MS can make it tough for some dental treatments
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By George Malkemus  November 29, 2013 12:00 am

Multiple sclerosis (commonly abbreviated to MS) is a chronic, progressive disorder that affects the nerves in the brain, spinal cord and other parts of the central nervous system.

MS is an autoimmune disease, wherein the body’s immune system attacks it’s own central nervous system. MS gradually destroys nerve cell’s ability to control muscle movement and brain function. The effects can range from minor tingling in the hands and feet to abnormal muscle fatigue, tremors, slurred speech, impaired vision and even paralysis.

MS affects more than 1 million people in the United States and estimated to affect 2.5 million people worldwide. Multiple sclerosis affects two-to-three times as many women as men.

 

Treatment

Though there is no cure, MS is rarely fatal. Treatments for MS attempt to lessen and prevent attacks, as well as return health after an attack.  There are many variations to the disease, so the prognosis is difficult to predict. But usually patients can live healthy, active lives well into their 70s or longer, particularly if they take good care of themselves.

Many patients can significantly reduce the effects of MS by avoiding obesity, exercising regularly, avoiding smoking, reducing stress and eating a healthy diet. A physical or occupational therapist can teach stretching and strengthening exercises and show how to use devices that can make it easier to perform daily tasks. Treatment involves various medications, which vary from treating MS attacks, slowing the progress of the disease and treating MS symptoms. Some people have such mild symptoms that no treatment is necessary.

 

Symptoms

The person with MS can suffer almost any neurological symptom or sign, including changes in sensation, muscle weakness, muscle spasms, muscle stiffness or difficulty in moving, difficulties with coordination and balance, problems in speech or swallowing, visual problems, fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common.

Vision problems may include blurred vision, double vision, involuntary eye movements, temporary loss of sight, and eye pain.

Fatigue may be worse at certain times of day and interfere with daily activities. Muscle weakness may include clumsiness, dropping things, inability to pick up or hold something, or dragging a leg when walking. Poor balance may include changes in the way one walks, dizziness, bobbing from side-to-side when walking. Bowel and bladder problems may include the inability to hold urine or bowels, or the inability to fully empty bladder or bowels.

 

Oral health

The loss of muscle control makes it harder for the MS patients to brush and floss their teeth.  More frequent dental cleanings and examinations are recommended.  An electric toothbrush can help improve brushing and a stick-type floss can make flossing easier. Patients with severe multiple sclerosis symptoms may require the assistance of another person to clean their teeth, usually a trained family member or a caregiver. In this case, the caregiver should consult with the hygienist or dentist to find the best possible methods that will help the patient maintain good oral hygiene.

 

Dental comfort

Stress has been correlated with increased symptoms of MS.  Therefore, it is important to keep dental treatment as comfortable as possible.  Short appointments are recommended.  Often, frequent breaks are needed during dental treatment. Usually, early morning appointments are best to reduce stress. The use of nitrous oxide can help MS patients relax.  Using headphones with music, such as an iPod, can make a more pleasing visit, blocking the sound of the drill and suction. To reduce patients’ discomfort, it is recommended the dental chair have cushioned pads. Pads will avoid pressure sores and will make the patient feel more comfortable during the appointment.  Also, various head, neck and leg pillows can help support the body in a comfortable position.

Using conscious sedation is often needed with more advance cases of multiple sclerosis.  This includes MS patients with dental phobias, needing longer involved treatments, and difficulty relaxing in the dental chair, difficulty opening for long periods, or experiencing uncontrollable muscle movement of the face. In the latter stages of the disease, the respiratory muscles can be affected, so sedation has to be monitored closely.

 

Dental treatment

Multiple sclerosis could partially or totally paralyze a patient’s face, making dental treatment difficult. MS patients have reported temporary numbness in their teeth, cheeks, jaw or lips. Some MS patients can experience difficulties swallowing, decreased amount of saliva or difficulties of proper use of the tongue. Also, involuntary movements of the muscles of the tongue, jaw and face can make treatment challenging.

The use of dental aids that keep the mouth opened and the cheek and tongue retracted are helpful, such as bite block, rubber damn, or Isolite.  The Isolite is a new, comfortable technology that is particularly helpful, acting as a light, suction, retractor and bite block in one unit.

People suffering from multiple sclerosis are not advised to wear dentures. Because of uncontrollable muscle spasms, dentures are often accidentally dislodged.  This leads to embarrassment, discomfort, tissue sores and difficulty chewing.   However, all other dental treatments are recommended, including implants.  

 

Correlation between MS and periodontal disease

Periodontal disease, gum disease, is marked by bacterial overgrowth. However, a persistent immune response to chronic infections in the mouth is believed to play a major role in gum destruction. Autoimmune diseases, such as multiple sclerosis, Crohn’s disease, rheumatoid arthritis, lupus erythematous, CREST syndrome, have been associated with a higher incidence of periodontal disease.   Gum disease is also found to increase the symptoms of MS.

Many theories have been proposed for the cause of multiple sclerosis, and the cause is still in investigation.  One theory proposes that oral spirochete bacteria found in periodontal disease causes MS.  Spirochetes, similar to those found in dental plaque, have been found in the brains of autopsied MS patients.  Future study is needed.  Even so, the importance of good gum health is extremely important for overall health.

Multiple sclerosis patients require continual dental monitoring.  With reduced salivary flow and increased difficultly cleaning their gums and teeth, decay and gum disease can become rampant.   Catching dental problems early allows short, comfortable appointments, as well as reduced cost.

Enjoy life and keep smiling.

 

George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ website at www.malkemusdds.com.

Post Your Comments:
Jennifer
November 29, 2013
You also didn't mention the possiblity of trigeminal neuralgia that about 4% of people with MS experience. All dentists should be aware of this as sometimes you will be the first ones to see a person with MS and MS related trigeminal neuralgia.
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