Multiple sclerosis (MS) is a disease which impacts the central nervous system and the brain. Unfortunately, there is no cure for MS. Patients with multiple sclerosis or MS often experience symptoms of their immune system attacking the myelin sheath. The myelin sheath protects the nerve fibers within the spinal cord. This can result in incomplete communication between the brain and body. Over time, this slowly leads to physical disabilities and permanent nerve damage. MS commonly leads to eventual partial or full paralysis.
The symptoms associated with the disease can drastically vary for each patient. They are highly dependent on which nerves are affected and the amount of nerve damage. Common symptoms can include a lack of muscle control or coordination, challenges with balance or memory, and weakness or numbness. Patients may experience debilitating side effects and disability or have long periods of being asymptomatic. There is currently no cure for MS, however, there are effective treatments which can help patients manage the severity of the symptoms associated with the disease.
Inflammation is a primary characteristic of multiple sclerosis. This is a defense mechanism which is triggered by the immune system. Gingivitis and periodontitis are also considered to be an inflammatory disease. Inflammation from gum disease can trigger a flare-up of MS. During a flare-up, biochemicals are released which can increase inflammation in the gum. This cycle slowly causes the deterioration of the immune system and can also destroy gum tissue. Patients with multiple sclerosis find it especially critical to practice preventative dental care. Unfortunately, many MS patients find it difficult to practice good oral hygiene at home. Two common symptoms of multiple sclerosis include muscle weakness and the gradual loss of muscle control. As a result, it can be quite challenging for people suffering from MS to perform routine oral hygiene such as brushing and flossing. Poor oral hygiene can quickly result in tooth decay and other oral health issues which can compromise the patient’s oral health. In some cases, MS patients may even find it difficult to perform tasks such as swallowing, use the tongue, or produce saliva. These things can all negatively affect the patient’s oral health. Medications which are commonly prescribed in treating MS symptoms can result in xerostomia. This causes excessive dryness in the mouth and can lead to issues such as gum disease and cavities.
Patients can conscientiously focus on hydrating to aid in preventing the problems associated with xerostomia. The dentist may also recommend the use of a prescription salivary substitute and fluoride treatment to protect the teeth. Some types of medications can result in oral ulcers or oral thrush. These can cause significant discomfort when performing routine tasks such as brushing and flossing. The dentist may suggest the use of an over-the-counter brushing or flossing aid. They may also recommend that caregivers provide the patient with oral hygiene assistance. Because MS patients can experience muscle fatigue, some patients find it helpful to sit down while they brush their teeth. Flossing can also be completed while sitting or laying down.
Regular clinical care is vital for multiple sclerosis patients. MS patients should make routine visits to the dentist at least twice each year. The dentist may request they make more frequent visits. There are multiple factors to consider when multiple sclerosis patients make routine visits to the dentist. The severity of the disease may dictate certain modifications which may be needed such as shorter dental appointments or appointments in the morning when patients are more well rested. This helps to minimize the likelihood of muscle spasms and other types of painful symptoms. When the patient requires longer appointments, the dentist may need to take frequent breaks. As a general rule, dental professionals are encouraged to give MS patients a 5-10 minute break about every thirty minutes. It can also be beneficial for multiple sclerosis patients to sit at a 45-degree angle. This aids in keeping their airways open. It is common for MS patients to develop respiratory issues as the breathing muscles are often affected by the disease. Patients who are able to breathe well through their noses may find it helpful to use a rubber dam during the appointment. It can cause discomfort and stress for patients to voluntarily keep their mouth open for long periods of time. The dentist can use a mouth prop aid in holding the mouth open. This minimizes the patient’s effort and discomfort during the appointment.
Patients with multiple sclerosis often find it to be challenging to isolate the source of pain. In turn, it can be challenging to make an accurate diagnosis. The dental professional must be diligent and exhaust all resources to provide an accurate diagnosis. This is especially critical prior to recommending invasive procedures such as a root canal or extraction. Another common side effect of multiple sclerosis is extreme pain in the face. This is called trigeminal neuralgia or temporary numbness of the face, teeth, and jaw. It is also possible for multiple sclerosis to result in partial or total paralysis of the face. This can cause serious complications with nearly all types of dental procedures. Patients who have advanced cases of multiple sclerosis often use a wheelchair. The need for wheelchair access and transportation can be another concern in receiving dental care.
Tooth decay and periodontitis are not uncommon for patients who have multiple sclerosis. These issues can cause serious challenges and result in the teeth falling out or requiring removal. Various types of dental restorations have unique challenges when working with MS patients. Both partial and full removable dentures can be especially challenging for multiple sclerosis patients. Xerostomia or a chronically dry mouth can also make it especially challenging for the patient to wear removable dentures. Dentures can also make it difficult for the patient to eat or speak clearly. MS symptoms can also make simple placement and removal of dentures challenging. The muscle spasticity can make removable dentures quite difficult. Removable dental appliances can be quite dangerous in severe cases of MS. Patients who face challenges with swallowing from multiple sclerosis often find that bulky dentures just make matters worse. They can lead to the risk of choking or even make eating problematic.
Dental implants can be an extremely helpful solution for patients with multiple sclerosis. Implants can even be used to support dentures. This provides a strong foundation and eliminates the risk of slipping or coming loose. Dental implants have very high success rates and are at a low risk for complications. This is even true for patients with multiple sclerosis. Certain medications can interfere with the body’s ability to heal. Patients should share their complete medical history and have a list of medications to share with their dentist when considering dental implants. The dentist can evaluate the risk and discuss possible complications with patients.
Multiple sclerosis is a serious disease which can cause serious oral health issues. It is critical for patients to work with their caregivers and dentists to maintain good oral health. In the event of tooth loss, dental implants can be an excellent tooth-replacement option for MS patients.