What is Tardive Dyskinesia?
One of the most prominent reasons behind involuntary tongue and mouth movements in older adults is tardive dyskinesia (TD). The term “tardive” means “delayed,” as the condition typically develops after months or years of taking certain medications. The movements are involuntary, repetitive, and often affect the face, mouth, and tongue.
- Antipsychotic Medications: TD is most commonly associated with older antipsychotic medications used to treat conditions like schizophrenia and bipolar disorder. These drugs, such as haloperidol, block dopamine receptors in the brain, which can lead to involuntary movements over time.
- Other Medications: While less common, certain antidepressants, anti-seizure medications, and anti-nausea drugs like metoclopramide can also trigger TD.
- Risk Factors: Older age is a significant risk factor for developing TD, as is being female, and having a history of substance abuse.
Neurological Conditions Beyond TD
While TD is a major cause, other neurological disorders can also result in involuntary or abnormal tongue movements.
- Oromandibular Dystonia: This rare neurological disorder involves involuntary muscle contractions of the jaw, tongue, and other facial muscles. These contractions can be sustained or repetitive, and in some cases, can be painful.
- Parkinson's Disease: This progressive neurodegenerative disorder is known for causing movement problems, including tremors and slowness. In some individuals, these symptoms can affect oral muscles, leading to unusual tongue movements.
- Meige's Syndrome: A rare form of dystonia, Meige's syndrome involves both the muscles of the jaw and tongue (oromandibular dystonia) and the eyelids (blepharospasm).
- Dementia: Some forms of dementia can cause neurological symptoms that affect the mouth and tongue. For example, a phenomenon known as “perseveration” can cause repetitive gestures, which may include mouth or tongue movements.
Oral and Dental Issues
Sometimes, the cause is less complex and relates to the physical condition of the mouth itself. Changes in oral health that commonly occur with aging can trigger these movements.
- Poor Denture Fit: Ill-fitting dentures are a common problem for older adults and can be a major cause of involuntary mouth and tongue movements. The individual may constantly move their tongue to adjust the uncomfortable prosthetic.
- Dry Mouth (Xerostomia): Older adults are more susceptible to dry mouth, which can be caused by medication side effects or dehydration. To stimulate saliva production, a person may unconsciously move their tongue and mouth.
- Tooth Loss: The loss of teeth can alter muscle tone and function in the mouth and face. This may lead to involuntary muscle movements as the body attempts to compensate for the change in structure.
Comparison of Common Causes
| Cause | Mechanism | Key Symptom | Primary Treatment Approach |
|---|---|---|---|
| Tardive Dyskinesia | Long-term medication use, often antipsychotics, blocking dopamine receptors. | Repetitive, involuntary movements of the mouth, tongue, and face. | Adjusting or switching medication, specialized movement-disorder drugs. |
| Oromandibular Dystonia | Faulty nerve signals in the brain causing abnormal muscle contractions. | Sustained or repetitive jaw and tongue muscle contractions. | Botulinum toxin injections, medication management. |
| Parkinson's Disease | Neurodegeneration affecting movement control. | Tremors, slowness, rigidity, which can extend to facial and oral muscles. | Parkinson's medication, deep brain stimulation in severe cases. |
| Dental Problems | Physical discomfort from poor denture fit, dry mouth, or tooth loss. | Constant tongue or mouth movements to adjust or stimulate saliva. | Addressing underlying dental or hydration issues, proper fitting of dentures. |
| Dementia | Neurological damage affecting motor control pathways. | Repetitive behaviors or gestures (perseveration), including mouth movements. | Management of underlying dementia, addressing oral comfort. |
Diagnosis and Management
Because there are several potential causes for involuntary tongue movements, a proper diagnosis from a healthcare professional is essential. A doctor will typically perform a clinical assessment, review the patient’s medication history, and may conduct neurological tests.
- Medication Review: For suspected tardive dyskinesia, a doctor will evaluate if a medication is the culprit. The dose may be lowered, the medication might be changed, or new medications to manage TD symptoms may be introduced.
- Dental Consultation: A dentist can check for issues with dentures, tooth loss, or dry mouth and recommend solutions. For some cases of orofacial dyskinesia, an oral appliance has shown promise as a form of sensory trick to manage symptoms.
- Specialized Treatment: For more complex neurological conditions, a neurologist may be required. Options like botulinum toxin injections can help manage muscle contractions in dystonia cases.
- Comprehensive Care: In cases of dementia or other neurodegenerative diseases, a comprehensive approach involving neurologists, geriatric specialists, and dentists is often necessary to manage symptoms and improve quality of life.
Conclusion
Involuntary tongue and mouth movements in older people, while sometimes unsettling to observe, are often symptoms of underlying and treatable conditions. From medication side effects like tardive dyskinesia to dental irritants and neurological disorders, the reasons are varied. Early diagnosis, a review of medications, and specialized care can help manage the symptoms and improve an individual's quality of life. Anyone observing these movements should consult a healthcare professional to identify the cause and determine the appropriate course of action.
A note on seeking help
It is important for both the patient and their caregivers to seek professional medical advice rather than attempting to self-diagnose or treat the condition. A proper evaluation ensures that the correct underlying issue is identified and managed safely. For additional information on movement disorders, the Cleveland Clinic offers valuable resources for patients and families.
