as rigidity, tremor and dyskinesias can cause discomfort in the joint that connects the lower jaw to
the skull. They can also be a cause of cracked teeth,
tooth wear, changes in the fit and wear of dentures
and tooth grinding. Too much saliva can lead to a
fungal infection at the corners of the mouth, which
is easily treated. By contrast, too little saliva or dry
mouth increases the risk of cavities. Sucking on
sugar-free hard candy or using artificial saliva substitutes can help. It may also help to avoid alcohol,
tobacco and spicy and acidic foods.
What Can Be Done? Tips for Visits to the Dentist
A few tips can significantly improve dental visits. Call first to make the office aware of you or
your loved one’s PD symptoms. This will help the
dentist and the staff to provide better treatment.
The dentist should have a sense of overall health
of a person with PD, and someone on staff should
record vital signs upon arrival. It is important to tell
the dentist if the person with PD is taking MAO-B
inhibitors (rasagiline and selegiline), as these may
interact with anesthetics.
Lastly, because dental visits may become more
troublesome as PD progresses, consider scheduling the replacement of old fillings, crowns and
bridges, and ill-fitting dentures, during the early
stages of PD. For other tips see box above.
What Can Be Done? Tips for Home
Regular brushing, flossing and rinsing with an
over-the-counter fluoride rinse help prevent cavities and gum disease, but PD movement symptoms
Tips for Visiting the Dentist
• Ask to keep the dental chair more upright, to make swallowing easier.
• Plan short appointments early in the day.
• Schedule appointments to start about 60-90 minutes
after a levodopa dose.
• After the treatment is over, get up slowly from the
dental chair (to prevent dizziness).
• Request all instructions in writing, with copies for the
care partner as well as the patient.
• Get check-ups/cleanings every three to six months.
• For people who wear dentures, the dentist should
screen for oral cancer and evaluate the fit of the dentures as part of the routine visit.
can interfere with one’s ability to maintain oral hygiene. People with PD should try using a toothbrush with a large-handled grip and soft bristles.
A small brush head reaches the corners better. To
make the toothbrush easier to grasp, it may help
to place the handle inside a bike handlebar grip or
tennis ball or to use an electric toothbrush.
Aim to brush after every meal for two minutes, and also brush the tongue. It’s best to brush
one-handed, using the stronger side of the body.
If it’s not possible to brush after a meal, simply
rinsing the mouth with water will help. Flossing is
important, but may mean getting help from a care
partner. For fluoride rinses, if swishing and spitting
are difficult, the dentist may recommend a brush or
sponge applicator. Antimicrobial mouth rinses also
can be applied with a brush. If you have dentures,
remove after each meal, brush and rinse them. At
night, brush or clean them in a solution.
Conclusion
Parkinson’s can affect a person’s ability to swallow, and maintain dental and oral health. The good
news is you, or a loved one with PD, can address
these difficulties, while making meals enjoyable.
Michelle R. Ciucci, Ph.D., S.L.P., of the University of Wisconsin, and Jane Busch, D.D.S., a person
living with Parkinson’s, first presented this topic as
a PD ExpertBriefing, now available online at www.
pdf.org/parkinsononline.
If you have or believe you have Parkinson’s disease, then promptly consult a physician and follow your physician’s advice.
This publication is not a substitute for a physician’s diagnosis of Parkinson’s disease or for a physician’s prescription of drugs, treatment or operations for Parkinson’s disease.
Reprinted from the PDF News & Review, Fall 2014
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© 2014 Parkinson’s Disease Foundation