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Bell’s Palsy 1 The dental hygienist must have a background in conditions of the head and neck and carry this knowledge in order to identify these conditions prior to treatment. Bell’s palsy is one condition of the head and neck. It is a weakness in the face that can be caused by something as simple as a cold sore. Bell’s palsy occurs in few people and symptoms could be like that of a stroke. With or without treatment most people tend to feel better within a couple weeks after diagnosis. Bell’s palsy is an acquired weakness of one side of the face due to the sudden breakdown or damage to the seventh cranial or facial nerve (Hain, 2001). Other cranial nerves might also be affected such as inflammation of the circumvallate papillae (9th), a decreased gag reflex (9th), and palatal (10th). Bell’s palsy can develop over hours or even days. The most common cause of Bell’s palsy is the common cold sore or herpes simplex (Wolfe, 2002). In 75 percent of Bell’s palsy cases there is no cause found, but a viral infection is usually speculated (Hain, 2001). Bell’s palsy is more common in pregnant women, people recovering from a viral infection, people with diabetes, sarcoid, HIV, various cancers, those with recent influenza or respiratory infection, and those with a family history of the disease (Hain, 2001 & Wolfe, 2002). In pregnant women with Bell’s palsy the satisfactory recovery rate was significantly lower than for those in the general public (Gillman, Klein, May, & Schaitkin, 2002). According to Hain, about 25 out of 100,000 people develop Bell’s palsy per year (2001). Chances increase slightly with age and there is even a higher chance of development in the winter. Most people tend to feel better within two weeks and about 80 percent recover in three months (Wolfe, 2002). In a few people, symptoms may last longer or never disappear. It is possible for Bell’s palsy to reoccur in the same person, but only 10-15 percent of the time according to Wolfe (2002). The highest reported number of recurrences is nine (Kurica, 2001). The symptoms of Bell’s palsy may be very sudden with pain behind the ear before any noticable facial muscle weakness or numbness (Hain, 2001). It may first be noticed by the person when he or she looks in the mirror or when food tends to collect between his or her cheeks and gums. Symptoms of Bell’s palsy may resemble those of a stroke and should be reported to a doctor immediately (Wolfe, 2002). Individuals with Bell’s palsy may have the inability to wrinkle the forehead on the affected side, inability to whistle and a person’s speech may be slurred (Hain, 2001). Tearing can occur because of the eye’s inability to close completely, causing difficulty with blinking. Taste sensation on the front half of the tongue may be obliterated along with difficulty chewing on the affected side, and papillitis may occur on the fungiform papillae. Sounds may appear louder on the affected side. Drooling, dropping of the mouth at one corner, inability to smile, twitching of the muscle, and pain in the face or ear may also occur (Wolfe, 2002). Diagnosis of Bell’s palsy is based on the medical history of the patient, a physical examination and laboratory tests. Tests for diabetes, sarcoidosis, and HIV are occasionally performed if weakness occurs on both sides of the face (Hain, 2001). Bell’s palsy has no specific treatment, but injections of anti-inflammatory medications or physical therapy may be helpful (Fehrenbach & Herring, 2002). Patients of Bell’s palsy need to be careful not to let the eye dry on the side of facial weakness (Wolfe, 2002). Generally artificial tears are used during the day and lacrilube jelly during the night, but these may cause side effects. Eye patches are not recommended because they can be counterproductive by causing discomfort and potential damage. The antiviral drug Acyclovir can improve facial function when used with steroids. Painkillers and moist heat may provide some short-term relief. The affected individual may feel more tired than normal during the healing period, therefore rest is very important to the recovery process. To remove the food that may get stuck between the gingiva and cheek, frequent brushing of the teeth and rinsing of the mouth is important. A dental hygienist must know the causes and the symptoms of Bell’s palsy to be able to detect it in patients prior to dental treatment. The hygienist can review the medical history along with doing a visual exam while talking to the patient to check for things such as weakness on one side of the face when smiling, slurred speech or the eye’s inability to close on one side. The elderly should be watched extremely close because the chances of developing this condition increases with age. If the hygienist suspects Bell’s palsy the patient should be advised to see a physician to be diagnosed and to begin treatment. When a patient has been diagnosed with Bell’s palsy, the hygienist can instruct the patient how to have the best oral hygiene possible. Brushing after every meal or at least rinsing with water may be necessary to remove food particles that may get stuck between the gingival a cheek. The dental hygienist must have knowledge about the nervous system involved with the head and neck. The relationship of Bell’s palsy with the facial nerve makes it important to the head and neck. The weakness on one side of the face may be caused by a cold sore. It is a rare condition common in pregnant women or people with recent viral infections. Symptoms look like those of a stroke with inabilities on the side of the face affected. Diagnosis is determined by a physical exam and laboratory tests. Treatment is usually medication and physical therapy. A dental hygienist must by aware of the aspects of Bell’s palsy to detect it in patients prior to treatment and be able to better help those patients achieve and maintain the best oral hygiene possible. References Drobny, M., Kurica, E.,Goldman, A., Grofic, M., Nosal, V., Strakova, J., & Vosko, M. (2002). Unique case of eleven Bell’s palsy episodes. The International Journal of Neuroscience. 111(1-2): 55-66. Fehrenbach, M.J. &Herring, S.W. (2002). Nervous system. Illustrated Anatomy of the Head and Neck. (pp. 212-213). W.B. Saunders Company. Philadelphia, Pennsylvania. Gilman,G., Klein, S., May, M., & Schaitkin B.(2002). Bell’s palsy in pregnancy: a study of recovery outcomes. Otolaryngology and Head and Neck Surgery. 126 (1): 26-30. Hain R. (2001). Bell’s palsy. Neurology. Northwestern University Medical School. Retrieved: http://www.neuro.nwu.edu/meded/CRANIAL/bells.html Wolfe, K. (2002). Bell’s palsy. Discovery health.com. Retrieved: Http://health.discovery.com/diseasesandcond/encyclopedia/543.html.
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