Let’s Face It: Mindful Mouth Movements Are Needed

I bit my tongue hard enough to draw blood, releasing that unique rusty-iron taste. This wasn’t the first time. When I have had multiple teeth removed (leaving open spaces for a few weeks while artificial teeth were being made), my mouth muscles had difficulty adjusting. The consequences are quite painful. The solution is mindful mouth movements.

Eating (particularly chewing) is like walking. It’s an over-learned motor sequence we repeat without much thought. Most people can walk and chew gum at the same time. Just not me. I must direct mindful attention to both walking and chewing. When I do, there are few problems. When I don’t, there are always negative consequences. It’s another example of broken scenario looping. It is not just chewing. I need to be mindful of swallowing. I can’t be talking around the family dining table while I’m eating — not even between swallows. Mrs. Dr. C. dislikes the choking spasms that are the consequence. It can be scary for loved ones watching. I need to assign to the mouth one motor task at a time and pay attention.

Drinking aspiration has been alleviated a bit by using a straw. I have a big cup with a screw-on top. It saves me from having to refill a small glass multiple times during the day. The top helps when I invariably miss reaching for it, potentially spilling the contents. The big cup requires a long straw. Strangely enough, they are hard to find. Those drink straws from fast-food places don’t extend much beyond the top edge of the cup. A little internet searching, and we were able to find 14-inch straws. Another accommodation in the quest to manage Parkinson’s.

Public speaking is something I enjoy doing and I dread the day when the Parkinson’s thief arrives. I used to talk daily with other gamers inside a virtual reality computer game. But then the vision loss happened. Mrs. Dr. C helps with my talking. She has profound hearing loss, so I need to increase my volume to almost a shout and do this without sounding angry. This gives me lots of vocal projection practice. I find I need to slow down the speed of my words and make sure I can devote full attention to what I’m saying. I can’t be emotionally distracted or engaged in thinking about things or occupied with the weekly “honey-do” list. All my attention is on speaking clearly, loudly, and calmly. I am worried that this is not enough mouth therapy to keep the old professorial voice in shape. I hope to return to playing the guitar and singing.

There seem to be conflicting reports of the influence of levodopa on swallowing and other related mouth movements like dysphagia. Just recently I have started clenching my teeth at night, possibly nocturnal bruxism. Nocturnal bruxism is defined as “nighttime tooth clenching or grinding. Like many of the movement behaviors in PD, nocturnal bruxism is an involuntary behavior and not simply the result of stress. It’s considered both a symptom of PD and a free-standing sleep disorder.” The article continues:

“It’s interesting to note that, while bruxism can happen at any time of day, daytime versions are seldom a complaint in someone with PD. Complaints of morning jaw pain, or the discovery of loosened or even broken teeth, may signal a case of nocturnal bruxism. Tight or sore neck muscles are also common. It might be easy to blame the pillow or aging for these problems, but it would be better to rule out bruxism first, as it can be treated.”

A 2018 study in the Journal of Oral Rehabilitation states, “Patients with PD/PR reported significantly more often bruxism during sleep and wakefulness than controls. Also, patients with PD/PR had more often possible TMD and reported a significantly higher mean pain intensity in the orofacial region than controls.”

Neurologists generally do not screen for bruxism as a motor dystonia and many dentists are not trained in recognizing the impact of Parkinson’s on dental problems. A review of the literature indicates that only since 2015 has there been an increase in awareness of bruxism as a definable Parkinson’s symptom. Instead, I work on paying attention to coordinating mind and mouth movements: daytime, nighttime, and all of the time.

Do you have mouth problems and suggestions? Please share in the comments.

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