Multiple Sclerosis and Dental Implants
Multiple Sclerosis (MS) is a degenerative neuromuscular disorder that often leaves the patient partially or fully paralyzed due to complications in the nervous system which cause it to attack the brain and spinal cord. The myelin sheath, the material protecting the nerve cells, is damaged in patients with MS and causes messages traveling between the brain and body to slow or become blocked all together. This can result in poor muscle control and coordination, inability to balance, numbness, memory issues, and a pins and needles sensation in the legs. There is currently no known cure for MS but complete and partial remission are possible.
How does MS affect dental care?
Patients with multiple sclerosis often have trouble receiving dental care. Preventative care is the best way to improve and maintain the overall oral health for anyone, especially patients with MS. When choosing a dentist, it is important that the provider is able to meet the needs of a patient with MS. In order to accommodate their unique needs during treatment, special considerations must be taken. Most patients with MS will not be able to tolerate long appointments and are generally better off being treated in the morning hours. When restorative treatment is necessary, the patient will need 5 to 10 minute breaks every half hour or so. Some patients with MS may have a compromised airway since the muscles in charge of breathing can be affected by the disease but may be aided by seating the patient at a 45° angle instead of flat on their back. Using a bite block to prop their mouth open can also be very beneficial. It will allow them to relax and not have to worry about keeping their mouth open themselves. It can also be beneficial to both the patient and the provider if the patient is able to receive some form of sedation such as nitrous or even Valium.
When caring for a patient with MS, the provider must take extreme care when diagnosing dental problems as the patient may have a hard time pinpointing the precise location of any pain or discomfort that they are experiencing in their mouth. Another thing to consider for both providers and patients seeking treatment is wheelchair accessibility. Some patients with severe MS may be wheelchair-bound but some providers are able to treat the patient in their own chair instead of trying to transfer them to the dental chair.
A couple of issues that are common in patients with multiple sclerosis include trigeminal neuralgia and TMJ issues. The trigeminal nerve is the nerve responsible for facial functions and sensations such as biting and chewing. Patients with trigeminal neuralgia may experience numbness in the lips and jaw or a constant burning sensation, which can be triggered simply by touch. For temporomandibular joint issues, some dental offices may offer treatment but will likely refer the patient to a physical therapist or to a pain clinic with a clinical massage therapist who specializes in treating TMJ disorders.
How does MS affect oral health?
Every patient should practice good oral hygiene at home, especially patients with MS. Oral health is directly related to our overall health, so good home care can help prevent the need for restorative treatments. Patients with MS may find it difficult to floss and brush their teeth properly which can make them more susceptible to periodontal disease, decay, and infection. Their dentist may be able to suggest modified brushing and flossing materials and techniques to help the patient with their home care. Caregivers should also be shown how to help the patient brush and floss.
Patients with MS are sometimes on medications that cause dry mouth which can lead to the development of gum disease and tooth decay. Such medications may include immunosuppressants, corticosteroids, muscle relaxants, and antidepressants. Inhibited saliva production can exacerbate dry mouth, causing patients with MS to have trouble ingesting and swallowing food. Saliva helps to regularly remove food particles and bacteria when we swallow, keeping our teeth clean during the day. Salivary substitutes and fluoride treatments can help patients with dry mouth keep their mouth hydrated regularly.
Patients living with MS may also benefit from a more frequent professional cleaning recall schedule than the standard twice a year. Having their teeth professionally cleaned three or four times a year can greatly increase their oral health and help prevent periodontal disease. Patients who are already at high risk for periodontal disease should also have their teeth professionally cleaned more often.
Dental Implants for Patients with Multiple Sclerosis
Dental implants may be the best restorative treatment for patients with MS. Dental implants are a much more stable option for replacing missing teeth for any patient, even more so for patients with neuromuscular challenges. Traditional dentures and bridges that can become loose or dislodged can turn into a choking hazard for patients with multiple sclerosis. Patients with MS often already have trouble with dry mouth and relying on a denture can make that worse. Eating and speaking with dry mouth is difficult enough without adding a denture adhesive to the mix!
An implant supported denture is a great option when all of the teeth on one or both arches need to be replaced and can be easier for patients living with MS to handle. An implant supported denture works just like a traditional denture but secured in place onto implants using screws and cannot become loose or dislodged and may be a much safer option if a number of teeth need to be replaced.
Finding a provider that is able to accommodate the specific needs of a patient with multiple sclerosis is crucial to the patient’s oral and overall health and comfort. If you are visiting a dentist for the first time, be sure to inform them of your needs beforehand so that they can be prepared to provide you with the best dental care possible!