- According to the cognitive ability of the patient, obtain consent to treat from an appropriate person (patient or guardian/caretaker).
- As this is a progressive disease, attempt to provide as much dental treatment during the earliest possible opportunity.
- Sedation may be necessary during the later stages of the disease when the patient may not be able to sit still in the dental chair.
- Schedule the patient at the time when he or she exhibits the least symptoms. This is usually during morning hours and shortly after having taken their medications.
- Be aware of possible depression, dementia, and diseases associated anger and frustration (see oral health care considerations for Alzheimer’s disease).
- Assist the patient with sitting down and arising from the dental chair.
- Be aware of possible orthostatic hypotension.
- If swallowing difficulties are present, position the chair in a 45-degree angle, utilize high volume evacuation suction.
- Consider the use of a mouth prop.
- Protect the patient’s tongue and airway by using a rubber dam.
- Consider possible oral dryness due to medications or impairment of the autonomic nervous system.
- Be aware of possible increased orofacial pain, including temporomandibular dysfunction due to increased muscle rigidity.
- Be aware of movement restrictions of the hands, as well as facial musculature, that may limit the patient’s use removable prostheses.
- Due to patient’s progressive inability to chew and swallow, improving the patient’s masticatory function is a priority.
- Address possible drooling by reducing salivary flow, when appropriate.
- Be aware of possible interactions of catechol-o-methyl transferase (COMT) inhibitors with epinephrine, and segiline or rasagiline with epinephrine and levonodefrin resulting in tachycardia and increased blood pressure.
- Institute a good oral hygiene maintenance program that includes the care giver.
| Drugs/ drug|
See Medical Complexity Status for more information.