Objective: We are presenting 3 cases of bruxism, which presented in elderly (>65 years) Parkinson’s disease (PD) as disabling features. The patients were psychologically and socially disturbed because of bruxism.
Design: Bruxism is one of the disabling but rare described symptom of PD. Bruxism is believed to have multifactorial etiologies including factors such as local malocclusion, occlusal interference, high restoration, or some local irritating conditions. Systemic factors include nutritional deficiencies and endocrinal disorders. Bruxism has also been considered a psychosomatic phenomenon. Elderly PD patients attending neurology OPD enquired for history of bruxism, severe enough to affect functional and social well being. Out of 47 PD patients 3 had significant bruxim. In these cases, local, systemic, and psychological etiologies were ruled out by relevant examination and investigation.
Materials and Methods: A team of doctors, which included 2 dental surgeons, one neurologist and one psychiatrist, examined elderly patients who had bruxism as disabling feature of PD patients. The surgeons took detailed history of bruxism and dental surgeons preformed a local examination of gum and teeth. The neurologist confirmed diagnosis of PD and helped in excluding systemic cause of bruxism. The psychiatrist helped in excluding psychosomatic cause of bruxism. The following are the characteristics of 3 cases-
Case1- A 65 year old male has history of grinding of teeth on and off over the last year. After 6 months of these symptoms, he developed feature, suggestive of Hemiparkinson’s disease at right side. In this case, bruxism was presenting features of PD which are very rare.
Case 2- A 68 year old male had history of PD for 7 years, then he developed severe bruxism. His social life was miserable because of this problem.
Case 3- A 70 year old female has Hemiparkinson’s disease for 2 years and then developed bruxism severe enough to produce psychological disturbances in her.
Results: The common features in all these patients were that they were psychologically and socially disturbed because of bruxism. All had cardinal features of PD, i.e. akinesia, rigidity and tremor, and postural imbalance. Parkinson's plus features were excluded by appropriate clinical examination by neurologist. There was attrition of teeth (wear and tear) on incisal, occlusal, and approximal surface, loosening or drifting of teeth, gingival recession, and hypertrophy of masicatory muscle. Patients were treated with levodopa-carbidoapa combination and advised to use teeth guard. All patients showed improvement in PD symptoms, as well as in bruxism.
Conclusion: Bruxism is rare clinical presentation in PD. Although exact cause of bruxism in PD is not described it may be due to occlusion defect because of tremor and rigidity of masticatory muscle found in PD. Physician and dental surgeon should know this entity so that appropriate diagnosis can be made.
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