Understanding Involuntary Mouth Movements in Older Adults
When an older person exhibits constant, repetitive movements of the mouth and tongue, it is known as orofacial dyskinesia. These movements can include lip-smacking, puckering, grimacing, or chewing motions, and they are almost always involuntary. While not a disease itself, this symptom can be a sign of several underlying health issues, with the most prominent being medication-induced tardive dyskinesia. Recognizing the cause is the first step toward finding a management strategy.
Tardive Dyskinesia: A Common Medication-Induced Cause
Tardive dyskinesia (TD) is a movement disorder that develops months or years after taking certain medications, particularly older antipsychotic drugs. These medications, known as dopamine receptor-blocking agents (DRBAs), are used to treat conditions like schizophrenia, bipolar disorder, and other psychiatric issues. Older adults, especially post-menopausal women, are particularly vulnerable to developing TD. The dopamine-blocking action of these drugs can lead to a hypersensitivity of dopamine receptors in the brain, resulting in excessive, involuntary muscle movements.
TD can manifest in a variety of ways, from chewing or sucking motions to tongue protrusion and cheek puffing. Some people might experience fidgeting or swaying, and the severity can range from mild and barely noticeable to severe and debilitating. It is crucial to note that TD is a medical condition, not merely a medication side effect, and can persist even after the offending drug is discontinued.
Neurological Disorders Beyond Medications
While medication is a leading cause, several other neurological conditions can cause an older person to constantly move her mouth and tongue. These disorders also involve disruptions in the brain's signals that control movement.
- Parkinson's Disease: While most known for tremors in the hands, Parkinson's can also cause involuntary movements, including rhythmic tremors of the jaw, lips, or tongue. As the disease progresses, stiffness in the mouth and jaw muscles can also lead to speech and swallowing difficulties. The medications used to treat Parkinson's, such as levodopa, can also cause dyskinesia as a side effect.
- Other Dyskinesias: Spontaneous or idiopathic dyskinesias can occur in elderly individuals without any history of drug exposure. A related condition, Meige syndrome, is a form of dystonia that causes involuntary contractions of the face, tongue, and jaw muscles.
- Dementia-Related Behaviors: Repetitive behaviors, known as perseveration, can occur in people with dementia. A constant chewing motion or other repeated oral movements can be a symptom. Dry mouth, a common issue in older adults and often a side effect of medication, can also cause an individual to constantly chew or move their mouth to stimulate saliva production.
The Role of Oral Health and Dentures
Surprisingly, factors related to dental health can also trigger repetitive mouth movements in older adults. Edentulous dyskinesia, characterized by abnormal jaw and mouth movements, can occur in elderly people who have lost their teeth. The loss of teeth and subsequent weakening of facial muscles can contribute to these unintentional movements. Ill-fitting dentures are another common culprit, as the discomfort can cause a person to unconsciously chew or move their tongue as they adjust. Regular dental check-ups are essential to rule out these possibilities and ensure proper oral care.
Treatment and Management Options
If the underlying cause is a medication, the first course of action is typically to adjust or change the drug, if medically safe. However, in many cases, especially with tardive dyskinesia, symptoms may persist even after the medication is stopped. The recent development of VMAT2 inhibitors, such as valbenazine and deutetrabenazine, has provided effective treatment options for managing the symptoms of TD.
For dyskinesia related to other conditions, or when medication is not the cause, other treatments may be explored:
- Botox Injections: Injections of botulinum toxin can be used for localized, focal dyskinesia, such as persistent lip-puckering or tongue protrusions.
- Deep Brain Stimulation (DBS): For severe cases that do not respond to other treatments, surgical options like DBS, where electrodes are implanted in the brain to block irregular nerve signals, may be considered.
- Stress Management: Anxiety and stress can worsen involuntary movements. Relaxation techniques, such as deep breathing or mindfulness, can be helpful.
- Lifestyle Changes: A healthy diet rich in antioxidants and adequate sleep are important for brain health and may help manage symptoms. Some studies have also explored supplements like Vitamin B6 or Ginkgo biloba.
Comparing Common Causes of Orofacial Dyskinesia
| Feature | Tardive Dyskinesia (TD) | Parkinson's Disease | Dental/Oral Issues | Dementia (Perseveration) |
|---|---|---|---|---|
| Primary Cause | Long-term use of dopamine-blocking medications, such as antipsychotics or metoclopramide. | Damage to dopamine-producing neurons in the brain. | Ill-fitting dentures, loss of teeth, dry mouth, or weakened facial muscles. | Neurological changes associated with cognitive decline. |
| Onset | Delayed, typically months to years after starting a medication; can be faster in older adults. | Gradual, with symptoms like tremors or slowed movement progressing over time. | Can be immediate if caused by new dentures, or gradual with age-related muscle and tooth loss. | Appears as part of the cognitive decline and associated behavioral changes. |
| Type of Movement | Repetitive, jerky, or writhing movements like lip-smacking, tongue protrusion, and chewing motions. | Rhythmic tremors of the jaw, lips, or tongue, often present at rest. | Unconscious chewing or adjusting motion to stimulate saliva or adapt to dentures. | A repeated, non-purposeful gesture, word, or phrase. |
| Treatment | Adjusting medication, VMAT2 inhibitors, Botox injections for specific areas. | Dopaminergic medications (like levodopa), Deep Brain Stimulation (DBS) for severe cases. | Dental adjustments or replacement, treatments for dry mouth, and oral care. | Behavior management, memory aids, and underlying dementia treatment. |
Conclusion: Seeking a Medical Diagnosis is Crucial
The constant movement of an older person's mouth and tongue is a complex symptom that should never be ignored. While it can stem from a variety of causes, from medication side effects like tardive dyskinesia to neurological conditions such as Parkinson's, a definitive diagnosis from a healthcare professional is essential. Many of the potential causes have effective treatment options, and early intervention can improve quality of life and prevent further complications. By carefully reviewing the individual's medical history, including all medications, and performing a thorough neurological and oral examination, a doctor can accurately pinpoint the cause and recommend the most appropriate course of action. Encouraging a loved one to seek medical attention is a vital step toward managing this concerning health issue. For more information, consider exploring resources from reputable organizations like the National Institute of Neurological Disorders and Stroke (NINDS).
