Διαχείριση οδοντιατρικών προβλημάτων σε ασθενείς με νόσο του Parkinson. Σύγχρονα πρωτόκολλα θεραπευτικής προσέγγισης
Creators: name: Λιοσάτος, Αλέξιος Σπυρίδωνα
Publisher: name: Aristotle University of Thessaloniki
Year: 2023
Subjects: Νόσος Πάρκινσον
Οδοντιατρική διαχείριση
Parkinson Disease
Dental Management

description: Η νόσος του Πάρκινσον (ΝΠ) είναι μια χρόνια προοδευτική νευροεκφυλιστική διαταραχή. Εμφανίζεται σε περίπου 1 στα 1000 άτομα στο γενικό πληθυσμό και στο 1% της ηλικιακής ομάδας άνω των 60 ετών. Η νόσος θεωρείται ιδιοπαθής με άγνωστη αιτιολογία, ενώ στην εκδήλωσή της φαίνεται ότι εμπλέκονται ελάχιστα κατανοητοί γενετικοί και περιβαλλοντικοί παράγοντες. Τα κύρια χαρακτηριστικά της νόσου είναι: ο τρόμος ηρεμίας, η βραδυκινησία, η ορθοστατική αστάθεια, η μυϊκή ακαμψία και το ανέκφραστο πρόσωπο. Τα άτομα με ΝΠ αντιμετωπίζουν μια σειρά παθολογικών εκδηλώσεων από τη στοματογναθοπροσωπική περιοχή που σχετίζονται με τη νόσο, ενώ παράλληλα ορισμένα από τα φάρμακα που χρησιμοποιούνται για τη θεραπεία της ΝΠ οδηγούν σε ανεπιθύμητες ενέργειες από τη στοματική κοιλότητα. Ο οδοντίατρος καλείται να είναι ικανός ώστε να αναγνωρίζει τα βασικά σημεία και συμπτώματα της νόσου, τις βασικές στοματολογικές εκδηλώσεις της και τα βασικά πρωτόκολλα οδοντιατρικής διαχείρισης ασθενών με ΝΠ. Η παρούσα διπλωματική εργασία αποσκοπεί στο να συμβάλει σε αυτή την κατεύθυνση.
description: Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder of the dopaminergic as well as of non-dopaminergic neurons of the brain, causing limitations in motor and non-motor skills as well as neuropsychiatric symptoms. PD mainly affects the basal ganglia of the brain, due to the destruction of cells that produce dopamine, the neurotransmitter that connects the substantia nigra to the striatum and makes muscles capable of smooth, controlled movements. The disease is considered idiopathic with unknown etiology, while poorly understood genetic and environmental factors seem to be involved in its manifestation. The main features of the disease are: resting tremor, bradykinesia, postural instability, muscle rigidity and inexpressible face (mask-like face). People with PD face a series of pathological manifestations from the oromaxillofacial region related to the disease, while some of the drugs used to treat PN also lead to adverse effects from the oral cavity. Xerostomia, dysphagia, drooling, periodontitis, burning mouth syndrome, halitosis, decay, bruxism and incapacity of adequate oral hygiene are some characteristic manifestations that belong to dentist’s field. These patients have difficulties during dental treatment and need special management due to motor and cognitive problems as well as disorders of the autonomous nervous system, while the dentist must several measures, both to facilitate and encourage them during the treatment, and to prevent serious risks to these patients, such as the risk of aspiration, pneumonia and choking. The dentist may be able to notice early symptoms of PD and may need to modify treatment plans, taking into account the disease and the stage of the disease. Basic dental goals are the relief and treatment of the orofacial complications of the disease, the comfortable experience of providing dental treatment in dental clinic, the preservation of natural teeth, inclusion in a program of regular and aggressive dental prevention, and the maintenance of patient self-care. The PD patient should be scheduled for dental treatment in morning hours, 60–90 minutes, in a calm and reassuring atmosphere. If the patient suffers from dysphagia, he/she should be placed in a semirecumbent position, and the presence of an assistant and strong suction may be vital to providing safe and comfortable care. Dentist should work, when necessary, with reduced water flow, judicious use of the dental air-water syringe and a rubber dam. In the presence of hyposialia and dry mouth, the dentist should recommend measures such as frequent drinking of water, saliva substitutes or cholinergic agonists. A reduced capacity for oral self-care is associated with both motor problems and reduced manual dexterity, as well as cognitive problems, apathy and depression, memory loss and dementia. These limitations require modifications and special care to maintain an adequate oral hygiene routine whenever possible.