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Teeth grinding from Caffeine or acidic food or drink?


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#1 miracleseeker

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Posted 10 November 2012 - 09:14 AM

Hi,

This is my first time posting here. My mom has had PD for 15 years and dementia for 8 years. 6 months ago she stopped swallowing her medication out of fear of choking so she would chew them up first. She takes Stalevo which supposedly need to be taken whole. I tried every which way to substitute other medication that does not need to be swallowed whole with little success. One of which was Parcopa. It gave her bad breath and she lost 3 teeth from the medication. I know this for certain because all of her teeth are intact after I took her off of the drug. Because of her condition no dentist will work on her fear of her lashing out at them during any long procedures. My mom is very gentle and does not have a bad bone in her body but the stigma stays with the disease.

One dentist was willing to clean her teeth and nothing more so she got that. That same day my mom started to grind her teeth and has been doing so daily for the past 6 months. Some days it is worse than others. She has had days where she didn't grind at all. Her doctor prescribed Artane but again some days she would grind more than others so the drug is not working.

I first blamed it on misalignment of her teeth then I started looking into her diet. I give her instant coffee latte every morning with her cereal. I removed it from her diet a week ago and the grinding has lessened. However she likes sofas so I occasionally give her Pepsi with lunch or dinner. I did this a day ago and yesterday she grind her teeth non stop from morning and it was truely frightening to witness. it's not the first time she's had a caffienated drink with lunch or dinner so I don't understand why it hit her so hard this time. How long does a can of soda with Caffeine stay in the system? She finally stopped before grinding before dinner. But then again why didn't she grind in the middle of the night which was closer to the time she had it with dinner? She didn't start until the morning which was 10 hours later?

Maybe I'm grasping at straws and caffeine is not the reason? I try to time it all but nothing makes sense. At the beginning when she first started to grind she would only grind in the late afternoon where I would give her a lemon ice tea or a fruit juice blended with cranberry. Is it acide? Is that bad too? My mom has always been the type of person that liked everything and could eat or drink anything with no problems. Do you think that's changed now? What should she avoid?

She takes crushed Stalveo and it's better than nothing. I have also suspected maybe it's too much going into her system and it's over stimulating her which results in the teeth grinding to relieve pressure. Sinemet and all the other PD meds I have tried is not strong enough for her which is why I stayed with Stalevo until something else comes along where swallowing whole is not necessary and is as effective as Stalevo. I have too many suspects to deal with and I can't get a definite answer from anyone nor can I find out myself through trial and error. I hope you can give some insight based on what you have read from others.

Thank you for listening.

#2 Kathrynne Holden, MS

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Posted 10 November 2012 - 01:03 PM

Dear Miracleseeker,
I would be inclined to think that the levodopa itself is causing the teeth grinding/bruxism; this is a known side effect of the medication. It is possible that the caffeinated and acidic drinks are causing enhanced / quicker absorption of the levodopa and thus increasing the bruxism.

As PD progresses, it can affect more areas of the brain and nervous system, including the autonomic nervous system; and also, new side effects which were never present before, can start to emerge. That may be what your mother began experiencing six months ago, perhaps set in motion when the dentist cleaned her teeth.

You might ask her neurologist about trying “liquid Sinemet” since she is afraid of swallowing pills. In this case, the day’s allotment of regular Sinemet is crushed and mixed with water or fruit juice and vitamin C, and given in small amounts throughout the day. The liquid form is absorbed much quicker than the pill form; it also wears off sooner, so it must be given oftener. However, it does allow for closer titrating, and it may be that you could reduce the amount of levodopa needed; if so, that might help reduce her bruxism.

I hope this is helpful; let me know if you have other questions.
Best regards,

Kathrynne Holden, MS

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#3 miracleseeker

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Posted 10 November 2012 - 05:41 PM

Thank you for responding. I have tried Sinemet in crushed and liquid form. She grinds too and it also makes her very sleepy and "high" and she cannot move freely like she does with Stalevo. She goes to a daycare center in the morning until after lunch so I cannot give her medication to her at that time because she will be knocked out.

Actually she gets sleep attacks all day long and is really only awake about 4 hours altogether in a day. She takes Mirapex with Stalevo which probably contributes to the sleep attacks but she needs that to function. I've tried getting her off slowly with really bad consequences. She takes her afternoon dose around 1:30pm which is after she's had lunch from the center. Unfortunately I know this means it is fighting with the food in the stomach and probably does not get absorbed as much as it should but I do not have a choice in the matter. She does not sleep soundly for her afternoon nap meaning she moans and groans. I don't know what I can give her to sleep more peacefully. I got some calcium gummy bears for her hoping that will have a calming effect? She's already taking multi vitamins in the same form so I thought might as well give her calcium too.

She seems a little better today with the grinding. I gave her only milk this morning and she's not as bad. I bought some Ovatine for flavoring to her milk and gave that to her yesterday. I don't know if that was part of the problem too? Will malted beverages make the levodopa get absorbed quicker too?

#4 Kathrynne Holden, MS

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Posted 11 November 2012 - 07:08 PM

To help with calming, and perhaps improve sleep, consider powdered calcium and magnesium -- you can crush the tablets in an inexpensive pill crusher. She should be able to safely have up to 800 mg calcium and 350 - 400 mg magnesium daily. Divide this into 2-3 portions, given throughout the day. Also, if she will accept it, chamomile tea is both relaxing, and an aid to sleep. You might also omit caffeinated drinks, switching to decaf lattes, and sodas that do not contain caffeine.

Regarding the Mirapex, if she is over age 70, I would be a bit concerned. Elderly folks do not do as well on the agonists; besides sleep attacks, it may contribute to the teeth grinding.

Milk is a good choice for calcium, and can be soothing; however, milk protein can be especially bad for blocking levodopa absorption, particularly as PD advances. I suggest you switch to Rice Dream or a soy milk alternative on cereal, smoothies, etc., for a couple of months and see if there is any improvement in her symptoms. Some people have found that they could actually reduce the amount of levodopa needed when they avoided milk protein.

Let me know if you have other questions, I will help if I can. If you care to provide more data, I might be able to give a fuller response:
- age
- when diagnosed with PD
- the names of all medications used (both PD, and other medications, including over-the-counter medications, vitamins, herbal or other supplements)
- any other diagnosed conditions (such as elevated blood pressure, food allergies, diabetes, high cholesterol, etc.)
- any particular complaints or concerns such as dyskinesia, motor fluctuations, nausea, edema, weight changes, constipation, sadness, etc.

It is important to see a neurologist who is a movement disorders specialist; please note whether that is the case.
Best regards,

Kathrynne Holden, MS

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#5 miracleseeker

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Posted 12 November 2012 - 09:15 AM

My mom turned 74 last month. She's had PD since she was 59 years old. The dementia set in about 8 years ago and then everything went downhill from there. She was no longer able to manage her medication and then eventually stopped swallowing it whole and instead would chew everything that was placed in her mouth. I know the teeth grinding is from chewing Stalevo and getting the medicine too much too soon overstimiulating her. A few months ago I had caught her off guard and she swallowed one whole and she was so awake and alive for the next 6 hours. I always wished I could shoot the pill down her throat so she could be like this always.

Her medication:

Stalveo 150mg 3 times a day (5:30am, 1:30pm, 8:30pm)
Mirapex .75mg 3 times a day (taken with Stalevo)
Namenda 10mg 2 times a day (5:30am and 8:30pm)
Norvasc 10mg once a day (8:30pm)
Multivitamin gummy bears after breakfast
Calcium with vitamin D gummy bears after breakfast
Fish oil gummy bears after dinner

I was giving her bee pollen with ginseng that comes in a vial that she drinks out of a very thin straw for energy. I think it may her grinding worse so I stopped it. It seems anything that is good for energy will just make her grind. I am trying very hard to find ways to make her stay awake and this grinding business is blocking my intentions.

I would occasionally stop the milk during times when she had loose stools and give soy or almond milk but they don't taste that good to her. Thanks for the tip about milk protein interfering with absorption. I will try and see what happens if I take out the dairy.

She used to shake a lot in between doses but now not so much and more stiffness and shuffle walking instead. She seems to thrive on Mirapex. The more the better but I decreased it to a comfortable level so she wouldn't be as sleepy.

I know all the medication is actually contributing to her brain fog but what can I do?

I thought the grinding would stop when caffeine is removed but she's still at it. It sounds like she's chewing glass.

#6 Kathrynne Holden, MS

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Posted 13 November 2012 - 06:02 PM

Well, again, teeth grinding is a known effect of levodopa; so while removing caffeine may help to some extent, it could well be that the levodopa is still the root cause.

I remain concerned about the Mirapex, in view of her age; have you discussed this with her neurologist? I do understand that she is doing better with the Mirapex, and perhaps it is best she stay on it. But I do wish you would post this question to “Ask the Doctor” as the side effects of agonists can become quite severe for the elderly.

Regarding her sleepiness, Namenda and Norvasc can have sleepiness, dizziness, and fatigue as possible side effects. So, with the Mirapex, she may be experiencing additive effects from the three medications. Perhaps her prescribing doctor(s) would consider reducing the dosage, in hopes of decreasing these side effects; it would be worth discussing.

Also, milk and dairy products, and citrus products, can increase blood levels, and thus the effects, of Namenda. We can hope that substituting an alternative milk product, and removing citrus and caffeinated products may bring about some improvement. Ideally, she would be able to have good control of PD symptoms on a reduced amount of Stalevo; but let us see what happens.

I know you are in a most difficult situation, and you are dealing with it admirably. Your mother is fortunate to have such a capable and perceptive caregiver. Let me know if I can help further; I do think that Dr. Okun would be a good source with regard to Mirapex, and that her sleepiness warrants a talk with her doctors regarding dosage of Namenda and Norvasc.
Best regards,

Kathrynne Holden, MS

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#7 miracleseeker

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Posted 13 November 2012 - 06:29 PM

I think my first priority is getting the teeth grinding removed. Today her doctor prescribed Amantadine and reduced Stalevo from 150mg to 125mg 3 times a day. Based on prior experience when I tried taking out just 25 mg for one dose, my mom couldn't even stand on her own or walk unassisted. I will keep her on 150mg and hope the Amantadine will block out the ill effects while maintaining the level of Stalevo my mom's body needs.

I tried changing my mom from Mirapex to Requip but it didn't work well for her. Without Mirapex my mom will shake uncontrollably. I know her dementia like persona is mostly from the side effects of the PD meds. I pray every night that it is discovered my mom does not have PD and that it is safe for her to go off all her drugs and her old self is back and we can once again talk and laugh and do things together like before. Yes I was always a mama's girl and it shows right?

I get frustrated with my older sister who does not live with us. She visits and takes my mom to the doctor but never asks enough questions or act like she cares enough to ask. This is why I feel compelled to do everything I can possibly do because I do not have the support I need.

#8 Kathrynne Holden, MS

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Posted 14 November 2012 - 07:18 PM

You are a postcard daughter. You have made your mother's life safer, healthier, and happier, believe me. No one knows her needs and circumstances as well as you do, and you are both patient and determined in seeking further information to continue to help her. I truly wish you had more help and support; this is such a challenging, and wearing, situation for you.

Do let me know if you see any results from switching away from cow's milk, and if the amantadine is helpful. If there is any insight I can provide, I'll do my best. Dr. Okun is on your side as well, don't hesitate to post your questions to him. You and your mother are in my thoughts and prayers.
Best regards,

Kathrynne Holden, MS

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#9 miracleseeker

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Posted 15 November 2012 - 09:18 AM

Thank you. I had a slight change of plans and haven't started the Amantadine. I have decreased the Stalevo from 150 to 125 for morning and afternoon only leaving the 150 for evening because that's the longest time between dosages. So far the teeth grinding has lessened greatly and she hasn't lost much strength at the same time and seems to smile more and talk more (gibberish mostly but I'll take it) But then it's only been a day so we will see.

Yes I write to Dr. Okun and the Pharmacist too. I cover all the grounds. :razz:

I have stopped milk and given her Rice Dream the past 2 days. It is very watery and tasteless but she doesn't seem to mind. She still loves ice-cream so i will only give that to her on a treat basis.

#10 Kathrynne Holden, MS

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Posted 16 November 2012 - 06:36 PM

PD manifests in such incredibly different ways in different individuals. In a few cases, I have known of people who required less medication as they aged and/or as PD progressed, This is by no means always the case. But I would never discount the possibility. If she is experiencing dyskinesia during the day, but not at night, then it is just possible that she is now overmedicated, where she was not before.

Maybe she is less well able to tolerate milk protein now and was requiring increasing doses, which then in turn became too much and caused dyskinesia. PD is an endless guessing game, with very few clues for us to go by, unfortunately. Perhaps omitting milk protein and reducing Stalevo may help, I only wish there was a guarantee.

Meantime, do consider adding magnesium, and perhaps chamomile tea to help with relaxation, and perhaps - just maybe - lessen her teeth grinding. You are both in my thoughts and prayers.
Best regards,

Kathrynne Holden, MS

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#11 miracleseeker

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Posted 18 November 2012 - 09:04 AM

I also think my mom requires less medication too. How else can this be explained that she can go without the PD meds for 9-10 hours in between doses from evening to morning and be alert and walking unassisted to the bathroom at the 10th hour?

Yesterday was not a good day. She grind in the afternoon shortly after her meds which is the norm for her but she also grind at bedtime after the evening meds and was hallucinating with her eyes closed really bad. I finally gave in and gave her Amantadine. It kept her awake most of the night and I don't know if it really calmed her down or just the PD meds had settled and she was going to calm down anyways.

I really don't know what to do. She is already taking a decreased dose of Stalevo for the past week but nothing much as changed. She seems better between doses. It's like I am causing her to grind and moan and groan and be out of it by giving her medication. Does she really have Parkinsons? Maybe she's been mis diagnosed all this time and have been drugged for so long that her body has gotten used to it and will suffer withdrawals similar to someone who has PD so it's hard to tell. I know because she gets Stalevo crushed instead of whole it is too much too soon but seriously she has the same effects with regular Sinemet too and with Sinemet she has no strength on it.

I work full time so I don't have the time to take her to specialists that are far away and cannot afford to pay their fees. I feel so bad for my mom.

#12 Kathrynne Holden, MS

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Posted 18 November 2012 - 06:20 PM

If she responds to levodopa, that is generally considered a definite sign that PD is present. I do believe, though, that a neurologist who is a movement disorders specialist is the best solution for your mom. Her case is very complicated, due to dementia along with the advancing PD. Could your sister help out here? Or could you take a day off work and take her? I do realize it is expensive, but your sister should share the costs or else help by driving your mom. An expert opinion could make all the difference for her -- and for you as well.

Also, I wonder if she has had recent blood tests for vitamin B12 and homocysteine. As we age, it becomes more difficult to metabolize B12 from food; our body's supply declines very gradually over a period of several years, and the signs of deficiency mimic Alzheimer's disease such that many people have been misdiagnosed with dementia when in fact they were deficient in B12.

Homocysteine is a substance that builds up in the blood after meals; it is normally cleared from the blood by the combination of vitamins B6, B12, and folate. But if any one of these vitamins is deficient, the homocysteine builds up in the blood and can cause memory impairment and dementia. The reason this is of concern is because research shows long-time users of levodopa are more likely to have elevated homocysteine. If her primary care doctor has not conducted tests for B12 and homocysteine, I would ask that this be done as soon as possible. If she is deficient in B12, that can be corrected with supplements.
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#13 miracleseeker

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Posted 23 November 2012 - 05:24 PM

Her blood levels have always been fine. I have heard of this before and have paid attention to it.

I am at my wit's end. My mom has been on a reduced dosage of Stalevo from 150mg to 125mg 3 times a day for the past week and for the 1st 4 days she stopped grinding and I thought this is it. The reduction worked and then slowly she started up again. Her doctor said it would take up to 2 weeks for Amantadine to work and that's if it will work and during this time she will be a walking zombie from the side effects. I am so frustrated.

I've stopped diary, caffeine, and now sodas from her diet to see if this will help. She's also had urinary retention the past few days. One of those days she didn't pee for over 12 hours straight. Because of the reduction of her PD medication she cannot walk unassisted anymore because she has trouble balancing. The shaking is still at a minimum so thank god for that. If the grinding continues then I might as well have her go back to her usual dosage of 150mg 3 times a day or bring back 150mg to the night dosage. All this trial and error is confusing me greatly and all at my mom's expense and the expense of my sanity.

My sister has her own family and does not live in the same city as us so we are not her priority. She does not have to live with the constant moaning and groaning and teeth grinding and lack of sleep that I have to experience nightly. My anxiety level is creeping up and I am just at a loss for words.

People always say you need a break. What people do not understand is a break is just a temporary escape from reality. I rather stick around until a resolution is found and then I can rest. I could be physically away but not mentally.

#14 Kathrynne Holden, MS

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Posted 25 November 2012 - 07:15 PM

I know this is most frustrating and very hard on you, and it's not possible to provide individualized answers via an email forum. PD advances, and with its advance, medication regimens that previously worked well suddenly stop working. It can be very difficult to manage late-stage PD, especially when dementia is present. As her serum B12 and homocysteine levels are fine, the dementia does not appear to be related to deficiency.

Is her physician a movement disorders specialist? That is the single most important thing in her life right now. Generalist neurologists often don't have the same level of experience with PD and this is of special concern in the later stages, and with the presence of dementia.

Is it possible that the Norvasc, taken at night, is increasing her sleepiness, and perhaps that's why she can go so long without Stalevo? I would also ask the prescribing physician whether the Namenda is helping or not; it can cause hallucinations, dizziness, and back pain. Perhaps the reason for her moaning could be pain-related. There is considerable research regarding the way people with dementia demonstrate pain, and the moaning could be such a sign. If it is not helping, the physician may want to discontinue it in view of her many concerns with hallucinations, teeth grinding, moaning. It may be that the hallucinations are the cause of teeth grinding, it's hard to say.

I wish you and your mother the very best, and wish I could offer more help.
Best regards,

Kathrynne Holden, MS

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#15 miracleseeker

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Posted 26 November 2012 - 01:14 PM

You have been more help to me than you know. At least you are putting questions in my head to think about all the possible causes. My mom's previous neurologist prescribed Namenda after Aricept and Exelon gave her nightmares or muscle weakness. I asked her once if it was necessary and how I can tell if it's even working. She said to keep her on because without it she would be farther along with the dementia. I really don't know if that is true so to this day she's still taking it.

The Norvasc is a godsend for my mom. Her blood pressure was sky high for a while before that and now it's been regular for a long time. I always suspected that it caused drowsiness which is the reason I have her take it at bedtime.

The moaning and groaning is more of a 'dopamine high' and not of agony. Trust me she does not look like she's in pain when she's doing it. I've watched her while she took her nap and seen how the teeth grinding occurs. It is during the moaning and groaning stage where she would then yawn a few times and as she's closing her mouth then... she will have a look of discomfort like her jaw is feeling tight and she then bites down and the clicking noises and chewing glass noises begin.

Yesterday I had her take 1.5 tablets of Sinemet in place of the 125mg Stalevo in the afternoon and she had a very peaceful nap and no grinding. The only downside was it wore off quickly and by the 6th hour she was twitching and drooling a bit. My sister thinks we haven't given it enough time so she thinks we should continue with 125mg Stalevo for all 3 doses of the day. The Amantadine was not good for her. She kept rubbing her chest which I thought meant she had heart palpitations or pain. Her legs were like wet noodles when she walked. Just like Stalevo she thinks I didn't give it enough time. I told her I know how my mom is. If something works it works. I don't want her to suffer for 2 weeks to find out if something will work and in my personal experience I dont' think it's for her. The only dyskinesia she's having is in the mouth area so I don't think it qualifies to say she has dyskinesia to take Amantatine.

We have found a movement specialist from the yellow pages that is somewhat close to us but he's on vacation right now so we will have to wait to see him. There is also the matter of the cost involved. Botox treatments are extremetly expensive if that's what the doctor will suggest for the grinding. I was just hoping decrease of the meds will solve the problem. Sometimes the answer is right in front of our noses but we are just not looking.

Thanks again for your suggestions. Talking to a woman is always better in a comfort level.

#16 Kathrynne Holden, MS

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Posted 28 November 2012 - 07:21 PM

I'm happy to know her moaning is not due to pain. It sounds as though you may have hit on a solution with the 1.5 tablets of Sinemet and that it might be a better choice in terms of less teeth grinding. Perhaps you might ask her doctor about a combination -- a Sinemet pill and then at the sixth hour some liquid Sinemet for its quick effect while waiting for the next pill to kick in?

It's good you've found a movement disorders specialist; it may be that Botox isn't needed, I hope not. Let us know the results of your visit; I will be hoping for a decrease in her medications, that would be ideal.
Best regards,

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#17 miracleseeker

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Posted 29 November 2012 - 09:28 AM

No I think it's still a total amount of Levodopa she gets in a day that contributes to the grinding. She's been on 125mg Stalevo for a few days consistently and so far she seems to finally adjust to it with minimal grinding. Of course she's been like this before and I get my hopes up and then BAM she starts grinding non stop again.

The 1.5mg Sinemet was good but like I said it wore off fast and my sister thinks it's always better to get the same medication instead of cutting and pasting with similar meds. If we give her more Sinemet to reduce the wearing off time then that's just more Levo. Yes vivious cycle indeed. The moaning still continues and is very disruptive to her sleep and MINE. I tried giving her a lose dose of Melatonin and it gave her nightmares. I am trying to find some Calcium with Magnesium that is small enough so I can crush and have less for her to take with apple sauce.

My sister said she knows people at her church that is way worse off than our mother so seeing my mom like this is really not that bad. I do not want to compare since I know there will always be someone in better or worse condition. I just want my mom whole and happy and what's best for her. I get very sad when I see people who have given up on their loved ones and lets them deteriate because they were told it was hopeless. I'm constantly researching and trying. I only have 1 mother and I love her dearly.

#18 Kathrynne Holden, MS

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Posted 30 November 2012 - 05:34 PM

There is a product called "Natural Calm" distributed by Natural Vitality. It is powdered magnesium that you dissolve in water and drink. The company also makes "Osteo Calm" which is a liquid calcium-magnesium product. These should be easy for your mother to take. Iherb.com sells them in the larger size. My Natural Market has smaller 8 oz sizes and individual packets which are a less expensive way to try and see if they work. http://www.mynatural...al calm&mp_mt=b

I don't care to compare different people's circumstances; who is to say which person is worse or better off? That is not in our power to judge. You're doing the right thing in seeking information to best help your mother, and she, on some level, knows this.
Best regards,

Kathrynne Holden, MS

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#19 miracleseeker

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Posted 17 December 2012 - 05:41 PM

Hi,

My mom's teeth grinding has decreased dramatically after decreasing the Stalevo from 150 to 125 three times a day. It took a month but finally it seems to be working. Unfortunately she's lost 2 teeth in the past week. I was giving her almonds to crunch on these past 6 months on a daily basis to relieve the pressure of her jaw whenever she would grind. It's funny how it finally took it's toll now just when the stress of the grinding was coming to an end.

I need to take her to see a dental specialist about getting implants. I don't know if she will be a good candidate but I do not know of any other options. My poor mom already lost a few teeth the prior year but this latest episode just made created more empty space in her mouth and I feel so badly for her. The one thing that gives her pleasure is to eat and she always has a good appetite.

I am now so paranoid that I give her soft mushy food to eat and not surprising I have removed all nuts from her diet. Even with missing teeth last year she still managed to crunch the hard almonds each time and never had a problem. What broke her tooth was eating a chocolate whopper ball. Can you believe this? The next day another came off with a very soft piece of pork chop. I am filled with panic now that another tooth will break off. Her gum seems to be strong since the teeth are breaking off and not falling off. She always drinks milk and takes calcium gummies so I am hoping she will be able to get implants.

I do not want my mom to end up like those old women with the sourpuss face because they have a mouth of gums and no teeth.

#20 Kathrynne Holden, MS

Kathrynne Holden, MS

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Posted 01 January 2013 - 04:52 PM

I'm sorry to be so long in replying; family matters intervened and I was away from internet access. I am very sorry to hear your mother has lost teeth, I know that must be a bitter experience both for her and for you. I do hope that the decreased grinding will help to save the remaining teeth, and that she will be able to have implants, or perhaps dentures. You might also ask the dentist if fluoride treatments might help strengthen her teeth. If it is any consolation, I know many folks who have lost all their teeth and yet still enjoy eating and have a fairly normal diet -- jaws and gums are often remarkably strong and capable of chewing much better than one would think. She is in my thoughts and prayers for this coming year, for better management of PD symptoms, and for important dental work.
Best regards,

Kathrynne Holden, MS

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