Medical Management, Orofacial Findings, and Dental Care for the Patient with Parkinson's Disease.

Parkinson's disease (PD) is the second most prevalent neurodegenerative disease in North America, next to Alzheimer's disease. Patients who suffer from PD typically present with neuromuscular, cognitive, postural and psychiatric deficits, which make oral hygiene challenging, but extremely important. Although the cardinal signs of PD are movement-related, manifestations in the orofacial complex are ubiquitous. Weakened facial musculature, gaunt appearance, tremors of the tongue, lips and eyes, erratic mandibular movements, bruxism, xerostomia, sialorrhea, dysphagia, dysgeusia and glossitis are examples of the plethora of atypical orofacial findings associated with PD. Further complications, including angular cheilosis, attrition, temporomandibular joint disorders, burning mouth syndrome, hyposmia and hypophonia, may arise as a consequence of these orofacial manifestations. The effects of PD on the orofacial complex may result in poor nutritional habits, which can exacerbate weight loss and contribute to a negative impact on physical, psychosocial and emotional health. Dentists should be able to identify signs of PD systemically, including but not limited to the orofacial region, to optimize the management of PD patients. Here, we report practical recommendations for the medical and dental management of patients with PD in accordance with the most recently published clinical practice guidelines.