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Multiple Sclerosis (MS) can affect any part of your body including your mouth. Dealing with the effects of MS is never easy and your dentist can help in identifying problems that can occur with your mouth, teeth and smile and implement a treatment program. Not everyone will develop these challenges however being forewarned is forearmed in making sure you are taking the best care of your health that is possible.
MS, in some patients, may cause partial (and in extreme cases – complete) paralysis of facial muscles – some MS patients have reported temporary numbness in their teeth, cheeks, jaw or lips.
MS may also cause pain in a specific tooth, causing the patient to seek dental care on what is really a very healthy tooth. This is called Trigeminal Neuralgia (TM) (sometimes called tic doloureux -French for “painful twitch”) and is perhaps the most intensely painful MS-related symptom. It is one of the types of pain described as “neurogenic pain” or “primary pain” meaning it is the direct result of the disease process of MS, caused by demyelination and lesions on specific nerves. It can occur in the lower part of the face (often triggered by chewing, drinking or brushing teeth) and is usually an intense, sharp pain. Usually the most intense pain is short-lived (from a few seconds to up to two minutes however, it can result in a more constant burning or aching. In some cases, it can also have the following characteristics: extending as far as the ear and often mistaken for the pain of an ear infection and can be triggered by loud sounds. It is very important to note that TM is rare, with only 4% of people with MS experiencing this kind of pain. If you do experience this type of pain it is important to know the following:
- TM pain can be brought on by chewing or touch. It is caused by lesions on the trigeminal nerve, which is also called the fifth cranial nerve. (The 12 cranial nerves emerge directly from the brain instead of from the spinal cord.) The trigeminal nerve controls the muscles needed for chewing, and is responsible for most facial sensation.
- TM can get so severe and so distressing that it can require hospitalization and intravenous painkillers. It can interfere with a person’s intake of food and fluids and require that these also be supplemented intravenously. Some people may require surgery for this symptom. Please note that this is extremely rare that it gets this severe.
- Due to the intensity of this symptom, anxiety and fear about the possibility of it recurring can cause unnecessary suffering and interfere with daily life, even when the symptom is not present.
- It tends to be episodic: Each “bout” with TM usually lasts a couple of weeks. However, this symptom tends to recur and can happen as often as every couple of months. Some people will go years between episodes of this symptom. Unfortunately, as time passes, time between episodes may get shorter.
- Hold off on the root canals: Given the location and nature of the pain associated with TM, it is often mistaken for dental pain. This could lead to unnecessary (and irreversible) procedures like tooth extractions, root canals and even procedures to reposition the jaw. Make sure that you see your neurologist if you are experiencing this kind of pain, especially before undergoing any kind of drastic dental work.
- o Appears Early: TM tends to be one of the first symptoms of MS for those who experience it.
It is important that your dentist is aware of these signs – identifying the early symptoms of the disease will help your dentist identify the proper treatment planning for your needs. Some MS patients can experience difficulties swallowing, decreased amount of saliva or difficulties of proper use of the tongue. In these conditions it’s harder for the patient to maintain good oral hygiene therefore patients experiencing this may be at a higher risk for tooth decay and periodontal disease.
The primary concern that arises in MS patients is the loss of muscle control and this condition can limit the ability to brush and floss - this is extremely important for dental health. Depending on the muscles affected, you may or may not be able to reach every tooth. If you cannot manage your oral hygiene – brushing and flossing - you will need to ask for some assistance. Your dentist and hygienist will help you and your caregiver to reach the optimum results. It is important to emphasize that the most common problems that dental professionals might have to deal with when treating MS patients with severe MS symptoms are: halitosis (bad breath) and periodontal disease (loss of gum and root structure) – these are typical problems that are usually associated with poor oral hygiene – and are common with MS patients due to their inability to brush and floss.
Another area you may want to be careful is ensuring that your dentist is well versed in the symptoms and treatment of MS. For instance - it could be hard for the patient to open his mouth for extended periods of time. Controlling patients tongue movements and swallowing could also be a problem. Dentists that understand this issue can use a new product called Isolite to keep a patient’s mouth open and isolate their tongue to prevent the patient from swallowing debris and water.
There are also a few other areas you may want to be aware:
- Dentures: With time, multiple sclerosis might get worse and affect patients that wear full or partial dentures. Muscle spasticity makes it difficult or almost impossible to wear dentures comfortably and the more severe these episodes are the more likely it is the patient may hurt themselves or even worse - believe-it-or-not – swallow the dentures. A possible solution to avoid this problem is to place dental implants that can support the denture and decrease the accidental risks of dislodging the denture while MS symptoms occur.
- Appointment time: Dentists should always attempt to keep the length of your dental visits at a comfortable length of time because you must avoid as much stress and fatigue as possible. In general MS patients have a hard time sitting in the dental chair during lengthy appointment and it’s advised that the dental professional needs to allow multiple breaks of five to ten minutes every half of treatment. When dentists need to deal with compromised patients that are not able to move upper or lower limbs the situation becomes more complicated – there is an immediate need to change their position during the appointment to minimize stress and possible muscle soreness. The use of foam pads to reduce patients discomfort is strongly advised. In this way - pads will avoid pressure sores and will make the patient feel more comfortable during the appointment. It is best to schedule the appointments early in the morning because it is less stressful.
For any patient undergoing the challenges of MS - you can be assured that our office will help you maintain the most optimal oral health you can achieve, while keeping you aware of the specific needs you may have with your MS. Together we will keep your mouth healthy and comfortable. You have exceptional circumstances and we want you to keep smiling! That is our mission.
Best regards for a healthy and beautiful smile,
Mark Sayeg, DDS
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