Objective: To describe the case of a patient with Parkinson’s disease (PD) who suffered from a rapid deterioration of his oral health status following treatment adjustment and apomorphine pump initiation.

Background: The physical, behavioral and iatrogenic patterns associated with PD may have an overall and potentially cumulative detrimental effect on patients’ oral health. However, little is known about the effects of continuous subcutaneous apomorphine infusion (CSAI) on oral status.

Method: Case report, review of literature and pharmacovigilance databases search (French Pharmacovigilance database & VigiLyze).

Results: A 72-year old male with a history of PD (disease duration: 12 years) and type 2 diabetes presented with a rapid deterioration of his oral health status following PD treatment adjustment and apomorphine pump initiation. CSAI was initiated in February 2019 (flow rate: 4,5mg/h later increased at 4.8mg/h, 15h/day). Concomitant treatment included rasagiline, levodopa/benserazide, piribedil, alfuzosine, domperidone and metformine.
Within the following year, the patient -who already benefited from dental follow-up prior to treatment changes- suffered from two broken teeth associated with tooth decay at the collar level (portion between the crown and the root, around which the gum line develops). Functional discomfort was also reported.
If known preexisting risk factors  are found (diabetes and PD medications), CSAI initiation appears to have triggered a cascade of deleterious events. Levodopa and dopaminergic agonists are known to have several oral implications, but data are scarce on the potential deleterious effect of CSAI. The only available information comes from pharmacovigilance databases, where 3 cases of oral health degradation (tooth decay, broken tooth, dental root canal treatment) following CSAI initiation are reported, although direct causality was not established.

Conclusion: This case warrants further investigation on the effect of CSAI on the oral cavity. It also illustrates the necessity of multidisciplinary follow-up in PD patients, as underreporting is a major limitation to drug safety surveillance.

References: [1] Fiske J, Hyland K (2000) Parkinson’s disease and oral care. Dent Update 27, 58–65. [2] Friedlander AH, Mahler M, Norman KM, Ettinger RL (2009) Parkinson Disease: Systemic and Orofacial Manifestations, Medical and Dental Management. The Journal of the American Dental Association 140, 658–669. [3] Zlotnik Y, Balash Y, Korczyn AD, Giladi N, Gurevich T (2015) Disorders of the oral cavity in Parkinson’s disease and parkinsonian syndromes. Parkinsons Dis 2015, 379482. [4] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R (2012) Periodontitis and diabetes: a two-way relationship. Diabetologia 55, 21–31.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deterioration-in-oral-health-status-potentially-associated-with-apomorphine-pump-initiation-a-case-report/