Much about multiple sclerosis (MS) is unknown: what exactly causes it, why its symptoms manifest unpredictably, and how to cure it. But the multiple sclerosis dental considerations people living with the disease must take into account are known.
MS is a chronic, often progressive disease in which the body’s immune system attacks the central nervous system. It harms the myelin—the nerves’ protective covering—in the brain and spinal cord, a process called demyelination. Permanent nerve damage and deterioration can result.
Individuals with MS experience a wide range of symptoms, to varying degrees. Changes in motor, sensory, and cognitive functions can occur. Some of these symptoms and changes make maintaining good oral health more difficult.
At Penn Dental Medicine (PDM), we offer treatment from dentists who know how multiple sclerosis affects oral health. Our MS dentists are skilled in helping patients meet the challenges to the mouth, teeth, and gums the disease presents.
MS and Mouth Sores, Gum Disease, and More Oral Health Issues
Heightened risk of tooth decay (dental caries) and gum disease (gingivitis and periodontitis) are among the chief multiple sclerosis dental considerations. The risk rises in part due to patients’ abnormal immune response. Increased inflammation in multiple areas is characteristic of MS, so MS and gum disease are an especially problematic combination.
Additionally, the lack of muscular strength and coordination patients with MS experience make proper oral hygiene challenging. Due to demyelination, the brain and spinal cord’s nerves don’t properly conduct impulses stimulating muscle movement. Muscle weakness and atrophy can follow.
Patients frequently feel fatigue, pain, and imbalance, all of which can reduce their levels of physical activity. Reduced activity further weakens muscles. Patients also often experience spasticity (stiffness and involuntary muscle spasms). Depending upon their severity, these MS symptoms can make properly holding and using a toothbrush or floss all but impossible.
Other oral health issues MS may cause or complicate include:
- Mouth and tongue sores
The inflammation characterizing MS can affect not only nerves but also the mouth’s inner lining (mucous membranes). Painful sores in the mouth and on the tongue can result.
- Burning mouth syndrome (oral dysesthesia)
Burning mouth syndrome is the presence of pain similar to sunburn or electric shock in oral membranes that appear normal. This pain originates in the nerves MS attacks.
- Dry mouth (xerostomia)
Patients who have MS sometimes lack saliva. Dry mouth makes chewing, swallowing, and speaking more difficult. It can also lead to tooth loss because saliva isn’t helping wash away decay-causing food residue and bacteria.
- Swallowing difficulties (dysphagia)
Patients with advanced MS often have trouble swallowing. But dysphagia can occur at any point during the disease’s progression. Apart from interfering with normal eating and drinking, dysphagia can mean food and drink stay in the mouth longer, giving them more time to feed bacteria that cause tooth decay and gum disease.
- Temporomandibular joint (TMJ) disorders
The temporomandibular joint (TMJ) connects the jawbone to the skull like a “sliding hinge.” TMJ disorders can cause pain in the jaw, in and around the ears, and in the face; difficulty or pain while chewing; and locking of the joint. Clinical research reveals a greater prevalence of TMJ disorders among patients with MS than among those without, perhaps because poor muscle control fatigues TMJ structures.
In addition to MS itself causing oral health problems, so can some of the disease-modifying drugs (DMDs) used to treat it. DMDs are one reason MS and gum disease often occur together. Dry mouth, toothache and tooth decay, and mouth and tongue sores are also all among the dental and oral side effects DMDs commonly produce.
Dealing with MS and Teeth Issues on a Daily Basis
How can patients with MS maintain good oral hygiene? The National Multiple Sclerosis Society (NMSS) offers these daily dental care tips:
- Use easy-to-grip toothbrushes (for example, with built-up handles) or an electric toothbrush, as well as electric flossing devices.
- Sit down to brush and floss if standing at the sink proves tiring.
- Floss in the morning if too tired to floss at night, or floss in bed.
- Recruit a family member or personal assistant to help with brushing and flossing.
- Wear a weighted glove while brushing to manage tremors.
The NMSS also has advice for dealing with dry mouth caused by MS or drugs used to treat it:
- Sip water or sugarless drinks frequently.
- Use mouth-moistening products available in pharmacies.
- Avoid alcohol, caffeine, and tobacco.
- Squirt small amounts of lemon in the mouth or suck on sugarless lemon candies to stimulate salivary glands.
- Sleep in a room with a humidifier.
Managing Multiple Sclerosis and the Dentist Visit
Among the most important things patients with MS can do for their oral health is visit a provider who understands multiple sclerosis dental considerations and is equipped to care for them.
The dental office must be physically accessible. Once inside, patients, including those using wheelchairs, should be able to sit in chairs that accommodate their needs.
An experienced MS dentist will know how the disease may complicate dental visits. Patients may have difficulty holding their heads still and mouths open during an exam, for instance. Or they may experience respiratory issues, making it hard to breathe when reclining in the dental chair.
Dentists prepared to care for patients with MS have equipment that reduces risks to the patients and themselves (for example, mouth openers and finger protectors). They also use techniques for completing treatments as quickly and comfortably as possible.
Penn Dental Medicine is a leader in providing compassionate, high-quality, patient-centered dental care to persons with a wide range of disabilities, including MS. Our state-of-the-art Care Center for Persons with Disabilities, with its Personalized Care Suite, is where patients receive the customized, comprehensive treatment they need.
To find out more about how PDM serves adults with MS and other disabilities, download our free eBook, Overcoming Oral Health Barriers for People with Disabilities.
