Dental Issues

Facial palsy can make it more difficult to brush your teeth on the affected side and food may accumulate in your cheek when eating without you being aware. A combination of food residue after meals and less efficient oral hygiene may increase your risk of tooth decay and gum disease.

Cleaning tips

It is important to clean your teeth or rinse your mouth after eating to make sure there is no food residue left in your mouth which could cause decay.

It can be difficult for some people with facial palsy to rinse. Some people find a waterpik or similar is useful to help get the food out.

Dry mouth

In addition, some causes of facial palsy may be associated with reduced saliva production which can lead to a dry mouth (xerostomia). One important function of saliva is to protect the teeth so when less saliva is produced your teeth will become more vulnerable to decay. It is therefore important to visit your dentist more regularly to help prevent unnecessary damage to your teeth and gums. Follow this link for further advice on dry mouth.

Dentures

Facial palsy can have an impact on how well dentures fit for people with false teeth. This is because normal cheek tone helps keep the denture in position. If the cheek is floppy, then dentures may not fit as securely as before. Visit your dentist for advice and help with any of these issues.

Altered taste

Occasionally, when a specific branch of the facial nerve (the chorda tympani) is affected, this can result in altered taste perception.

Mouth opening

Damage to the muscles and/or nerves responsible for opening and closing the mouth and chewing can cause the mouth to not open fully. This is referred to as trismus. This can be a common problem in facial palsy where there has been surgical input or radiotherapy. Being unable to open the jaw fully can cause problems with brushing the teeth, eating and chewing, as well as causing jaw pain or stiffness. Ask your GP for a referral to a consultant, Speech and Language Therapist or Physiotherapist with experience in managing trismus.

Ulcers and blisters

If you have experienced a sudden facial paralysis and have painful mouth ulcers and/or blistering of the tongue, your doctor should consider tests for Ramsay Hunt syndrome. See the mnemonic below for red flags and recommended treatment.

Mnemonic – spot the warning signs of Ramsay Hunt syndrome

What dentists should be aware of

Breathing difficulties

Some patients with facial palsy have nasal obstruction although this is uncommon. Dentists need to be aware that if someone has nasal obstruction and also struggles to open their mouth widely, having dental work carried out can be very traumatic.

Facial pain

Someone with unilateral facial palsy will often chew their food on the unaffected side of their mouth more. This overactivity can result in jaw pain and Temporomandibular joint (TMJ) disorder.

It can be difficult for someone with facial palsy to keep their mouth open for a length of time due to tight muscles in the face and neck. Dentists may wish to consider providing a mouth brace that allows the patient to rest one side of their face and helps to prop the mouth open.

Psychological impact

Some patients may be scared of having numbing injections after a facial palsy. It is extremely rare to have complications from dental injections but dentists should be prepared to listen and answer questions, and not minimise the patient’s concerns.

Gum health

Dentists should be aware that some people with facial palsy bite the inside of their cheek or the surface of their gums, which can lead to ulcers and infections. This can sometimes be due to having no feeling but not always.

Hearing

Some patients with facial palsy have hearing difficulties in one or both ears and may not hear instructions such as where to move the tongue.

Another problem for some facial palsy patients is when facial nerve damage affects the small protective muscle in the ear. This is called hyperacusis and makes everyday sounds seem much louder than they really are. It can also be painful. The noise from a dental drill may cause extreme discomfort.

Downloads for dentists

Download the Facial Palsy UK dental poster