Simple Steps To Better Dental HealthBack
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Neuromuscular Diseases and Conditions

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space placeholder. Bell's Palsy.
space placeholder. Epilepsy.
space placeholder. Multiple Sclerosis.
space placeholder. Cerebral Palsy.
space placeholder. Muscular Dystrophy.
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space placeholder. Myasthenia Gravis.
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space placeholder. Bell's Palsy
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Oral Effects
Bell's palsy is a temporary paralysis of certain facial muscles. It comes on very quickly, sometimes overnight. It usually affects only one side of the face. Bits of food are more likely to build up on the paralyzed side of your mouth. Therefore, frequent and careful dental hygiene is important. If you wear dentures, clean them daily. You also may have less saliva flow and a loss or decrease in the sense of taste on the paralyzed side of your mouth.

At the Dentist
If you have Bell's palsy, visit a dental or medical specialist to see if the cause can be identified. Causes can include herpes simplex virus, Lyme disease, herpes zoster and certain tumors in the ear.

If possible, reschedule elective dental treatment until the paralysis has disappeared. If your treatment can't be delayed, your dentist may use special dental tools (retractors) to help control the paralyzed parts of your mouth and tongue. If your eyelids cannot close properly, you also should see an eye doctor. Sometimes the eye needs to be protected with lubricating eye drops, ointment or a patch. You should wear protective eyewear during dental treatment to keep debris out of your eyes.

Make sure to always tell your dentist about all the medicines you take. This should include over-the-counter vitamins and herbal supplements.

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space placeholder. Epilepsy
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Oral Effects
If you are taking phenytoin (Dilantin) or other anti-seizure medicines for epilepsy, your gums may overgrow. This effect occurs in nearly half of people taking phenytoin. Good oral hygiene can help prevent or limit the overgrowth. Some people with severe overgrowth will need a type of gum surgery called gingivectomy. Overgrown gum tissue that is not treated can cause changes in the bone supporting your teeth and may lead to tooth loss. If you stop taking phenytoin, your gums should improve (recede) somewhat, but some people may still need gum surgery.

Children take phenytoin as a chewable tablet or a syrup. Both forms are high in sugar, so parents should pay special attention to good oral hygiene.

People taking carbamazepine (Tegretol or Carbatrol) may have dry mouth, bleeding of the gums or both.

At the Dentist
Routine dental treatment for people with well controlled epilepsy is no different than for people without epilepsy. Routine use of sedation is not necessary. You also don't need to increase your dose of anti-seizure medicine before a dental visit. If you have seizures frequently, you may be referred to a hospital-based dental practice.

Your dentist should be familiar with your medical history. Tell your dentist how often you have seizures and what usually triggers them.

Keep your dentist informed of your medical history, including the medicines you take. This includes over-the-counter vitamins and herbal supplements. Many drugs can interact with anti-seizure medicines and may affect the way they work.

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space placeholder. Multiple Sclerosis
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Oral Effects
Because multiple sclerosis affects muscle control, it may be more difficult for you to brush and floss your teeth. You might need to consider toothbrushes that are adapted to make them easier to hold, as well as other adaptive dental care appliances.

Multiple sclerosis also may paralyze all or part of the face. Associated nerve diseases can affect your face and mouth and may cause severe tooth, jaw, chin or lip pain or numbness. Your dentist and neurologist may need to address these issues. Problems with oral hygiene and swallowing can lead to tooth decay and periodontal (gum) disease.

It may become difficult or impossible to wear dentures as your multiple sclerosis gets worse. Small partial dentures may be dislodged and swallowed. Larger dentures may fall out more often or just not fit well anymore.

At the Dentist
Try to keep your dental appointments to a comfortable length of time. The purpose is to avoid stress and fatigue.

It also may be difficult for you to sit in the dental chair throughout an appointment. If you are paralyzed (paraplegic or quadriplegic), your dentist may use padding in the dental chair and change your body position frequently to avoid pressure sores and pain. You may need help getting in and out of the dental chair. If you are unable to transfer from your wheelchair to the dental chair your dentist may be able to treat you in your wheelchair.

It may be difficult for you to hold your mouth open for long periods of time and to control your tongue movements and swallowing. Your dentist has special devices that can help. A rubber bite block, or mouth prop, can be placed between your teeth to keep your mouth open. This reduces the stress on your muscles. A tongue retractor can be used to help keep your tongue in one place. A thin piece of rubber ("rubber dam") can be stretched over your teeth to prevent you from inhaling foreign substances during dental procedures.

Be aware that if your dentist needs to prescribe sedatives, they can worsen your muscle control.

If you are under active treatment, give your dentist copies of your most recent blood tests. Also, tell your dentist how to get in touch with your physician so they can coordinate dental and medical treatment if needed.

Some medicines used to treat multiple sclerosis affect blood cells. Make sure to always tell your dentist about all the medicines you take, including those by injection. This should include over-the-counter vitamins and herbal supplements.

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space placeholder. Cerebral Palsy
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Oral Effects
Cerebral palsy refers to a group of body movement (motor) disorders that result from brain injury and do not get worse over time.

Children with cerebral palsy have more defects in their tooth enamel, although the cause of this is not known. The permanent teeth of children with cerebral palsy may come in late. They may be stained a greenish color.

People with cerebral palsy may experience:

  • Malocclusion (upper and lower teeth that do not come together properly)
  • Severe grinding of teeth (bruxism), which wears them down and requires repair
  • Damage to front teeth as a result of falls
  • Problems in controlling plaque and in chewing and swallowing food, which can increase the risk of tooth decay and periodontal (gum) disease
  • Problems with control of oral, facial or neck muscles, which can result in excess saliva flow or drooling
  • Underdeveloped tooth enamel

Some people who have cerebral palsy also have seizures and take anti-seizure medicines. These may cause gum overgrowth. Good oral hygiene can help prevent or limit the overgrowth. Some people with severe overgrowth will need a type of gum surgery called gingivectomy. Overgrown gum tissue that is not treated can cause changes in the bone supporting your teeth and may lead to tooth loss. If you stop taking the medicine, your gums should recede somewhat, but some people may still need gum surgery.

At the Dentist
If you have cerebral palsy, you may need help getting into the dental chair. You also may need, or want, pillows or other stabilizers to keep you comfortable. If you cannot get in and out of your wheelchair, your dentist may be able to treat you while you are in your wheelchair. People with severe cerebral palsy may need to be treated in a hospital using sedation or general anesthesia.

Your dentist may have an assistant to help keep you relaxed and comfortable during dental procedures. It may be difficult for you to hold your mouth open for long periods of time and to control your tongue movements. Your dentist has special devices that can help. A rubber bite block, or mouth prop, is placed between your teeth to keep your mouth open. This reduces the stress on your muscles. A tongue retractor can be used to keep your tongue in one place. A thin piece of rubber ("rubber dam") can be stretched over your teeth to prevent you from inhaling foreign substances during dental procedures.

Always tell your dentist about all the medicines you take. This includes over-the-counter medicines, vitamins and herbal supplements.

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space placeholder. Muscular Dystrophy
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Oral Effects
Muscular dystrophy is a genetic disease that causes muscle weakness. Over time, the weakness gets worse, often becoming severe.

There are several types of muscular dystrophy. They are caused by different genes and have somewhat different symptoms. Some types of muscular dystrophy affect the muscles in the face, head, neck and hands. For example, people with myotonic dystrophy may have trouble chewing, moving their lips and turning their head. Other types usually do not involve facial muscles.

In some people with muscular dystrophy, the upper and lower teeth don't meet properly. This can be caused by muscle weakness, and by the tongue pushing the teeth out toward the lips. Some people with muscular dystrophy also may have problems with their jaw joints (temporomandibular joints). This can lead to difficulty with chewing, clicking of the joints, headaches or muscle tenderness.

Many people with muscular dystrophy have trouble brushing, flossing or rinsing. Power-assisted brushes and tools to help with flossing are available.

At the Dentist
Your treatment at the dentist will depend on the type of muscular dystrophy you have and how severe your condition is. Bring a complete list of all your medicines and the doses you take. Tell your dentist how to contact your physician. They will work as a team to coordinate your dental and medical treatment.

Try to keep your dental appointments to a comfortable length of time, especially if stress worsens your condition. It also may be difficult for you to sit in the dental chair throughout an appointment. If you are paralyzed (paraplegic or quadriplegic), your dentist may use padding in the treatment chair and change your body position frequently to avoid pressure sores and pain.

Your dentist may have someone help you get in and out of the chair and assist with dental procedures. Your dentist may be able to treat you in your wheelchair. If your condition is severe, it may be best for you to be treated in a hospital setting.

It may be difficult for you to hold your mouth open for long periods of time and to control your tongue movements and swallowing. Your dentist has special devices that can help. A rubber bite block, or mouth prop, is placed between your teeth to keep your mouth open. This reduces the stress on your muscles. A tongue retractor can be used to keep your tongue in one place. A thin piece of rubber ("rubber dam") can be stretched over your teeth to prevent you from inhaling foreign substances during dental procedures.

Be aware that if you need sedatives, they may worsen your muscle control.

Always tell your dentist about all the medicines you take. This includes over-the-counter medicines, vitamins and herbal supplements.

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space placeholder. Parkinson's Disease
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Oral Effects
Parkinson's disease mainly affects adults in middle to late life. It apparently is caused by continuing breakdown of nerve cells in the brain. The result is a decrease in dopamine, a chemical that transmits messages between cells. People with Parkinson's disease have uncontrolled muscle movements (tremors) and stiffness.

Many people with Parkinson's disease are older adults, who may be less likely to seek dental treatment except in an emergency. Older adults may have other barriers to dental care, including transportation problems and chronic diseases.

If you have dentures, they may become difficult or impossible to wear as your disease worsens. Small partial dentures could be dislodged and swallowed. Larger dentures may fall out more often, break from sudden movements, or not fit properly anymore.

Some medicines taken by people with Parkinson's disease can cause dry mouth (xerostomia). This can increase your risk of tooth decay, and fungal/yeast infections because there is less saliva in your mouth to wash away bacteria and bits of food. If you have this condition, your dentist can prescribe a topical fluoride treatment or an artificial saliva solution to help protect your teeth from decay.

At the Dentist
Anxiety can aggravate symptoms of Parkinson's disease. Therefore, it is important for people with this condition to be calm and reassured during a dental appointment. The environment at your dentist's office should be low-stress. It also helps to keep your appointments as short as possible.

The tremors caused by Parkinson's disease can make dental treatment challenging. If your disease is severe, you may need to have treatment using sedation or general anesthesia. This may be done in a hospital or in a properly equipped dental office by a dental anesthesiologist.

It may be difficult for you to hold your mouth open for long periods of time and to control your tongue movements and swallowing. Your dentist has special devices that can help. A rubber bite block, or mouth prop, may be placed between your teeth to keep your mouth open. This reduces the stress on your muscles. A tongue retractor can be used to keep your tongue in one place. A thin piece of rubber ("rubber dam") can be stretched over your teeth to prevent you from inhaling foreign substances during dental procedures.

Levodopa/carbidopa (Sinemet) is a common treatment for Parkinson's disease. People taking this medicine should be careful when getting up from the dental chair. It can reduce blood pressure and lead to light-headedness or fainting if you move too quickly from a lying to a sitting or standing position.

Always tell your dentist about all the medicines you take. This includes over-the-counter medicines, vitamins and herbal supplements.

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space placeholder. Huntington's Disease
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Oral Effects
People with Huntington's disease have muscle movements that they can't control. This includes muscles in the face and tongue. They can have trouble swallowing as well. It can be difficult for people with Huntington’s disease to brush and floss their teeth. Preventive dental treatment (regular dental visits) is very important for people with Huntington's disease and those at risk of it. Dental care should be thorough and frequent. If you become unable to take care of your mouth and teeth, a family member or caregiver should help you. A proper diet is also important in reducing the risk of decay.

Good oral hygiene is important in order to decrease infections and tooth loss. Some people with Huntington's disease should not wear dentures. It can be difficult for people with Huntington's disease to adapt to dentures. The sudden and violent facial movements associated with the disease can break dentures. Patients with Huntington's disease must be careful to avoid accidentally swallowing, dislodging or ejecting dentures from the mouth.

At the Dentist
Dental treatment of patients with advanced Huntington's disease can be difficult, because they may not be able to open their mouths very wide or sit still for long periods. Dental appointments should be kept to a comfortable length of time. Your dentist can use mouth props and tongue retractors to ease some of the strain on your muscles. You may need sedation or general anesthesia for dental treatment. You may need to go to a hospital for this.

Always tell your dentist about all the medicines you take. This includes over-the-counter medicines, vitamins and herbal supplements.

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space placeholder. Myasthenia Gravis
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Oral Effects
People with myasthenia gravis may have partial or no facial expression because they cannot move their facial muscles. Some people have difficulty chewing food. Their muscles may be so tired that they cannot keep their mouths closed after eating. They may also have weakened tongue and palate muscles.

If you have myasthenia gravis, you may not be able to keep complete dentures in your mouth because your muscles may be too weak. Ill-fitting dentures may make it more difficult to close your mouth. This may result in dry mouth, tongue fatigue, a tight upper lip, and difficulty with speaking, chewing or swallowing.

As much as you can, choose foods that promote dental health and reduce the risk of decay. If weakness prevents you from performing regular dental care, consider using a power-assisted brush or other aids. A family member or caregiver can help you with dental care.

Medicines used by people with myasthenia gravis may have oral effects. Tell your dentist about any medicines you are taking. This should include over-the-counter vitamins and herbal supplements.

At the Dentist
Your dental appointments should be early in the day and should be kept to a comfortable length of time. You may find it most comfortable to receive dental care an hour or two after taking your medicines. Your dentist and physician can work as a team and talk about adjusting your schedule so you can take your medicine before your dental appointment.

Some people have such poor muscle control that there is concern about maintaining proper breathing during dental procedures. Some of these people are treated in the hospital.

During your appointment, a dental assistant may observe you and monitor your vital signs. These include blood pressure, pulse and breathing rate. Your dentist may use a mouth prop, or bite block, to reduce the strain on your jaw muscles. He or she also may use a tongue retractor and rubber dam. Let your dentist know if you feel like you are tipped too far back in the dental chair. Ask for rest periods during treatment if you think that would help you.

Be aware that if you require sedatives, they can worsen your muscular control.

If you have problems keeping your teeth clean, there are modified brushes and other appliances that can help. Your dentist or dental hygienist can tell you about them. If you take medicines that weaken your immune system and your ability to fight off infection, be sure your dentist is aware. Bring your updated medical records to each dental appointment so your dentist can see what medicines you are taking and their doses.

Tell your dentist how to contact your physician. They may work together to coordinate your medical and dental needs.

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space placeholder. Spina Bifida
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Oral Effects
People with spina bifida have no unusual dental problems. However, if your arms or chest are paralyzed, it may be difficult for you to brush and floss without help. There are many adaptive dental aids and techniques to help you maintain good dental care. A family member or caregiver also can help you.

Some people with spina bifida may take medicines that cause oral side effects (for example, gum overgrowth).

At the Dentist
Try to limit your dental appointments to a comfortable length of time. It also may be difficult for you to sit in the dental chair throughout an appointment. Your dentist may use padding in the treatment chair and change your body position frequently to avoid pressure sores and pain. Your dentist probably will have someone help you get in and out of the chair and assist with dental procedures. If you can't be moved, your dentist may be able to treat you in your wheelchair.

It may be difficult for you to hold your mouth open for long periods of time and to control your tongue movements and swallowing. Your dentist has special devices that can help. A rubber bite block, or mouth prop, may be placed between your teeth to keep your mouth open. This can help to reduce the stress on your muscles. A tongue retractor can be used to keep your tongue in one place. A thin piece of rubber ("rubber dam") can be stretched over your teeth to prevent you from inhaling foreign substances during dental procedures.

Infants with spina bifida are at a high risk of developing a latex allergy. The dentist should ask about any allergies and avoid exposing infants to latex products.

If you have a surgically placed plastic tube or shunt, you may need to take antibiotics before dental treatment (such as draining an abscess or infection). Discuss these shunts with your physician and dentist before treatment. Also bring a copy of any paperwork that may explain the type of shunt.

Make sure to always tell your dentist about all the medicines you take. This should include over-the-counter vitamins and herbal supplements. Also, tell your dentist how to get in touch with your physician so they can coordinate dental and medical treatment if necessary.

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