As with Parkinson's patients, PSP sufferers need your guidance
by Cynthia L. MacDonald, RDH
Progressive supranuclear palsy (PSP) may appear on a patient's health history; however, many dental team members may not understand the disease or the importance of working within the potential limitations that may accompany it. The purpose of this article is twofold: first, to identify and promote awareness of PSP, and second, to educate and share knowledge about how to provide treatment to these patients.
You may recall that the comic actor and acclaimed concert pianist Dudley Moore was afflicted with this disease. As a dental hygienist, I have encountered two patients diagnosed with PSP, and I also have more than 10 years of personal knowledge since this fatal disease is responsible for ending my mother's life.
PSP is a sporadic, progressive, neurodegenerative brain disease which affects nerve cells that control walking, balance, mobility, vision, speech, and swallowing. Five to six people per 100,000 will develop PSP, similar to the numbers of those diagnosed with ALS, also known as Lou Gehrig's disease. In its early stages of gait disorder, PSP is most often diagnosed as Parkinson's or a "Parkinsonian" disorder. PSP is identified later through progressive symptoms. On average, PSP begins between 40 and 60 years of age and has no known geographic, occupational, or racial preference. Clinical studies and research around the world show there is a clumping of Tau proteins in the cortical and subcortical areas of the brain. Currently there is no effective treatment, medication, or cure, and aspiration pneumonia is usually the final cause of death.
Because of weakened movement of the mouth, tongue, and throat, it is critical that the dental practitioner be aware of the stage the patient is displaying at the time of any dental treatment. Aspiration complications will likely occur in later progression of PSP as the pharyngeal flap loses its ability to close properly, resulting in difficulty in swallowing. Keeping the patient upright in the chair with little or no additional water will help eliminate coughing and possible aspiration of liquids. While the patient still has the ability to be in attendance, he or she would benefit from frequent oral hygiene appointments to aid in reducing bacteria. Because there is a genuine threat of introducing bacteria into the lungs of the pneumonia-prone PSP patient during episodes of aspiration, it is essential to have oral hygiene discussions with the patient, family members, and caregivers to stress the importance of minimizing bacterial growth.
Some additional recommendations to aid in home care should include the use of a power toothbrush and a non-alcohol mouth rinse such as Biotene. A moist oral environment encourages easier swallowing. Avoiding or minimizing consumption of noncooked dairy items - such as ice cream, cottage cheese, and milk -will reduce thickening of saliva. Drinking club soda or sparkling water will also cut through thickened secretions. If a patient has dentures or partials, be sure they fit well and are kept clean to promote easier swallowing and reduce bacterial growth.
Although a patient's eyes may give the appearance of being disengaged, it is very important to know that PSP DOES NOT impair the patient's ability to understand and comprehend. At all times give the PSP patient the respect of speaking to them directly and not as a "third party." Asking direct questions that require yes or no answers will make it easier for patients to respond, while allowing them to keep their dignity intact. Practicing patience and allowing a little extra chair time will help avoid what could be a stressful appointment.
PSP support groups are located around the country through the Foundation for PSP|CBD and Related Brain Diseases in Maryland. Volunteering to present an oral health care meeting would be a great community service for all those involved with this life-ending disease. PSP patients and their families go through this journey with hope. As the Cure PSP motto states: "Because hope matters."
For more information, please contact Cure PSP Foundation for PSP|CBD and Related Brain Diseases, (800) 457-4777, www.curepsp.org, Cynthia MacDonald, RDH, Support Group Facilitator, swflasuppgrp.aol.com.
Cindy MacDonald, RDH, is a 1993 graduate of Georgia Perimeter College (formally DeKalb College) in Dunwoody, Ga. She is employed full time with Dr. H. Richardt in Naples, Fla., and part time for Dr. S. Binslev on Marco Island, Florida. Cindy holds licensure in Michigan, where she was born and raised, and Florida. On the second Saturday of every month she facilitates the Southwest Florida PSP Support Group of Naples. She is a member of ADHA.
- Boeve B. Cure PSP Webinar. Mayo Clinic. Rochester, MN. 2010.
- Verdum L. Cure PSP Webinar. Mayo Clinic. Rochester, MN. 2010.