How MS Can Affect Your Oral Health

“Multiple sclerosis can affect motor function and motor coordination,” says Payam Kashani, DDS, of Gentle Family Dental in Queens, New York. People can lose the ability to control their muscles well, Dr. Kashani adds.

“To have good oral hygiene, you need good manual dexterity to brush and floss properly. People with MS are not always able to do that well,” Kashani explains.

With some careful planning and adjustments to their routine, people who have MS can maintain healthy oral hygiene.

MS Can Pose Challenges to Dental Hygiene

Adequate oral self-care can be difficult for people with MS for a number of reasons.

• Your MS-related health needs may distract you from taking proper care of your teeth and gums.
• Fatigue and mobility problems are common symptoms of MS, notes the?NMSS.

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  People with significant mobility impairment or fatigue may find regular dental visits too challenging to manage.
• Certain symptoms of MS can make it difficult to properly care for your teeth and gums. Fatigue, spasticity, weakness, tremor, facial pain (trigeminal neuralgia) and sensory changes (numbness, tingling, pain) in the hands can affect brushing and flossing. One study found that close to 90 percent of 500 subjects, all of whom had MS, had some form of facial or mouth-related symptom (including numbness or pain).

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• Some medications used to treat MS symptoms can cause dry mouth (xerostomia), which in turn can cause bacteria to accumulate. According to a study conducted in Poland, the most frequent oral health symptoms among patients with MS were dry mouth (43.2 percent) and bleeding from gums (28.1 percent). Both dry mouth and bleeding from the gums were found to be more frequent in people with longer-lasting and more advanced types of MS.

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Why Dental Hygiene Is Vital for Good Health

“Good oral hygiene has been shown to be very important,” says Kashani. “Studies have demonstrated links between periodontal disease caused by poor oral hygiene and heart disease, diabetes, and other types of disease that are modulated by inflammatory processes.”

Poor oral hygiene may lead to infection, which can?worsen MS symptoms, notes the NMSS. Furthermore, good oral hygiene also impacts your smile and appearance, which play a role in self-esteem.

The Effect of MS Medications on the Mouth

Some medications used to treat MS symptoms can have consequences for oral health. One common side effect is dry mouth.

“Dry mouth usually goes along with tooth decay that is very difficult to treat,” says Kashani. “It can progress very quickly to the nerve, and if you don’t catch it in time, the patient can lose the tooth.”

Dry mouth can also lead to halitosis, or bad breath.

Steroids, which are often used to treat MS relapses, suppress the immune system, which can make gum disease worse. “The body needs to be able to deal with gum disease properly,” says Kashani. “In immunosuppressed patients, gum disease progresses faster. They tend to lose teeth more quickly.”

Immunosuppressive and immunomodulating therapies were found to increase susceptibility to gingivitis (gum disease), candida infections, human papillomavirus (HPV) infection, and leukoplakia (white patches or spots in the mouth).

Common side effects of medications used to treat MS progression (mostly immunomodifiers) include toothache, sinusitis, and mucositis (inflammation of the digestive tract).

Steps for Maintaining Good Dental Hygiene

Good dental self-care can help prevent dental problems before they happen. In an adequate oral hygiene regimen you:

• Brush your teeth twice a day: after breakfast and before going to sleep.
• Use a toothpaste with fluoride.
• Floss daily.
• Use a tongue scraper or brush your tongue daily.
• Eat a well-balanced diet without too many sweets.
• Have regular dental appointments, usually every six months.
• Replace your toothbrush at least every three to four months.
• See your dentist as soon as possible if you experience bleeding gums, tooth or jaw pain, or tooth sensitivity.

Adjusting Your Dental Routine When You Have MS

• Use toothbrushes with built-up handles. One trick is to cut a small slit in the side of a tennis ball and slide it onto the handle of the toothbrush.
• Use flossing tools to help you floss.
• Consider electric toothbrushes and flossing devices, but avoid those with circular brush heads, advises Kashani. “They require a specific technique that dentists use in the office,” he says.
• Sit down when you brush and floss if standing up is too tiring. Rest your arm on a countertop while brushing if you have tremors.
• Floss in the morning if you are too tired at night, or floss while you’re in bed.
• Ask a family member or caregiver to help you brush and floss.

• Regularly sip water or sugarless drinks.
• Avoid caffeine, tobacco, and alcohol.
• Suck on sugarless candies to stimulate the parotid glands (which control saliva).
• Run a humidifier at night to add moisture to the air.
• Try products that are available over the counter to moisten a dry mouth. Kashani recommends a mouth rinse such as alcohol-free Biotène Dry Mouth Oral Rinse. “Their mouth rinse is very effective. It contains some protective enzymes that would normally be available in saliva,” he says.

Alcohol-based mouthwashes for bad breath are not appropriate for people with MS. “Alcohol tends to dry out the mouth even more,” says Kashani.

If you're still having trouble brushing and flossing effectively, your dentist may recommend:

• Toothpastes with prescription-strength fluoride. “These are used twice a day like regular toothpaste,” says Kashani.
• Daily fluoride treatments at home
• Tooth remineralization products to repair tooth enamel

Tips for Seeing the Dentist When You Have MS

The dentist plays an integral role on the healthcare team of a person with MS, and regular dental appointments are crucial. “If the patient is able to take care of oral hygiene well at home, one visit every six months is fine,” says Kashani. “When oral care at home is compromised, they’re advised to come in more frequently.”

When making your appointment, the following tips can help:

• If you have mobility challenges, call your dentist in advance to find out whether the office building is sufficiently accessible.
• Let the office staff know about any special needs you may have before your appointment.
• Check to make sure the office has a dental chair that is sufficiently accessible for you.
• Schedule your visit for a time of day when you typically feel the most rested.
• Rest before and after your visit.

The Takeaway

MS symptoms can make caring for your teeth and gums more challenging, and many MS medications have side effects, like dry mouth, that worsen oral health. It’s important to adjust and adapt your routine to maintain good dental hygiene when you have MS.