Multiple Sclerosis and Dental Care

Multiple Sclerosis (also just simply referred to as MS)  is an autoimmune disease in which the body attacks the nerve fibers of the  brain and spinal cord. Multiple Sclerosis is a progressive disease. This later results in demyelination of the nerve fibers and  paralysis. Demyelination is the general term for diseases of the nervous system.  Demyelination occurs when the myelin sheath (covering of nerve fibers) gets damaged. This in turn results in disorders or impairments in muscle functions, cognition and sensation.

For reasons unknown, it mostly affects adults living in the northern hemisphere. Canada has one of the highest rates of Multiple sclerosis in the world. Multiple sclerosis is just one form of demyelination and also the most common  type. Other diseases include Acute Disseminated Encephalomyelitis and Transverse Myelitis. The disorder was first described by Jean-Martin Charcot in 1868.

Specific symptoms of multiple sclerosis can include:

• -Muscle spasms
• -Trouble maintaining a good balancing
• -Easily fatigued
• -Difficulty walking
• -Difficulty moving the arms or legs and tremors in the arms or legs.

Additional symptoms include constipation, the need for frequent urination, loss of bladder control, double vision, vision loss, facial pain, depression and hearing loss. These symptoms can occur intermittently and can intensify during times of stress, sun exposure, fever or when taking a hot bath.

Multiple Sclerosis Risk factors

These factors can increase your chances of developing multiple sclerosis:

• -Age. multiple sclerosis can develop at any age, but generally affects people between the ages 16-55.
• -Sex. Women are more than 2-3X as likely as men are to have multiple sclerosis.
• -Familial history. If a parent or sibling has had multiple sclerosis, you are at an increased risk of developing the disease.
• -Infections. A variety of viruses have been linked to multiple sclerosis, including Epstein-Barr (infectious mononucleosis).
• -Ethnicity. White people, particularly those of Northern European descent, are at highest risk of developing multiple sclerosis. People with ethnic backgrounds of Asian, African or Native American descent have the lowest risk.
• -Climate Factors. Multiple sclerosis is much more prevalent in locations with temperate climates. This includes Canada, the northern United States, New Zealand, southeastern Australia and Europe.
• –Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of multiple sclerosis.
• -Autoimmune Disease Link. A slightly higher risk of developing multiple sclerosis is possible if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.
• -Smoking. Smokers who experience an initial event of symptoms that may signal multiple sclerosis are more likely than nonsmokers to develop a second event that confirms multiple sclerosis. Treatment for multiple sclerosis includes taking medications to slow the progression of the disease. These include interferon, natazalizumab, methotrexate, azathioprine, cyclophosphamide or steroids. Amantadine may be taken for fatigue, antidepressants may be taken to control mood and behavior, and cholinergic medications can soothe urinary problems. Physical therapy, relaxation and exercise may also be used to manage multiple sclerosis.

One of the parallel connections between multiple sclerosis and the patient’s oral health is loss of muscle control. A patient with MS experiences a harder time brushing their teeth depending on the muscles involved in the patients MS. Due to poor muscle control sometimes MS patients can only achieve what is considered poor brushing. Those suffering from severe multiple sclerosis symptoms will need help from family and loved ones to simply clean their teeth.

Multiple sclerosis patients may also have a difficult time simply relaxing in the dentist’s chair. This makes it very difficult for the dentist to do a thorough dental examination as well as to conduct any needed dental procedures. For this reason, it is imperative to keep Multiple Sclerosis patients in the chair for as little time as possible. Appointments should be as short as possible. Multiple breaks of 5-10 minutes per half hour of treatment should be given.

It is also recommended to schedule early morning appointments as this is usually the least stressful part of the day. This is all to lessen the discomfort on the patient. Stress, fatigue, and muscle spasms may also play an important factor in chair time. Patients suffering from multiple sclerosis are not advised to wear dentures. Muscle spasticity makes it difficult to wear dentures comfortably. The reason is due to the patients uncontrollable muscle spasms. Experiencing uncontrollable spasms could potentially result in dislodgement of the dentures or even swallowing of the denture.

Multiple sclerosis patients need regular dental care not only for reasons mentioned above but there are other factors. Tooth decay, halitosis, or periodontal disease can also occur at higher rates in these patients. All of these can easily be avoided with proper hygiene. Multiple sclerosis may also cause pain in a specific tooth. This causes the patient to seek care on what is essentially a healthy tooth. This is caused by Trigeminal Neuralgia and is probably the most intensely painful multiple sclerosis related symptom. This can occur in the lower part of the face and is usually an intense, sharp pain. Luckily, this is rare with only about 4% of Multiple Sclerosis patients experiencing this type of pain. There is no cure for Multiple Sclerosis.

Dentists have a few set rules for management of patients with MS:

1. Maintain oral function. Allow patient to be as self sufficient as they can for as long as possible.

2. Keep patient healthy so they do not develop other disorders or diseases that could complicate their MS.

3. Maintain a person’s cosmetic appearance so they do not develop self esteem issues which will further accelerate their decline via depression. If you have noticed, one of the primary concerns of dentists is for the patient to be able to maintain their own oral hygiene. This is achievable especially with patients whose condition has not yet reached its worst. In cases where this is not possible, family members or care givers are trained to assist the patient.

Lastly, maintaining positive attitude towards life is very important. There are a lot of people suffering from diseases and ailments worse than multiple sclerosis. If the dentist, patient, and family work together a Multiple Sclerosis patient can live free of dental worries their entire lives.