What topics should integrated neurologists and dentists focus on?

Integrated Care Topics for Neurologists and Dentists

Core Collaborative Focus Areas

Neurologists and dentists should prioritize interprofessional collaboration on obstructive sleep apnea (OSA), neurodegenerative disease oral health management, orofacial pain syndromes, and medication-related oral complications. These represent the highest-impact areas where integrated care directly improves morbidity, mortality, and quality of life outcomes.

Obstructive Sleep Apnea and Sleep-Disordered Breathing

• Dentists serve as critical screening partners for OSA, with 61% of patients visiting dental offices at least annually, positioning them ideally to identify undiagnosed sleep-disordered breathing 1
• Mandibular advancement devices (MAD) are first-line alternatives when CPAP fails or is not tolerated, reducing apnea frequency, improving nocturnal oxygenation, and demonstrating superior adherence compared to CPAP 1
• Bidirectional referral protocols are essential: qualified dentists screen and refer to sleep physicians for polysomnography or home sleep testing, while physicians refer back for MAD fabrication and titration 1
• Contraindications requiring neurologist awareness include severe temporomandibular disorders, severe periodontal disease, and inadequate dentition 1

Neurodegenerative Disease Oral Health Management

• Parkinson's disease patients require proactive dental integration from diagnosis, as oral health problems exacerbate dysphagia, mental health symptoms, and increase aspiration pneumonia risk—a leading cause of death in this population 2
• Progressive motor impairment directly correlates with worsening dental status, including increased decayed teeth and plaque accumulation requiring individualized preventive care plans 2, 3
• Huntington's disease patients show significantly more decayed teeth and plaque compared to controls, with higher motor impairment and lower functional status leading to deteriorating dental health even in premanifest stages 4
• Regular preventive dental examinations must begin at diagnosis, not after oral complications develop 2, 4

Orofacial Pain Differential Diagnosis

• Trigeminal neuralgia presents with brief, severe unilateral pain radiating from jaw toward ear, triggered by chewing, shaving, or cold exposure, requiring carbamazepine as first-line treatment with phenytoin or baclofen alternatives 5
• Cluster headache (Horton's syndrome) manifests with extreme unilateral eye, forehead, temple, jaw, or tooth pain associated with lacrimation and rhinorrhea, treated with ergotamine, sumatriptan, or verapamil prophylaxis 5
• Atypical facial pain is continuous with intermittent episodes in non-muscular, non-joint areas, where dental procedures like extractions are contraindicated and exacerbate the condition—requiring antidepressants rather than surgical intervention 5
• Temporomandibular disorders require non-surgical management including splints, occlusal equilibration, and NSAIDs, with surgery reserved for carefully selected cases 5

Medication Management and Oral Complications

• Neurologists must coordinate with dentists before initiating treatments affecting oral health, particularly in patients preparing for radiation therapy, chemotherapy, or hematopoietic stem cell transplantation 1
• Steroid management for infantile spasms requires cardiology and dental consultation due to cardiomyopathy risk and oral complications 1
• Antiepileptic medications commonly cause gingival hyperplasia and xerostomia requiring preventive dental protocols 1

Pediatric Neurological-Dental Interface

• Infants and children with severe developmental disabilities require specialized dental referral for behavior management and clinical care challenges 1
• Cleft lip/palate and craniofacial anomalies demand coordinated care between pediatric neurosurgeons and pediatric dentists for comprehensive management 1
• Head trauma evaluation requires dental assessment for tooth fractures, intrusion, luxation, and avulsion, with immediate referral for crown fractures with pulp exposure 1, 6, 7

Systemic Disease Oral Manifestations

• Cardio-facio-cutaneous syndrome patients require baseline neurologist evaluation with ongoing dental monitoring for feeding difficulties, gastroesophageal reflux, and failure to thrive affecting oral health 1
• Sickle cell disease patients need coordinated pain management protocols addressing both systemic and oral pain manifestations 1

Practical Implementation Framework

Screening and Referral Protocols

• Dentists should screen for neurological red flags including altered mental status, severe headache, facial asymmetry suggesting Bell's palsy, and sleep-disordered breathing symptoms 1
• Neurologists should assess oral health status at each visit, particularly evaluating ability to perform oral hygiene, medication side effects, and dysphagia risk 1, 2
• Establish clear referral pathways with defined urgency criteria: same-day for severe pain or pulp exposure, within days for moderate sensitivity, within weeks for preventive care 6, 7

Communication and Documentation

• Shared electronic health records should flag patients requiring integrated care, including those with Parkinson's disease, Huntington's disease, epilepsy, and OSA 1, 2
• Document medication changes affecting oral health, particularly anticonvulsants, anticholinergics, and immunosuppressants 1

Patient-Centered Care Coordination

• Patients and caregivers must receive anticipatory guidance about oral health risks specific to their neurological condition at diagnosis 1, 2
• Schedule coordinated appointments when possible to reduce burden on patients with mobility limitations 1, 3
• Address social determinants affecting both neurological and dental care access, including transportation, cost barriers, and health literacy 1

Common Pitfalls to Avoid

• Never delay dental referral for neurodegenerative disease patients until oral complications develop—preventive care from diagnosis is essential 2, 4
• Avoid performing dental extractions or sinus surgery for atypical facial pain, as these procedures exacerbate the condition rather than providing relief 5
• Do not prescribe MAD without sleep study confirmation of OSA diagnosis, as proper patient selection and device titration require objective data 1
• Never underestimate oral health impact on aspiration pneumonia risk in patients with dysphagia from neurological conditions 2