Patient Positioning & Armamentarium

Patient positioning goes hand-in-hand with providing a comfortable, stress-free, safe environment. Orthostatic hypotension is a symptom of PD and a common adverse event associated with many of the medications prescribed to manage PD.45,46 It is important to be prepared for this by raising the chair slowly when a procedure is complete. The patient will likely need some adjustment time to prevent falling.50,61

Providers who deliver care to patients diagnosed with PD should consider the patient’s ability to swallow, ability to open his or her mouth, and the amount of involuntary movements the patient experiences. Dysphagia and muscle rigidity often accompany a diagnosis of PD.1-4 Dysphagia increases the risk of aspiration and choking. When dysphagia is present, providers should deliver care in a semi-supine (45°angle) position.22 Limitations with swallowing make the use of power scaling devices and air polishers problematic. These devices should be used with caution. When muscle rigidity is present, and a patient has difficulty opening his or her mouth, providers should offer a mouth prop or bite block.22

Involuntary movements usually accompany PD at some point in the disease process.1-4 Providers must assess the level of involuntary movements and provide the “least restrictive” intervention to safely deliver care. Often a safe environment can be provided by cradling the patient’s head during treatment to minimize involuntary movements of the head and neck.22,61 Assistants can also be helpful to facilitate stabilization.22 Patients with advanced disease, or patients who are having invasive dental procedures, may require the use of a patient stabilization device to safely deliver care.42

Glass ionomer cement and resin-modified glass ionomer cement are the restorative material of choice when providing restorative care to patients diagnosed with PD. These materials are less sensitive than composite to restorative techniques. The adhesive properties of glass ionomer allow for minimal preparation and bonding to both enamel and dentin. Additional advantages include biocompatibility, acceptable esthetics, and ability to release fluoride.7,62,63