Correspondence Address:
Shruti Dev
Master of Dental Surgery, Professor, Department of Prosthodontics, Kalinga Institute of Dental Sciences, KIIT- Campus-5, Bhubaneswar- 751 024
India

Full Text

Sir,

The central nervous system and oral cavity have a close anatomical location. At this time, diseases of central nervous system have been extensively studied in various specialties of biomedical sciences like as otology, ophthalmology, neurology, neurosurgery, and dentistry. Identification of orofacial manifestations of central nervous system is usually in direct relation with the liabilities of a dental surgeon. Preventive dental care for patients with neurological disorders needs a specific approach. Because of the fact that these patients belong to the category of patients with special needs; all kind of preventive and rehabilitative treatments necessitates a well-planned and specific approach. Neurological disorders affect the orodental tissues in different ways. As mentioned, the common neurocutaneous (phakomatosis) diseases include Sturge-Weber syndrome, tuberous sclerosis, and neurofibromatosis of von Recklinghausen and incontinentia pigmenti. These diseases are frequently remains unnoticeable but have significant direct relationship to oral cavity and orofacial structures. [1],[2] Oral environment may also be severely altered the neoplasias of orofacial nerves and their sheaths (e.g., neurofibroma, neurolemmoma, traumatic neuroma, and malignant schwannoma), cranial nerve tumors with orofacial affections (e.g., trigeminal neurinoma, acoustic neurinoma, and olfactory neuroblastoma), and systemic tumors with significant neural and orofacial symptoms (e.g., Gardner syndrome and multiple endocrine neoplasia). [3],[4],[5],[6]

Parkinson's disease frequently masquerade unique challenges in establishing and maintaining an effective and efficient dental management approach. People of nearly all ages with Parkinson's disorder countenance similar challenges; but for those who are older, the dilemmas can be particularly serious. The deleterious symptoms of Parkinsons pose challenges both for daily home dental hygiene measures and periodic recall visit intraoral examinations. Some of the key components household oral healthcare programs necessitate muscle-eye coordination, digital dexterity, and tongue-cheek-lip control. [7] Moreover, presence of tremor alleviates against effective oral hygiene and plaque control measures. Weakened swallowing capability can augment the risk of aspiration (choking) of sophisticated dental instruments. In addition, people with Parkinson's disease who have been on prescriptions like levodopa for several years may begin to develop dyskinesias, which can affect the jaw (where they are called orobuccal dyskinesias) as well as teeth grinding. Individuals suffering from Parkinson's disease may also experience dry mouth or xerostomia, which may be one of the most important aspects with consequences on the dental status and oral mucosa that frequently lead to the worsening of already existing masticatory difficulties or denture anxiety. As the normal salivary flow helps to maintain the integrity of the oral mucosa, reduction of the salivary flow severely compromises the remineralization process of oral hard tissues and new dental caries possibly will easily appear including root surface caries. [8] Dry mouth condition also lowers the resistance of the oral mucous membrane to the foreign body invasion. This is especially true for prosthetic trauma caused by the loosening of dentures due to the lack of the saliva as salivary biofilm is desirable for the perfect adhesion.

Orofacial manifestations of neurological diseases have direct relation with dentistry; therefore, dentists should be familiarized with those common diseases between neurology and dentistry. The potential overlap of neurological symptoms over dental one should be thoroughly explored as recognizing of them is very important and unfamiliarity with them may perhaps bothersome. [1],[9],[10] As a potent drug side effect, dry mouth has been known to be caused by over hundreds medications which necessitates a comprehensive salivary investigation including quality and quantity of saliva, the salivary pH, bacteriological salivary tests, and mycological salivary tests. Such patients are advised to take antimycotic drugs along with regular antibiotic therapy. Topical application of fluoride to teeth is not enough in case of low salivary pH as the efficiency of the fluorine decreases to a 5.5 pH (the critical pH). [11] Therefore, the regular contacts of tooth surface with acid foods; the demineralization is no subdued by the active fluorine ions. This led down the imperative role of patient motivation to stay away from strong acidic stuffs. So as to counterbalance the effects of the acidic pH, it is recommended to periodically moisten the oral mucosa with still water instead of artificial saliva (when it is possible). Furthermore, the use pharmaceuticals based on chlorhexidine mouthwash, gels, and toothpaste with baking soda is advocated that could increase the overall resistive capacity of the whole saliva. [12],[13] For physically or mentally handicapped or pediatric patients, the use of electric or sonic toothbrush is usually advocated as an excellent substitute to the normal manual toothbrush.

Oral manifestations of the neurological diseases fairly exhibit a coherent and reasonable association of these diseases with dentistry. We believe for the personalization of dental care for each patient with neurological diseases. Such act must concern with the recommendations for personal oral hygiene and the recall for dental hygiene in the dental clinics with the evaluation of overall dental profile, bacteriological and mycological tests, salivary flow estimation, and xerostomia diagnosis. Professional applications of dental pharmaceuticals like pit and fissure sealants which could help to check the development of dental caries. Moreover, a close communiqué between the neurologist and the dentist must be there in order to find the best recommendations for the patient in order to increase the life comfort for the patients who suffer from neurological diseases. So, as to familiarize dental surgeons with theses manifestations is important for them to have a better recognition, diagnosis, and correct decision upon treating these manifestations in such patients.

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