Multiple sclerosis (MS) is a chronic disease of the central nervous system where the immune system attacks the protective myelin sheath covering nerve fibers in the brain and spinal cord. MS does not directly damage dental tissue. However, its systemic symptoms and necessary treatments create significant indirect risks for oral health. The neurological impacts and medication side effects compromise a person’s ability to maintain hygiene and resist oral infections. This increases the risk for conditions like tooth decay, gingivitis, and periodontal disease.
Indirect Impacts on Oral Hygiene
The physical and cognitive manifestations of MS often interfere with routine tasks, making effective daily dental care challenging. Overwhelming fatigue, a common symptom of MS, reduces motivation and the ability to perform necessary two-minute brushing sessions and daily flossing routines. This drain on energy can make the effort required for brushing and flossing feel impossible.
Motor impairment, such as hand weakness, reduced dexterity, or spasticity, compromises the ability to grip and maneuver a standard toothbrush or dental floss effectively. Involuntary movements, like tremor, complicate precise cleaning, leading to poor plaque removal, especially from hard-to-reach areas. Without thorough plaque removal, the risk of developing dental caries and gum disease rises.
Cognitive changes, often referred to as “cog fog,” can undermine consistent oral hygiene. Memory issues or executive dysfunction may cause an individual to forget to brush or floss, or to rush the process without adequate attention to technique. Although some studies suggest no direct link between reduced cognition and poorer oral health, physical challenges remain a primary barrier to consistent care.
MS-Related Neurological and Medicinal Effects
MS management affects oral health through specific biological and pharmacological effects, extending beyond physical barriers. A common side effect is xerostomia, or chronic dry mouth, which is frequently caused by medications used to manage MS symptoms. Drugs prescribed for bladder control, spasticity, or nerve pain often have anticholinergic properties that reduce the production of saliva.
Saliva is a natural defense mechanism that rinses away food debris, neutralizes acidic compounds, and provides minerals for enamel remineralization. When salivary flow is reduced, this protective function is lost, leading to an increased risk of tooth decay and gum disease. The resulting dryness can also make wearing dentures uncomfortable and increase the risk of fungal infections like oral thrush.
Trigeminal Neuralgia (TN), a neurological manifestation of MS, involves intense, electric-shock-like facial pain. Since TN affects the trigeminal nerve, pain can be provoked by routine actions like touching the cheek, chewing, or brushing the teeth. This severe pain causes patients to avoid necessary brushing, flossing, or dental appointments, resulting in a rapid decline in oral health.
Certain Disease-Modifying Therapies (DMTs) used to treat MS affect the immune system, making individuals susceptible to oral infections. While these treatments manage disease progression, their immunomodulatory or immunosuppressive nature increases the risk for viral, bacterial, or fungal infections in the mouth. They may also delay healing following dental procedures, necessitating close communication between the neurologist and the dental team for safe treatment planning.
Strategies for Maintaining Dental Health
Maintaining oral health requires proactive strategies and adaptive tools to compensate for physical limitations. Electric or battery-powered toothbrushes are recommended because their larger handles are easier to grip. The powered action provides more effective plaque removal with less effort compared to a manual brush. For flossing, tools such as water flossers or floss picks with large handles simplify the task of cleaning between teeth.
To manage reduced dexterity or tremor, simple modifications can be made, such as adding a bicycle grip, a tennis ball, or specialized foam tubing to a toothbrush handle for a broader grasp. Sitting down to brush and floss helps conserve energy and improve stability, allowing for a more thorough cleaning, especially when fatigue is high. For those with severe motor impairments, involving a caregiver or family member in the daily hygiene routine is important.
Managing xerostomia is paramount and involves daily practices to mitigate damage caused by reduced saliva. Frequent sipping of water or sugar-free beverages keeps the mouth moist and washes away bacteria. Using over-the-counter saliva substitutes, specialized dry mouth rinses, or chewing sugar-free gum containing xylitol can stimulate saliva flow and provide relief.
When visiting the dentist, communicate all MS symptoms, including mobility issues, fatigue levels, and the presence of Trigeminal Neuralgia. Schedule appointments when energy levels are highest and request shorter chair time to make the visit more manageable. Inform the dental team of all medications taken, as this allows them to prescribe appropriate fluoride treatments or prescription-strength toothpaste to remineralize enamel and protect against decay.