Multiple Sclerosis

Question:

What is MS (Multiple Sclerosis)?

Answer:

Multiple Sclerosis (MS) is a progressive, degenerative neuromuscular disorder that often results in partial or full paralysis, with no known cure. Remissions, both complete and partial are common. This disorder causes the demyelination (the removal of the fat-like protective sheath that surrounds the nerves and protects them) of the nerves of the central nervous system (CNS). This can result in the following: a decrease in the speed of nerve conduction, partial blocking of the nerve conduction, a modification in the way nerve impulses are transmitted, or a complete failure of transmission for these nerve impulses.

Those individuals diagnosed with MS are particularly susceptible to suffering from unnecessary pain and treatments as a result of not recognizing the impact that MS can have on their oral health care. Preventative dental care and procedures can tremendously improve the oral health and lives of people with this debilitating disorder.

Question:

How does having MS (Multiple Sclerosis) affect your dental care in the office?

Answer:

Patients with MS (Multiple Sclerosis) can have their good days and their bad days. While minor cases of MS may not impact one’s dental care, severe MS requires special considerations when seen in the dental office. Patients with severe MS should have shorter dental appointments, preferably scheduled in the mornings. If a longer appointment is necessary, 5-10 minute brakes should be taken every half hour. Patients with MS should be seated at a 45 degree angle to avoid compromising their airway. Individuals with MS can develop respiratory problems, since the muscles that control their breathing are affected by the disease. It may be indicated to use a rubber dam, as long as the patient can breathe well through their nose. It can also be hard to maintain the mouth in an open position for extended periods of time. For this reason a mouth prop may be used to help the mouth remain open comfortably.

Patients with MS may also be unable to pinpoint the source of their pain or discomfort, so great care is required to diagnose dental problems before committing to root canal therapy or extractions. Sometimes individuals with MS can develop trigeminal neuralgia on one or both sides. Temporary numbness in the teeth, jaws and lips have been reported. Multiple Sclerosis may also result in partial or total paralysis of the face, causing dental procedures to become more challenging.

Additional considerations include: wheelchair access (if the disease becomes so debilitating) and some form of general anesthesia or sedation (either in the office or in a hospital).

Question:

How does having MS (Multiple Sclerosis) impact one’s homecare?

Answer:

Patients with Multiple Sclerosis may develop difficulties swallowing, using their tongue properly, and producing enough saliva. As a result, it becomes increasingly more difficult for these individuals to maintain proper home care and will therefore have a greater chance of developing cavities and gum disease. Since people with MS have compromised dexterity from the loss of control of their muscles, brushing and flossing can become very difficult. Special types of modified brushing and flossing aids are available (check with your dentist and pharmacy), and caregivers are encouraged to assist with the home care when appropriate. Additionally, various medications (such as immune-suppressant drugs, corticosteroids, muscle relaxants, and antidepressants) tend to dry out the mouth, accelerating the development of cavities and gum disease. Keeping the mouth hydrated, salivary substitutes and fluoride treatments are often recommended.

Question:

Are there any types of dental treatment that should be avoided with individuals that have MS (Multiple Sclerosis)?

Answer:

Patients who have more advanced stages of MS may have a lot of difficulty wearing full or partial dentures. First, since individuals with MS are more prone to developing a dry mouth, it will become increasingly more difficult to eat, talk, and wear their dentures. Second, the muscle spasticity makes wearing theses removable appliances very difficult and sometimes dangerous when the symptoms of MS become severe. In order to avoid these issues, one may consider placing dental implants that can anchor and support the denture, minimizing its chance of dislodging.

Question:

Is it possible to mistake early signs of Multiple Sclerosis for TMJ problems?

Answer:

Multiple Sclerosis (MS) can cause a variety of different symptoms depending on which nerves are attacked. While it may be possible that MS can affect the area where the TMJ dysfunction was diagnosed, it is more likely that the two are unrelated. To make the right determination, one should seek the care of a neurologist who specializes in treating patients with MS. Treatment should be coordinated with a dentist who is comfortable diagnosing TMJ disorders.