Parkinson’s symptoms can make daily mouth care harder to maintain

People with Parkinson’s disease who participated in a U.K. study said maintaining their oral health helped preserve their independence and well-being, although they faced challenges performing mouth care at home.

Interviews with patients and care partners showed that Parkinson’s symptoms, including impaired hand control, fatigue, and balance issues, often made toothbrushing difficult. Despite these challenges, many patients were reluctant to accept assistance because they viewed toothbrushing as a private task, while care partners were uncertain about how and when to help.

“The findings suggest that oral health is not well integrated into the broader management of Parkinson’s” and highlight that a “proactive, multidisciplinary approach providing earlier information and tailored practical support will be beneficial in supporting [people with Parkinson’s] to maintain their oral health at home,” the researchers wrote.

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Study explores mouth care at home

The study, “If you don’t sort out these problems, you end up building problems”: a qualitative study exploring mouthcare at home with people with Parkinson’s and their partners in care,” was published in Disability and Rehabilitation.

Parkinson’s disease is marked by the progressive death of nerve cells that produce dopamine, a signaling molecule involved in motor control. The resulting loss of dopamine causes many of the disease’s hallmark motor symptoms. Both motor and nonmotor symptoms may impair patients’ ability to perform mouth care. Previous studies have found that 29% to 47% of people with Parkinson’s report difficulty brushing their teeth.

To learn more about people’s experiences with mouth care at home, two researchers in the U.K. conducted a qualitative study based on interviews with 13 people with Parkinson’s, 61.5% of whom were men, and seven care partners.

Overall, researchers identified three themes: maintaining normality, familiar and unexpected problems, and negotiating help.

Participants viewed maintaining good oral health as an important part of preserving their identity, confidence, and social connections, as well as a sense of normality. Some saw healthy teeth as a visible sign of overall well-being and a way to influence how others perceived them.

“Trying to look healthy even if you’re not feeling healthy gives an impression to the outside world that you’re coping. If people see that your teeth are declining because you got Parkinson’s, that’s yet another thing that is a minus on your CV,” one participant said.

Many participants worried that the appearance of their teeth or bad breath could affect social interactions, and they saw maintaining a healthy mouth as one way to support positive connections with others. Another participant said that “smiling’s hard enough, so … on the occasions that you actually manage it, you want to flash a nice pair of gnashers, don’t you?”

Symptoms make brushing more difficult

Patients also described how motor symptoms affected their ability to hold and control a toothbrush, put toothpaste on it and brush effectively. Some found electric toothbrushes helpful, although their weight, controls and other features could create additional difficulties.

One patient said, “I’ve been trying to brush, and I’ve been a bit dyskinetic. And I’ve actually sort of put my toothbrush across the top of my gums and that’s made my gums bleed.” Being dyskinetic means experiencing involuntary, uncontrolled movements that can develop in people with Parkinson’s.

Balance problems, fatigue and difficulty getting to or standing at the bathroom sink added to these challenges and sometimes led participants to skip mouth care. Participants also said that apathy, which can make it difficult to feel motivated, and problems maintaining focus could interfere with a regular mouth-care routine.

Over time, repeatedly missing mouth care can lead to tooth decay, infection and pain, potentially requiring more invasive dental treatment. Some participants were especially motivated to avoid this because Parkinson’s symptoms could make receiving dental care more difficult. One participant explained, “I’m so fidgety now, being still while somebody jabs around in your mouth with a pointy hook can be quite difficult, so the less I have to have of that done the better.”

Participants also described practical strategies for maintaining daily mouth care, such as brushing their teeth when their medication was working best, switching hands, using an electric toothbrush or trying other assistive devices. As one care partner explained, “He chooses a good time, so when he’s feeling slightly normal, so he can get up the stairs and he can get into the bathroom.”

Care partners described small but meaningful ways they could help, such as putting toothpaste on a toothbrush, cleaning dentures or obtaining useful products. Some participants also used specialist equipment or adaptive aids, including a stool provided by an occupational therapist. However, many people with Parkinson’s expressed discomfort at the prospect of needing help. They viewed toothbrushing as a private activity closely tied to their independence, and some said they would accept direct assistance only as a last resort.

Care partners also described uncertainty about when and how to raise concerns about declining oral health without undermining a person’s independence or self-respect. Some continued to respect the person’s independence until they could no longer manage mouth care alone, potentially allowing preventable oral health problems to develop.

According to the researchers, rehabilitation professionals should consider oral health as part of broader self-care assessments. Rehabilitation professionals and other members of a Parkinson’s care team can suggest practical adaptations that may help people maintain their oral health independently for longer. They can also help care partners navigate conversations about oral health in ways that respect the person’s dignity and independence.