Dental implants are one of the best ways to restore missing teeth in almost all patients, including those with multiple sclerosis. Multiple sclerosis (MS) is a degenerative neuromuscular disorder that can leave the patient partially or fully paralyzed due to complications in the nervous system which causes it to attack the brain and spinal cord. We have a material that protects our nerve cells called the myelin sheath and in patients with MS, damage to the myelin sheath causes messages traveling between the brain and body to slow or become blocked.
Patients with MS can experience poor muscle control and coordination, numbness, a pins and needles sensation in the legs, and inability to balance, and even memory issues. Unfortunately, there is currently no known cure for MS but complete and partial remission are possible.
Multiple Sclerosis and Oral Health
Patients living with MS may be on medications with a side effect of dry mouth which can lead to gum disease and tooth decay. Medications may include immunosuppressants, muscle relaxants, antidepressants, and corticosteroids. Inhibited saliva production can exacerbate dry mouth, causing patients living with MS to have trouble chewing and swallowing food.
All patients should practice good oral hygiene at home as oral health is directly related to our overall health. Patients living with MS may find it difficult to perform oral hygiene properly, making them more susceptible to periodontal disease, decay, and infection. These patients may find that having their teeth professionally cleaned three or four times a year can greatly improve their oral health and prevent gum disease. Patients living with MS may consider salivary substitutes and fluoride treatments to help relieve dry mouth.
Additionally, your dentist may be able to advise on modified brushing and flossing techniques and materials to enable patients living with MS to carry-on with their home care. Caregivers should also know how to help the patient perform oral hygiene.
Dental Care For Patients Living With MS
Preventative care is the best way to improve and maintain oral health for any patient, but especially those living with MS. MS can cause some patients to have trouble receiving dental care so when choosing a dentist, it is important that the provider is able to meet the patient’s unique needs.
Special considerations must be taken into account to accommodate patients living with MS. Most will not be able to tolerate longer appointments and have an easier time being treated in the morning hours. If restorative treatment is necessary, the patient may need 5 to 10 minute breaks every half hour or so.
Additionally, some patients living with MS have a compromised airway as the muscles in charge of breathing can be affected by the disease. This can be aided by seating the patient at a 45° angle instead of flat on their back. A bite block can be very beneficial to prop the patient's mouth open, allowing them to relax and not have to focus on trying to keep their mouth open on their own. Some form of sedation may also be considered such as nitrous or Valium but this will of course depend on the patient and the medication's they are currently taking.
Patients living with MS can have a hard time pinpointing the exact tooth in the event that they are having pain or discomfort in her mouth so it is important that your provider take extreme care when diagnosing dental problems. For patients who utilize the assistance of a wheelchair, it is important to ensure that the dental provider’s office is wheelchair accessible. If the patient is wheelchair-bound, some providers are able to treat the patient in their own chair instead of executing a transfer to the dental chair.
Patients living with MS can experience TMJ (temporomandibular joint) issues as well because the trigeminal nerve is the nerve responsible for facial movements and sensations. Trigeminal neuralgia is common with patients living with MS and can cause them to experience TMJ problems, numbness in the lips and jaw or a constant burning sensation, which can be triggered simply by touch. For TMJ 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.
Dental Implants for Patients with Multiple Sclerosis
Patients living with MS are often best treated with dental implants when a tooth needs to be replaced since traditional dentures and bridges can come loose and become a choking hazard, especially for patients with neuromuscular challenges. An implant supported denture is also a great option in the event that all of the teeth on one or both arches need to be replaced.
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.
Dental implants are easier to care for and do not have to be taken out for sleeping. Since they can be cleaned with brushing and flossing just like natural teeth, it is one less thing for the patient to worry about.
It is important for patients living with MS to find a provider that they are comfortable with and who can accommodate their specific needs. Continuing oral care is crucial to the patient's overall health and comfort as well. 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.