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Multiple Sclerosis

Multiple Sclerosis, MS, was first recognized in 1868 by Jean-Martin Charcot. MS is a

progressive, autoimmune disease where the immune system breaks down the myelin within the

central nervous system. Myelin is a fatty substance that protects the nerve fibers in the brain and

spinal cord. When there is destruction to the myelin sheath, the nerves become weak, work

slower, and eventually become blocked. The damage to the nerve fibers in the central nervous

system is what progressively disables motor, sensory, and cognitive skills. Individuals with MS

may also experience mood swings and episodes of depression.

The direct cause of MS is still unknown, but there are several contributing genetic and

environmental factors that could be responsible for the development of MS. There are currently

2.5 million people worldwide living with MS. It most commonly occurs in individuals who live

in moderate climates and are of the Northern European descent. MS affects more Caucasian

women than men and onsets between the ages of 15 and 55. (Mayo Clinic Staff, n.d.).

The physical complications of MS are muscle stiffness, muscle spasms, paralysis of the

legs, paralysis of the face, and loss of motor skills. The initial symptoms are tremors, fatigue,

loss of coordination, tingling in hands or feet, and painful vision loss. Multiple sclerosis can be

treated by various medications. Corticosteroids are used for an anti-inflammatory.

Interferon-betas help with reduction and prevention of MS relapses. Glatiramer acetate can be

taken if patient develops a resistance to interferon-beta. Mitoxantrone is effective in destroying


the quickly multiplying cells inside the body and also helps with relapse prevention. The dental

effects of Mitoxantrane are mucositis and stomatitis. Antidepressants can also be prescribed for

depression. There are also several immunosuppressive medications that can be taken to reduce

the frequency of MS flare ups.

Multiple Sclerosis is a relapsing disease with different categories of progression.

Secondary progression is gradual neurological breakdown with acute relapses in individuals who

have already experienced relapsing-remitting MS. Primary progression is continuous from the

initial onset of MS. This disease progresses differently for each person. It is best to keep oral

infection under control because it can trigger a relapse. A relapse can last anywhere from a few

days to a few weeks.

There are several dental effects from the medications used to treat MS. One common

side effect is xerostomia. Dry mouth may cause a mild discomfort to the tongue and other soft

tissues inside the mouth or it can progress to oral disease if xerostomia is not controlled. Some

oral diseases that develop from uncontrolled xerostomia are dental caries, periodontal disease,

and gingivitis. Patients who experience depression may have episodes where they are

unmotivated to use oral health instruction at home. Bacteria and plaque must be disrupted at

least once a day by brushing and flossing. When bacteria and plaque are left inside the mouth

they will continue to multiply until disruption. The accumulation of plaque and bacteria will

eventually lead to disease if it is left for a long period of time. Proper bacteria removal is

important for patients with MS because an oral infection could stimulate a relapse.

Patients who experience muscle stiffness, tremors, muscle weakness, face paralysis, or

any other physical complications that interfere with proper home care should be instructed on the
use of helpful auxiliary aids and other toothbrush modifications. If patient is unable to brush and

floss on their own and a caretaker is responsible for their oral health, the caretaker should be

given the oral health instruction.

The use of an electric toothbrush is helpful because the toothbrush head moves in small,

circular motions by itself and will be easier on the patient’s hands. If patient is unable to close

their fist around toothbrush handle, a foam handle makes it easier to hold on to the toothbrush.

Flossing in the morning when patient has more energy or sitting down comfortably can help if

patient feels like home care is tiring. Tremors can be controlled by wearing a weighted glove

while brushing and flossing. Flossmate floss handle, floss picks, water picks, or other electrical

flossing devices can be used to help with interproximal plaque removal.

There are modifications that need to be made for dental appointments with MS patients.

Before dental treatment, the dental office must be handicapped accessible for wheelchairs. It

would also be beneficial to have a consultation with patient’s physician prior to appointment to

obtain any lab results needed for the appointment. Avoid putting patient’s chair in supine

position. They are more likely to experience pulmonary aspiration if their head is not above their

heart. Bite blocks can be used to hold mouth open for patient and minimizes muscle spasms of

the face. Appointment times must be appropriate for patient’s individual needs. Shorter

appointments with more frequent recalls are more tolerable for patients with MS. It is best to

schedule appointments during the time of day patient has the most energy. It is best for the

dental office to be aware of each special needs patient coming into the office so they can be

prepared for treatment modifications and are able to make treatment as comfortably as they can

for each patient.


References

Andreen, A. L. (2014). Multiple sclerosis. ​Dental Health, The Basic Facts.​ 1-4.

Crossley, H., Miller, T., & Wynn, R. (2014). ​Drug information handbook for dentistry.

Hudson, OH: Lexicomp Publishing.

Epstein, J. B., Fischer, D. J., Klasser, G. (2009). Multiple sclerosis: an update for oral health
care providers. ​Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and
Endontology. (​ 108)3, 318-327.

Mayo Clinic Staff. ​Multiple sclerosis. ​Retrieved from


http://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/dxc-
20131884​.

Wilkins, E. (2017). ​Clinical practice of the dental hygienist: twelfth edition. ​ Philadelphia, PA:

Wolters Kluwar.