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To Your Good Health: Teeth Grinding Is Common in the Elderly

Dear Dr. Roach: My mother-in-law is 95 and lives in a nursing home. Sometimes when we visit, I can barely stand to be in her presence because she savagely grinds her teeth, making an awful grating, creaking noise. Could there be some medical reason for this? — L.D.

Answer: Many conditions common in the elderly are associated with teeth grinding. (We have medical terms for pretty much everything — teeth grinding is called bruxism.) Alzheimer’s disease, Lewy body dementia (a type of memory loss often associated with visual hallucinations and movement disorders), stroke, Parkinson’s disease and many medications can cause this problem.

Treatment is difficult. A mouth guard to protect the teeth can be very useful, but some people won’t keep them in. Her geriatrician is the right person to discuss this with. Some medications (especially some classes of antidepressants) can cause or worsen daytime bruxism, so stopping those may help. Drug treatment of daytime bruxism is not very helpful. Botulinum toxin (Botox) has been effective in some instances.

Dear Dr. Roach: Could you shed some light on Cushing’s disease? Four people in the same family have it. The doctors say it has something to do with the thyroid gland. — Anon.

Answer: Cushing’s syndrome, which is different from Cushing’s disease, is an excess of cortisone or similar corticosteroids. It can be caused by taking too much steroid for too long, usually as treatment for a serious medical condition. Cushing’s disease is a special case of Cushing’s syndrome, when the excess cortisone is caused by a tumor in the pituitary gland, which spurs the adrenal gland to make excess amounts of hormone. Weight gain, almost exclusively in the abdomen, a striking round “moon” face, a fat pad on the back of the neck and upper back (“buffalo hump”), diabetes, pigmented stretch marks and high blood pressure are common findings in any form of Cushing’s syndrome.

It is very unusual for Cushing’s disease to run in families. Also, it does not affect the thyroid, although thyroid conditions can sometimes mimic Cushing’s (and vice versa). I suspect that what this might be is a rare condition called multiple endocrine neoplasia type I (MEN-1). This does run in families, and combines risk for pituitary, parathyroid and pancreatic islet cell tumors. (The parathyroid glands sit on top of the thyroid gland and secrete parathyroid hormone, responsible for calcium metabolism. The pancreatic islet cells are where insulin is made.) Not everybody with MEN-1 will have tumors in all of these glands. Parathyroid tumors are the most common. An endocrinologist is the expert in Cushing’s and the MEN syndromes.

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