Orofacial Dyskinesia in Elderly

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 Video 1. Segment 1: Severe orofacial dyskinesia. Segment 2: Dyskinesia improves with sensory trick (putting a handkerchief between teeth). Segment 3: Dyskinesia completely improved after use of denture. Segment 4: Re-emergence of dyskinesia during eating (food stuck in mouth). Segment 5: Without denture, eating is better (food bolus does not get stuck), but dyskinesia is worse

Author:  Sanjay Pandey

Article first published online:   25 JUL 2015 | DOI: 10.1002/mdc3.12192


A 65-year-old male presented with insidious onset of gradually progressive involuntary movement around his mouth and jaw for 2 years (see Video 1). Six months before onset of the movement, he had a partial teeth extraction. As movements worsened, he had great difficulty eating and talking. His dentist extracted the remaining teeth and advised a denture. A week after using the denture, there was marked reduction in his facial dyskinetic movement, but his difficulty eating did not improve. In the last 6 months, he has changed the denture on three occasions and each time has complained that it was ill fitting. He never had any exposure to neuroleptic medications.

Question

What is the most likely diagnosis?

  1. Tardive dyskinesia
  2. Oromandibular dystonia
  3. Edentulous dyskinesia

 

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Answer

Edentulous dyskinesia (ED) is characterized by stereotyped abnormal movements of the jaw and mouth, which occur in elderly edentulous persons.[1] This movement disorder occurs in 7% to 13% of edentulous individuals and may occur with or without dental prosthesis. In a study, 12 of 72 edentulous (16%) patients and none of the 75 nonedentulous patients had orofacial dyskinesia (P < 0.01).[2] Eight patients had total and 4 had a partial teeth extraction. Denture was used by 6 patients (1 had partial denture and 1 considered his denture to be ill fitting). Exact pathogenesis of this movement disorder is not clear, but loss in nerve endings and peridontal ligaments resulting from teeth extraction cause proprioceptive loss, which seems to play an important role. Movement pattern in ED is different and never associated with tongue movement, which is typically observed in tardive dyskinesia and oromandibular dystonia.[3] The majority of ED patients report problems with their dentures with a very high subjective denture dysfunctional index.[3, 4]

 

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