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Desafios nos tratamentos odontológicos nas diferentes formas/estadios da doença de Parkinson: estado da arte – revisão narrativa
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Abstract(s)
A doença de Parkinson é uma doença neurodegenerativa progressiva que afeta o sistema nervoso central. Manifesta-se por sintomas motores como tremor, rigidez muscular, lentificação de movimentos (bradicinesia) e alterações da postura e do equilíbrio. Além desses sintomas motores, a doença de Parkinson também pode causar vários sintomas não motores, como ansiedade, depressão, alterações cognitivas e comportamentais, e problemas de sono. Esses sintomas apresentam desafios significativos ao atendimento odontológico, que variam dependendo das formas e estágios da doença. De facto, o papel do dentista é crucial para os pacientes com doença de Parkinson devido aos problemas específicos de saúde oral que enfrentam. Primeiramente, os movimentos involuntários, como o tremor, complicam procedimentos odontológicos precisos, exigindo dispositivos de estabilização e, às vezes, sedação. A rigidez muscular e os problemas de postura tornam desconfortável sentar-se na cadeira odontológica, enquanto a bradicinesia prolonga a duração dos tratamentos.
Além disso, os medicamentos antiparkinsónicos podem causar secura de boca, aumentando o risco de cáries e infeções. As alterações de deglutição e os problemas cognitivos requerem atenção especial para garantir a segurança e a cooperação do paciente. O dentista ajuda a prevenir e tratar esses problemas, dá conselhos e adaptações para facilitar a higiene oral e trabalha em coordenação com outros profissionais de saúde para os cuidados gerais. É, portanto, essencial proporcionar uma abordagem multidisciplinar e adaptações específicas para proporcionar um atendimento odontológico eficaz e confortável a esses pacientes. A literatura sobre a doença de Parkinson estabelece claramente aspetos como a formação especializada dos médicos dentistas, a importância da comunicação com o paciente e a adaptação das práticas clínicas para pacientes com esta doença. No entanto, ainda existem lacunas no que diz respeito às estratégias de cuidados personalizados, dependendo da forma e do estádio da doença, necessitando de mais investigação e orientações práticas para otimizar o tratamento dentário para esta população específica. Este trabalho tem como objetivo abordar, através de uma revisão do estado da arte, as manifestações orais da doença de Parkinson, que possam suscitar dificuldades e desafios ao médico dentista, conforme a forma clínica e o estádio evolutivo, assim como apresentar os cuidados e estratégias durante o atendimento odontológico destes pacientes.
Parkinson's disease is a progressive neurodegenerative disorder that affects the central nervous system. It manifests itself by motor symptoms such as tremor, muscle rigidity, slowness of movements (bradykinesia), and problems with posture and balance. In addition to these motor symptoms, Parkinson's disease can also cause various non-motor symptoms such as anxiety, depression, cognitive and behavioural impairment, and sleep problems. These symptoms present significant challenges to dental care, which vary depending on the forms and stages of the disease. Indeed, the role of the dentist is crucial for patients with Parkinson's disease due to the specific oral health problems they encounter. First, involuntary movements, such as tremor, complicate precise dental procedures, requiring stabilization devices and sometimes sedation. Muscle rigidity and posture problems make sitting in the dental chair uncomfortable, while bradykinesia prolongs the duration of treatments. Furthermore, anti-Parkinsonian medications can cause dry mouth, increasing the risk of cavities and infections. Swallowing changes and cognitive symptoms require special attention to ensure patient safety and cooperation. The dentist helps prevent and treat these problems, provides advice and adaptations to facilitate oral hygiene, and works in coordination with other health professionals for overall care. It is therefore essential to provide a multidisciplinary approach and specific adaptations to provide effective and comfortable dental care to these patients. The literature on Parkinson's disease clearly establishes aspects such as the specialized training of dental practitioners, the importance of communication with the patient, and the adaptation of clinical practices for patients with this disease. However, there are still gaps regarding personalized care strategies, depending on the form and stage of the disease, necessitating further research and practical guidelines to optimize dental treatment for this specific population. This work aims to address, through a review of the state of the art, the oral manifestations of Parkinson's disease, which may pose difficulties and challenges to the dentist, depending on the clinical form and evolutionary stage, as well as presenting care and strategies during dental care for these patients.
Parkinson's disease is a progressive neurodegenerative disorder that affects the central nervous system. It manifests itself by motor symptoms such as tremor, muscle rigidity, slowness of movements (bradykinesia), and problems with posture and balance. In addition to these motor symptoms, Parkinson's disease can also cause various non-motor symptoms such as anxiety, depression, cognitive and behavioural impairment, and sleep problems. These symptoms present significant challenges to dental care, which vary depending on the forms and stages of the disease. Indeed, the role of the dentist is crucial for patients with Parkinson's disease due to the specific oral health problems they encounter. First, involuntary movements, such as tremor, complicate precise dental procedures, requiring stabilization devices and sometimes sedation. Muscle rigidity and posture problems make sitting in the dental chair uncomfortable, while bradykinesia prolongs the duration of treatments. Furthermore, anti-Parkinsonian medications can cause dry mouth, increasing the risk of cavities and infections. Swallowing changes and cognitive symptoms require special attention to ensure patient safety and cooperation. The dentist helps prevent and treat these problems, provides advice and adaptations to facilitate oral hygiene, and works in coordination with other health professionals for overall care. It is therefore essential to provide a multidisciplinary approach and specific adaptations to provide effective and comfortable dental care to these patients. The literature on Parkinson's disease clearly establishes aspects such as the specialized training of dental practitioners, the importance of communication with the patient, and the adaptation of clinical practices for patients with this disease. However, there are still gaps regarding personalized care strategies, depending on the form and stage of the disease, necessitating further research and practical guidelines to optimize dental treatment for this specific population. This work aims to address, through a review of the state of the art, the oral manifestations of Parkinson's disease, which may pose difficulties and challenges to the dentist, depending on the clinical form and evolutionary stage, as well as presenting care and strategies during dental care for these patients.
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Keywords
Doença de Parkinson Parkinsonismo Saúde oral Parkinson’s disease Parkinsonism Oral manifestations Oral health