Dental care often is irregular in people with Parkinson’s disease, who also require more dental treatments that those without this disease, a study from Denmark reported.
High-quality initiatives addressing basic care, from daily oral cleanings to regular checkups that could reduce cavities and tooth extractions, are needed for better oral health and to ease the economic burden that extensive dental treatments impose, its researchers noted.
“This knowledge can be used by clinicians and decision-makers to ensure the optimal dental care for persons with [Parkinson’s disease],” the researchers wrote.
The study, “Dental care utilization among persons with Parkinson’s disease in Denmark,” was published in the journal Community Dentistry and Oral Epidemiology.
Dental care a poorly studied area of Parkinson’s overall care
The motor symptoms of Parkinson’s can increase the difficulty of daily oral hygiene practices, while nonmotor symptoms like depression and cognitive changes can affect how well a person maintains good hygiene and makes regular dental appointments.
Disease treatments themselves, furthermore, often affect salivation.
“Controlled studies show a higher prevalence of caries, gingivitis, periodontitis and tooth loss” among Parkinson’s patients, the study noted, which “can lead to pain, decreased quality of life and malnutrition,” the scientists, all with the University of Copenhagen, wrote.
“Based on this, it is obvious that the need for both preventive dental care and dental treatment is high … and necessary to control oral diseases and secure a sufficient oral function and a healthy life,” they added, noting few studies have looked into dental care in this patient group.
Using the Danish National Prescription Registry, the researchers identified 6,874 patients with data covering their dental service use between 2015 and 2019. They then compared this information with data on 34,285 people without Parkinson’s, serving as controls.
Both groups were similar in terms of median age (71) and sex distribution (60.7% male). People with Parkinson’s had a higher educational and income level, were more likely to have a partner, and more likely to live in nursing homes and for longer periods than controls.
These people were further categorized by dental attendance over the study’s five years: non-attenders (no evidence of any dental service use), irregular attenders (one to two examinations or dental treatments only), or regular attenders (three or more examinations). Dental care, generally private, is reimbursed in part under Denmark’s national health policy once claims are filed, and partial reimbursement includes preventive care, tooth fillings or extractions, and periodontal treatments.
Irregular dental care, with need for fillings, more common with Parkinson’s
Most people in both groups were regular visitors to dental care, although a smaller percentage of those with Parkinson’s regularly went for care than did those in the control group (57.5% vs. 59.5%). Patients, overall, were significantly more likely to have irregular dental visits than those without the disease (21% vs. 16.9%).
Adults without Parkinson’s, however, were more likely to not use dental care services compared with patients (23.6% vs. 21.4%).
Among regular attenders, Parkinson’s patients more likely to need services, with a 1.10 times higher rate of examinations and preventative services, 1.62 times higher rate of fillings, and 1.49 times higher rate of extractions than controls. This amounted to an incidence rate for overall dental service use among regular attenders that was 1.18 times greater for patients than controls, and 1.12 times higher among those classified as irregular attenders.
“The incidence rate of dental services in the overall PD [Parkinson’s disease] population was significantly higher compared with the control population, especially for fillings and extractions,” the researchers wrote.
Fillings given to treat small cavities or broken teeth had a 1.71 higher incidence rate among patients than controls, the study noted. And regular care attenders, whether patients or controls, had almost double the number of fillings (8.3 for patients and 5.1 for controls) over the study’s years than did irregular attenders.
Absolute numbers of tooth extractions were small over these five years, the researches wrote, with an estimated mean of 0.9 teeth extracted among all controls and 1.3 among all patients. By category, patients had an estimated mean of 1.3 extractions for regular attenders and 1.4 with irregular attendance; for controls, these estimated means were 0.9 for regular attenders and 1.2 for irregular attenders.
“The small but statistically significant higher extraction rate among cases during a five-year period may emphasize the pattern of more severe oral disease among persons with PD,” the researchers wrote.
Regarding examinations and preventive treatments, the use rate was 1.1 times higher for Parkinson’s persons than controls, regardless of whether they were regular or irregular attenders to dental care.
“Overall, people with [Parkinson’s] received more dental services, especially treatments, than the control group, regardless of their attendance pattern,” the researchers wrote.
This finding might be related to ineffective prevention approaches in dental care or a dentist’s choice to offer treatment to a patient, they added.
Still, patients’ “significantly higher usage of dental care services … was most prominent for the treatment categories such as fillings and extractions, that is, for acute problems,” while it was “low for preventive measures,” the team wrote.
Given this high use rate and its associated economic burden, the researchers suggested that people with Parkinson’s “should get higher reimbursements for their dental visits or possibility a special subsidy for dental care” under Denmark’s health policy.
This study’s findings should also raise awareness among dental health professionals of the need to better promote oral health practices, like the use of high fluoride toothpaste, and preventive care initiatives that are tailored to people with Parkinson’s, like screening individuals for hyposalivation, the researches concluded.