Table 3.126.
Key considerations for dental management in Parkinsonism (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Difficult communication; involuntary movements |
| Appropriate dental care | 2/4 | Sympathetic handling; mouth prop; rubber dam |
| Pain and anxiety control | ||
| – Local anaesthesia | 1 | Avoid epinephrine |
| – Conscious sedation | 1 | |
| – General anaesthesia | 3/4 | For severe disease |
| Patient access and positioning | ||
| – Access to dental office | 1 | Assistance required |
| – Timing of treatment | 1 | Short appointments |
| – Patient positioning | 1 | Semi-reclined; orthostatic hypotension; possibly physical restriction |
| Treatment modification | ||
| – Oral surgery | 1 | |
| – Implantology | 1 | Implant supported prosthesis |
| – Conservative/Endodontics | 1 | |
| – Fixed prosthetics | 1 | |
| – Removable prosthetics | 1 | Soft mouth guard |
| – Non-surgical periodontology | 1 | |
| – Surgical periodontology | 1 | |
| Hazardous and contraindicated drugs | 1 | Avoid macrolides |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.