Participation in rehabilitation programs during the early to middle stage of the disease may be beneficial as it translates into long-term maintenance of motor and functional performance. Rehabilitation during the late stage aims to compensate for motor and functional losses. For long-term independent management, the therapist may develop home exercise programs for appropriate people.Additionally, an increasing number of people with HD are turning to palliative care, which aims to improve quality of life through the treatment of the symptoms and stress of serious illness, in addition to their other treatments. Medications
Tetrabenazine was approved in 2000 for treatment of chorea in Huntingtons disease in the EU, and in 2008 in the US. Although other drugs had been used "off label," tetrabenazine was the first approved treatment for Huntingtons disease in the U.S. The compound has been known since the 1950s. An alternative to tetrabenazine is amantadine but there is limited evidence for its safety and efficacy.Other drugs that help to reduce chorea include antipsychotics and benzodiazepines. Hypokinesia and rigidity, especially in juvenile cases, can be treated with antiparkinsonian drugs, and myoclonic hyperkinesia can be treated with valproic acid. Tentative evidence has found ethyl eicosapentaenoic acid to improve motor symptoms at one year. In 2017 Deutetrabenazine a heavier form of tetrabenazine medication for the treatment of chorea in HD was approved by the FDA. This is marketed as Austedo, and is the first small-molecule drug to receive U.S. FDA approval.Psychiatric symptoms can be treated with medications similar to those used in the general population.
Events such as tooth decay and tooth wear can also initiate dentine formation.Dentinogenesis is initiated by the odontoblasts of the pulp. Odontoblasts are specialised cells that lay down an organic matrix known as pre-dentine. This pre-dentine is subsequently mineralised into dentine. Mineralisation of pre-dentine begins at the dentino-enamel junction during tooth development and progresses towards the pulp of the tooth. After growth of pre-dentine and maturation into dentine, the cell bodies of the odontoblasts remain in the pulp, along its outer wall, and project into tiny tubules in the dentine. Pre-dentine is composed of 90% type I collagen and 10% non-collagenous proteins (including phosphoproteins, proteoglycans, growth factors, phosphatases such as alkaline phosphatase, and matrix metalloproteinases (MMPs)), and this composition is significantly altered when it is mineralised into dentine. See the Structure section for information about the composition of dentine. Structure
Unlike enamel, dentin may be demineralized and stained for histological study. Dentin consists of microscopic channels, called dentinal tubules, which radiate outward through the dentin from the pulp to the exterior cementum or enamel border. The dentinal tubules extend from the dentinoenamel junction (DEJ) in the crown area, or dentinocemental junction (DCJ) in the root area, to the outer wall of the pulp. From the outer surface of the dentin to the area nearest the pulp, these tubules follow an S-shaped path. The diameter and density of the tubules are greatest near the pulp.