Multiple Sclerosis Dental Implants

Patients with multiple sclerosis often have difficulty receiving dental care. Multiple sclerosis (MS) is a degenerative neuromuscular disorder that often leaves the patient partially or fully paralyzed due to complications in the nervous system, causing it to attack the spinal cord and brain. In patients with MS, the myelin sheath, the material protecting the nerve cells, is damaged 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, and ability to balance, numbness, memory issues, and a pins and needles sensation in the lens. Currently, there is no known cure for multiple sclerosis but complete and partial remission are possible.

How does MS affect dental care?

Preventative dental care is a great way to improve the overall oral health for patients with MS. When choosing a dentist for professional care, it is crucial that the provider is able to meet the needs of patients with MS. In order to accommodate the unique needs during dental treatment, special considerations have to be taken. Most patients with MS will not be able to endure long appointments and are typically better off being treated in the morning. 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 this can be aided by seating the patient at a 45° angle and using a bite block to prop their mouth open. This will allow them to relax and not have to focus on keeping their mouth open themselves. I can also be beneficial to both the patient and the provider if the patient is able to receive some form of sedation.

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 the chair instead of trying to transfer them from the wheelchair 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. Where the temporomandibular joint is concerned, some dental offices may offer some form of 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 can Multiple Sclerosis affect oral health?

Every patient should practice good oral hygiene at home, especially patients with MS. Our oral health is directly related to our overall health and good home care can help prevent the need for restorative treatments. Patients with MS may have a difficult time to properly floss and brush their teeth which can make them more susceptible to periodontal disease, decay, and infection. Their dentist may be able to suggest modified brushing and flossing materials to help patients with their home care. Caregivers also need to be trained to help the patient brush and floss their teeth.

They may also be on medications that cause dry mouth which can lead to the development of gum disease and tooth decay such as corticosteroids, muscle relaxants, antidepressants, and immunosuppressants. Dry mouth can also be exacerbated by inhibited saliva production. Patients with MS sometimes have trouble ingesting and swallowing food and have decreased saliva production. Our saliva helps 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 recall schedule than the usual every six months. Having their teeth professionally cleaned three or four times a year can greatly increase their oral health and help prevent periodontal disease.

Patients with Multiple Sclerosis and Dental Implants

Any patient missing one or more teeth can benefit from dental implants but for patients with MS, implants may be the best choice! 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! Dental implants are a much more stable option for replacing missing teeth for any patient but none more so than 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.

There is also the option of an implant supported denture which can be easier for patients living with MS to handle. An implant supported denture works just like a traditional denture and replaces all of the teeth on one or both arches. They are 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. They may also be easier to clean using a regular toothbrush and a WaterPik.

Finding a provider that is able to accommodate the specific needs of a patient with multiple sclerosis is crucial to the patient’s oral health and comfort. If you are visiting a dentist for the first time, be sure to inform them of your needs so that they can be prepared to provide you with the best dental care possible.

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