Bell’s palsy is a temporary weakness or paralysis that affects the seventh cranial nerve, commonly known as the facial nerve.2 Also known as “acute peripheral facial palsy of unknown cause,”1 this condition is frequently referred to as idiopathic because it often arrives without any known cause.1,2
Dental patients who have experienced Bell’s palsy may have difficulty adapting to “normal” oral hygiene procedures. The dental hygienist’s role with these patients is discussed below.
During an episode of Bell’s palsy, inflammation and swelling put pressure on the nerves surrounding the facial muscles, hindering the control and function of the muscles, and it should be noted that Bell’s palsy only affects one side of the face.1-3
While the condition is thought of as idiopathic, some research may support the theory that a viral infection can cause the condition.4
Quick Review of Nerve Anatomy
Anatomy class may have occurred many years ago for some dental hygienists, so here is a brief review of facial nerve anatomy. The facial nerve, also known as cranial nerve seven (CN VII), originates at the brain stem and travels through the facial canal located within the temporal bone, which exists via the stylomastoid foramen.4 Upon exit, the nerve splits into the terminal branches at the posterior edge of the parotid gland.4
This nerve provides motor innervation to the facial muscles, parasympathetic innervation to the lacrimal gland as well as salivary glands, and sensory innervation to the anterior two-thirds of the tongue.4
Who is at Risk of Bell’s Palsy?
As previously stated, Bell’s palsy has been deemed idiopathic, but there are identified risk factors for developing the condition. These can include the following viruses: Epstein Barr, herpes zoster, mumps, coxsackie viral infection, adenovirus, and herpes simplex.1,3 A few systemic risk factors can include diabetes, high blood pressure, and various autoimmune diseases. A person may also be at an increased risk for developing the condition if they have family members who have suffered from it.1,3
Pregnant women are at a higher risk for developing Bell’s palsy in their third trimester and immediately following delivery. Women suffering from preeclampsia or gestational diabetes may be at an even greater risk.1,3
Clinical Appearance of Bell’s Palsy
Patients suffering from Bell’s palsy have a unilateral drooping of their facial features. This often appears as follows: the patient’s forehead lines and/or wrinkles will disappear, an enlargement of the space between the eye and the eyelid, a straightening of the upper lip, and a downward turn of the corner of the mouth.3
These patients will often also suffer from dry eye due to the inability to close the affected eyelid, pain in the ear and face, headache, drooling, and tinnitus.1,3 Due to the paralysis and inability to control the muscles, people experiencing Bell’s palsy often have trouble eating, drinking, and speaking.3 This difficulty arises since the motor, parasympathetic, and sensory innervation pathways are disrupted during the paralysis.4
This nerve provides motor innervation to the facial muscles, parasympathetic innervation to the lacrimal gland as well as salivary glands, and sensory innervation to the anterior two-thirds of the tongue.4
How is Bell’s Palsy Diagnosed?
Bell’s palsy is diagnosed via the process of elimination. The treating physician will rule out other potential causes of facial paralysis such as stroke, tumor, and Lyme disease.1-3 Bell’s palsy can usually be distinguished from other causes of facial paralysis upon clinical examination due to its telltale rapid onset (usually over several hours) coupled with its lack of evidence of obvious trauma or other neurological disorders.1-3
What also sets it apart from other diagnoses is that with this form of facial paralysis, the patient usually recovers within days to weeks. 4
In some cases, the use of electromyography (EMG) testing to determine the extent of the nerve damage may be utilized and the use of imaging techniques such as MRI or CT to help rule out other potential causes for the paralysis.1-3
How Long Does Bell’s Palsy Last?
Around 85% of people who are afflicted with Bell’s palsy improve within three weeks of the onset of symptoms. For a smaller population, it may take three to five months to improve.1-3
Some clinicians recommend that patients have more testing/diagnostic procedures completed if they do not improve after three weeks to rule out nerve damage.5
In some cases, residual symptoms can linger, which can include weakness of the facial muscles, involuntary muscle movements, frequent tearing of the eyes, and contracture.4,5
Bell’s Palsy Treatment
If Bell’s palsy is caught early enough, the patient may be administered steroid medication to help prevent swelling in the face and help aid in a quicker recovery.4 An eye patch may be used in conjunction with synthetic tears to help prevent damage to the cornea.4
Antiviral medication may be given in some cases, but its efficacy has yet to be determined and is sometimes considered experimental.1,3 Physical therapy may be indicated for patients to help massage, stretch, and elongate the affected muscles.1
How Dental Hygienists can Help Patients with Bell’s Palsy
Patients battling Bell’s palsy may suffer from both emotional and physical pain. Emotional pain can be caused by temporary facial disfigurement and uncertainty of how long the paralysis may last. Physical pain can be caused by the disruption of the lacrimal and salivary gland function. As we know, our patients who suffer from xerostomia often complain of a painful sensation caused by the lack of saliva.
Dental hygienists can help by being compassionate, understanding, and supportive. These patients may not be able to tolerate their normal oral hygiene adjuncts or routines. For example, patients may not be able to tolerate a mouthwash if they cannot properly close their mouths. They may not be able to clean interdentally either for this same reason.
Offering alternatives such as water-powered devices, electric toothbrushes, and long-handled flossing devices may be beneficial. If they are suffering from xerostomia due to the disruption of salivary gland function, suggesting different dry-mouth products may be helpful to help lubricate the tissues and make the patient more comfortable.
If these patients are having difficulty closing their mouths properly, you can imagine this could create challenges during a dental appointment. Patients who are experiencing an episode of Bell’s palsy may benefit from their dental appointment being broken up into multiple visits, depending on the treatment recommended and their tolerance level.
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Bell’s Palsy References
- Bell’s Palsy. (n.d.). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034
- Bells’s Palsy. (n.d.). Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/bells-palsy
- Bell’s Palsy. (n.d). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/5457-bells-palsy
- Dulak, D., Naqvi, I.A. Neuroanatomy, Cranial Nerve 7 (Facial). Treasure Island (FL):StatPearls Publishing. 2021 Jan. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526119/
- Bernstein, M., Holland, N. Bell’s Palsy. J. BMJ Clin Evid. 2014 Apr; 2014: 1204. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980711/#__ffn_sectitle
