What Is Orofacial Dyskinesia?
Involuntary mouth movements, chewing motions, and lip smacking in older adults are medically known as orofacial dyskinesia. The term describes abnormal, involuntary movements of the face, tongue, and jaw. While it can occur at any age, it is more prevalent in the elderly population. These movements can be continuous, repetitive, and stereotypical, often impacting a person's ability to eat, speak, and socialise. Understanding the potential causes is crucial for family members and caregivers to know when to seek medical advice.
Common Causes of Involuntary Mouth Movements
The reasons behind why some old people constantly move their mouths are varied and often stem from a combination of factors. They can be neurological, medication-induced, or related to simple oral health issues. Identifying the specific trigger is vital for correct management.
Medication-Induced: Tardive Dyskinesia
One of the most well-known causes of constant mouth movements is a condition called Tardive Dyskinesia (TD). This is a neurological side effect resulting from the long-term use of certain medications, particularly older antipsychotics used to treat conditions like schizophrenia and bipolar disorder. These movements can also include grimacing, pursing of the lips, and writhing of the tongue. While newer medications have a lower risk, it is still possible for TD to develop. Early recognition and discussion with a doctor about adjusting medication are important for potential management.
Dental Problems and Ill-Fitting Dentures
For many elderly individuals, oral health plays a significant role. The loss of teeth, a condition known as edentulism, can lead to a type of movement disorder called edentulous dyskinesia. This is thought to be caused by a loss of proprioceptive feedback from the nerve endings in the gums and jaw, leading the brain to send faulty signals that result in repetitive chewing movements. Similarly, poor-fitting dentures can cause discomfort and lead a person to constantly adjust or move their mouth to achieve a better fit, which can be mistaken for a more serious condition.
Age-Related Changes and Neurological Issues
As we age, our bodies experience many changes, and the fine-motor control of facial muscles can be affected. The 'software' for coordinating tongue and teeth movements can become 'buggy,' leading to unintentional movements. Additionally, certain neurological conditions are linked to orofacial dyskinesia.
- Dementia: Patients with dementia may exhibit a behaviour known as perseveration, which is the involuntary repetition of a word, gesture, or phrase. In this context, it manifests as repetitive chewing or mouth movements.
- Parkinson's Disease: While known for tremors, Parkinson's can also lead to decreased motor control in the face, contributing to difficulties with swallowing and speaking, and sometimes causing involuntary mouth movements.
- Meige Syndrome: A rare and specific type of dystonia that causes involuntary contractions of the muscles of the eyes, face, tongue, and jaw. It often appears in mid-life but can be a cause in older adults.
Other Contributing Factors: Dry Mouth and Dehydration
Many medications commonly prescribed for seniors list dry mouth (xerostomia) as a side effect. This includes medications for high blood pressure, depression, and allergies. A dry mouth can feel uncomfortable, prompting an individual to constantly move their tongue and mouth in an effort to stimulate saliva production. Ensuring proper hydration is a simple step that can help alleviate this discomfort and reduce associated mouth movements.
When to Seek Professional Advice
While some constant mouth movement may be harmless, it is always best to consult a medical professional to rule out more serious causes. If you observe any of the following, a doctor’s visit is warranted:
- Sudden Onset: The movements begin abruptly and without a clear trigger.
- Medication Changes: The onset follows a change in medication dosage or a new prescription.
- Impact on Daily Life: The movements interfere with eating, speaking, or social activities.
- Associated Symptoms: The movements are accompanied by other signs such as difficulty swallowing, grimacing, or uncoordinated movements in other body parts.
A doctor can conduct a physical examination, review the person's medication history, and potentially refer them to a neurologist for a specialised diagnosis.
Management and Support Strategies
Managing orofacial dyskinesia involves a multi-faceted approach, depending on the underlying cause. Here are some strategies that can be helpful:
- Review Medications: A thorough review of all current medications with a doctor can identify potential triggers. Medications causing TD may be slowly tapered off or replaced with safer alternatives.
- Ensure Proper Dental Care: Regular dental check-ups are essential to ensure dentures fit correctly and to address any underlying oral health problems. A dentist can check for teeth wear, gum issues, and denture fit.
- Hydration: For individuals with dry mouth, increasing fluid intake can help. Sugar-free gum or lozenges can also stimulate saliva production.
- Behavioral Therapy: For cases linked to dementia, behavioral interventions can help manage perseveration. Distractions or redirects can sometimes help reduce the repetitive behavior.
- Botulinum Toxin Injections: For specific types of dystonia, botulinum toxin injections can be effective in relaxing the affected muscles.
- Support Groups: Connecting with others who have similar conditions can provide emotional support and practical tips for managing the condition. The Dystonia Foundation offers resources and information.
Comparison of Dyskinesia Types
| Feature | Tardive Dyskinesia (TD) | Edentulous Dyskinesia (ED) | Dementia-related Movements |
|---|---|---|---|
| Primary Cause | Long-term use of neuroleptic/antipsychotic drugs. | Loss of teeth (edentulism) and associated proprioception loss. | Symptom of dementia (perseveration); neurological decline. |
| Movement Type | Repetitive, involuntary movements of face, jaw, lips, and tongue. | Stereotyped, repetitive jaw and mouth movements. | Repetitive chewing, licking, or lip-smacking; gesture repetition. |
| Associated Factors | Older age, female gender, chronic psychiatric disorder. | Absence of teeth; ill-fitting or uncomfortable dentures. | Cognitive impairment; memory loss; decline in executive function. |
| Treatment Focus | Drug review, dosage reduction, alternative medications. | Improved denture fit, dental health, and potentially oral surgery. | Behavioral management, redirection techniques. |
Conclusion
While observing a loved one with constant mouth movements can be concerning, it's important to remember that there are many potential causes, and some are more benign than others. The key is to avoid jumping to conclusions and instead seek a professional medical opinion. A doctor's diagnosis is essential for determining the correct cause, whether it's a side effect of medication, a dental issue, or a neurological condition. With proper care, support, and management, it is often possible to reduce or manage the severity of these involuntary movements, leading to a better quality of life for the individual.
