Multiple sclerosis is an incurable disease that affects the brain and the central nervous system. When a person has multiple sclerosis, commonly referred to as MS, their immune system attacks the myelin sheath that protects the nerve fibers in the spinal cord, leading to improper communication between the brain and the body and eventually, in many cases, leading to physical disability and permanent damage to the nerves. Multiple sclerosis often gradually leads to partial or full paralysis. Symptoms vary widely from patient to patient and depend largely on the amount of nerve damage present and the specific nerves that may be affected. Common symptoms include lack of control or coordination of the muscles, loss of balance or memory, and localized feelings of numbness or weakness. Some people face significant disability while others experience long asymptomatic periods. While there is no cure for multiple sclerosis, treatments can help people with MS manage symptoms and affect the course and severity of the disease.
A primary characteristic of multiple sclerosis is inflammation, which is a defense mechanism prompted by the immune system. Gingivitis and periodontitis are also inflammatory diseases, and the inflammation caused by gum disease can trigger systemic inflammation, prompting MS flare-ups. These flare-ups release more biochemicals that lead to increased inflammation in the gum tissue, in a cycle that slowly deteriorates the body’s immune system and also destroys the tissues of the gums. Preventative dental care can be especially important for patients with multiple sclerosis. However, for many MS patients, dental hygiene and home care pose significant challenges. Weakening of the muscles and gradual loss of muscle control are two common symptoms of multiple sclerosis. This can cause challenges when people who suffer from MS try to perform dental hygiene practices like brushing and flossing the teeth; diminished oral hygiene practices contribute to tooth decay and other conditions of compromised dental health. Some MS patients also face difficulty in swallowing, using their tongues, and producing saliva, all of which can adversely affect the health of the mouth and teeth. Many of the medications prescribed to treat the symptoms of MS can also lead to a condition known as xerostomia, which is manifested by excessive dryness in the oral cavity and which stimulates the growth of cavities and the development of gum disease. Conscientious hydration can help prevent the problems caused by xerostomia, as can prescribed salivary substitutes and fluoride treatments. Some medications may also cause oral ulcers and oral thrush, which make brushing and flossing even more painful. Dentists may recommend brushing and flossing aids, which are available over the counter, or they may recommend that caregivers provide assistance with home care. People with multiple sclerosis may find it helpful to brush their teeth while sitting down, as the muscles fatigue more easily. They may also prefer to floss while sitting or lying down.
Frequent clinical care is very important for patients with multiple sclerosis, who should plan to see their dentist at least twice a year, if not more often. When patients with multiple sclerosis need to see their dentists, there are multiple factors to consider. Depending on the severity of the disease, patients may require shorter dental appointments, preferably in the mornings when well-rested, to minimize the likelihood of muscle spasms and other uncomfortable, or downright painful, symptoms. When longer appointments are unavoidable, frequent breaks are recommended; general guidance suggests 5 to 10 minute breaks every thirty minutes. Patients with multiple sclerosis should sit at a 45-degree angle, keeping their airways freely open, as many MS patients develop respiratory problems when their breathing muscles are affected by the disease. If the patient is able to breathe well through their nose, a rubber dam may be recommended. It may also be painful or stressful for the patient to voluntarily keep their mouth open for an extended period of time, and a mouth prop can be used to help hold the mouth open without undue effort or discomfort for the patient.
It is common for patients with multiple sclerosis to have difficulty pinpointing the specific source of their discomfort or pain, which makes accurate diagnosis more challenging. Dentists must take great care and use all available resources for accurate diagnosis before recommending more invasive procedures like root canal therapies or tooth extractions. Patients with multiple sclerosis may also develop a stabbing or searing pain in the face, known as trigeminal neuralgia, or temporary numbness in the face, teeth, and jaw. Multiple sclerosis can lead to partial or total paralysis of the face, which greatly complicates many dental procedures. Additionally, patients with more advanced multiple sclerosis may use wheelchairs for mobility, which raises concerns if wheelchair access is not readily available.
When tooth decay and periodontitis do develop in patients with multiple sclerosis, causing the teeth to fall out or to be extracted due to irreparable damage, many types of dental restorations will present their own set of challenges. Removable dentures, either partial or full, may be particularly problematic for patients with multiple sclerosis. Xerostomia can make it more difficult to wear removable dentures and usually affects the wearer’s ability to eat or to talk, and symptoms of MS can make it difficult to remove and properly insert dentures. Muscle spasticity can make removable dentures very difficult to wear, and, in more severe cases of MS, removable dental appliances can actually be dangerous. For example, if the patient faces swallowing difficulties due to their multiple sclerosis, a bulky removable denture can exacerbate these difficulties and lead to choking or the inability to eat. For dental patients with multiple sclerosis, dental implants can be immensely helpful, as they support the denture and minimize its chances of slipping or dislodging, and they don’t interfere with the patient’s ability to talk or to swallow. In many cases, patients with multiple sclerosis can receive dental implants with no complications. Certain medications may interfere with the healing of the gums and bone, so be sure to tell your dentist your complete medical history if you’re discussing the possibility of dental restoration treatment with dental implants.