Multiple Sclerosis

Kaylee Blum

Dental Hygiene IV

December 1, 2022
 Abstract

The disability that I have chosen to research is Multiple Sclerosis. Multiple Sclerosis is a

disease of the brain and spinal cord where the immune system attacks the myelin sheath and

causes communication errors between the brain and the rest of the body. The disease can

eventually cause permanent damage or deterioration of the nerve. The features of Multiple

Sclerosis were lectured on and given a name by Jean-Martin Charcot, a famous neurologist, in

1868. Predisposing factors of this disease include age, sex, family history, certain infections,

race, climate, Vitamin D, certain auto immune diseases, and smoking. Research has shown that

Multiple Sclerosis affects women, more than two to three times as likely, than men, and the most

common ethnicity that it affects is white people of northern European descent. Nearly one

million people are living with Multiple Sclerosis, most of the population affected is people ages

twenty to fifty, however it can occur in younger children and older adults.

Multiple Sclerosis can have many physical effects on the body. Signs and symptoms

depend on the extent and location of nerve damage and can include numbness or weakness of

limbs, typically occurring on one side of the body at a time, electric-shock sensations that occur

with certain neck movements, tremor, lack of coordination, blurry vision, partial or complete loss

of vision, double vision, slurred speech, fatigue, dizziness, tingling or pain in parts of the body,

and more. Some people with severe Multiple Sclerosis may lose the ability to walk on their own

or to walk at all. Intellectual concerns with Multiple Sclerosis include thinking and memory

problems, shortened attention span, trouble making decisions, and trouble understanding. There

is no cure for Multiple Sclerosis. There are treatments that can help speed recovery from attacks,

and slow or manage symptoms of the disease. Treatment for attacks include Corticosteroids,

such as Prednisone or Methylprednisolone, and Plasma exchange. Treatments to modify

relapsing-remitting Multiple Sclerosis, there are several disease-modifying therapies available.

Treatment options for this are injectable or oral medications such as Interferon beta medications,

Capaxone, Fingolimod, Siponimod, Natlizumab, and more. Many of these medications do have a

possibility of adversely affecting the body. Some side effects include skin irritation, flu-like

symptoms, liver damage, headaches, high blood pressure, blurred vision, diarrhea, nausea,

lowered white blood cell count, hair loss, birth defects, serious infections, and more. Multiple

Sclerosis is a lifelong condition that, in most cases, evolves into a chronic progressive phase.

People living with Multiple Sclerosis do experience remission phases. While one is in remission,

they may experience their symptoms disappearing, or some symptoms may continue and become

permanent. There is no obvious progression of Multiple Sclerosis in the remission phase, and

remission could last a few weeks, many months, or years.

Multiple Sclerosis can physically affect the oral cavity in many different ways. People

with Multiple Sclerosis are at a higher risk for cavities, gingivitis, and periodontitis. This

happens due to their weakened immune response and the physical effects of Multiple Sclerosis.

Systemic inflammation triggers Multiple Sclerosis to flare up or cause more symptoms, and

chronic periodontitis contributes to inflammation. According to Schroeder & Gurenlian (2016),

patients with Multiple Sclerosis often have more extensive gingival disease and more decayed,

missing, and filled teeth than people without Multiple Sclerosis. People with persistent

symptoms or physical disabilities due to their Multiple Sclerosis may have difficulty getting to

dental appointments or the dental appointment may be too challenging for their physical health to

be able to attend. Therefore, not receiving regular dental care also physically affects their oral

cavity. When it comes to the incidence of decay due to the disability of Multiple Sclerosis, there
is definitely a risk of increased decay when looking at the decrease in ability for a person to care

for themselves. Also, the side effects of their many medications, such as dry mouth, could play a

part in increasing decay. A study was done in 2008 on a small group of people with Multiple

Sclerosis, ranging in age from twenty five to sixty five and above. The study looked into many

factors of the oral cavity in patients with Multiple Sclerosis. Symons, Bortolanza, Godden &

Seymour’s (2008) found the following:

In spite of poor manual dexterity, chewing difficulties, soft diet, and medication

affecting oral immunity, the oral health and past dental experience did not indicate that

this group had either a higher caries experience or a higher periodontal disease

experience. However, the authors acknowledge that this group may not be representative

of MS sufferers, since it was small, and all were volunteers.

Another study done in 2019 reviewed oral health and Multiple Sclerosis. They assessed oral

health, oral hygiene, dental caries, periodontal disease, temporomandibular disease, and other

oro-maxillofacial diseases in patients with and without Multiple Sclerosis. According to

Manchery, Henry & Nanglestated (2019), there is limited proof that people with Multiple

Sclerosis are more likely to develop dental caries compared to people without the disease.

The same goes for incidence of periodontal disease, as one would lead to believe that due to

physical disability and added factors of medication side effects, etc., that Multiple Sclerosis

brings onto a person, that there would also be an increased risk of periodontal disease. The 2008

study did not find higher periodontal disease in the small group of patients they evaluated with

Multiple Sclerosis. The 2019 study also found that gingival disease was not higher in their

patients. When it comes to incidences of alignment, one may end up having to have teeth

extracted due to periodontal issues or decay due to their Multiple Sclerosis affecting the way
they can take care of their teeth. With that being said, alignment could be affected. Multiple

Sclerosis often causes system inflammation, which can affect facial nerves and the mouth. It is

seen that this inflammation can cause pain around those nerves, ulcers in the mouth, and sensory

changes such as touch around the face and mouth. These are all things we should be aware of for

malformation considerations of people with Multiple Sclerosis. As reviewed earlier, there are

many medication options for people with Multiple Sclerosis. Some of the effects one would see

of a patient with Multiple Sclerosis and on medications due to it are chronic cough, mouth sores,

and dry mouth. Other dental considerations that the medication side effects bring on are nausea

and vomiting, and increase of blood pressure. The nausea and vomiting could cause erosion and

other dental issues and increase of blood pressure could affect dental appointments.

There is definitely a need for a caretaker for people with Multiple Sclerosis. When they

are having flare ups, there are many things they need help with and need someone around to

make sure they are taken care of. When their Multiple Sclerosis gets to the chronic stages, they

typically do have an in-home caretaker or go to a nursing home. Their caretaker should be the

one taking care of their oral hygiene if they are at that stage, and if they are not a toothbrush with

a large handle would be very beneficial. If their disease is in a manageable stage, a GUM

toothbrush could still be beneficial since the handle is wide, and as they worsen one could

consider attaching a tennis ball to help grasp onto it when brushing. Flossing could become very

challenging for one with Multiple Sclerosis, hand held flossers would be an option so that they

had something to hold onto rather than wrapping the string floss around their fingers, or they

could try a water flosser with a bigger handle. If the patient experiences dry mouth as a side

effect of medications, one could recommend Biotene rinse, Xylitol gum, or Xylitol lozenges.

There could be little or many appointment modifications when seeing a patient with Multiple
Sclerosis, depending on the person’s stage of disease. Some considerations to be made are the

time of day the appointment should be made, some may find they feel better in the mornings,

some may feel they would do better later on in the day, it is important to discuss this with the

pain. Short appointments would be best so that the patient is not laying back too long, multiple

appointments may then be needed and they should be frequent to keep the patients oral hygiene

the best it can be. Other considerations are adjusting the chair to a comfortable position for the

patient, going over medication oral side effects and how to help manage those is important, and

extensive oral hygiene instructions will be helpful for the patient. Another consideration when

discussing oral hygiene with the patient would be nutrition, as dental hygienists are very

knowledgeable in nutrition and how it can affect our teeth. It is important that the person with

Multiple Sclerosis is taking care of their overall health and nutrition guidance could be

beneficial, however, the hygienist should also encourage the patient to see a nutritionist to help

in ways that are outside of the scope of practice of a hygienist. When discussing Multiple

Sclerosis and oral hygiene, Isenberg (2021) stated:

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. In a

study published in the Journal of Oral Maxillofacial Surgery, close to 90 percent of study

subjects, all of whom had MS, had some form of facial or mouth-related symptom

(including numbness or pain).

It is important to make sure your patient is getting the care that they need and to keep in mind

that they may be experiencing pains a normal person has never felt before.
 Overall, Multiple Sclerosis is a very complex and serious disease that many people

around the world are living with every day. There are so many ways that this disease affects ones

life and it is beneficial for hygienists to be knowledgeable on Multiple Sclerosis and how they

can help their patients maintain a healthy mouth.

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