Multiple Sclerosis Dental Implants

Multiple sclerosis, commonly referred to as MS, is a progressive neurodegenerative disorder that affects the myelin sheath, which is the protective material that shields the nerve cells. This complicates the patient’s ability to convey messages to and from the brain, causing symptoms like numbness or a prickling sensation in limbs or digits, a loss of muscle control, and compromised coordination, memory, and balance. In addition to these challenges with motor impairment, symptoms among people with MS can include problems with vision, chronic pain, and fatigue. More severe symptoms may include problems controlling the bladder or bowels, facial pain or paralysis, depression and anxiety, and difficulties with speech or swallowing. While the exact cause of MS remains unknown, it is believed to arise due to a combination of genetic predisposition and environmental factors, and it may be exacerbated by systemic inflammation and a flawed immune system response. In many patients, MS appears as a pattern of flare-ups and remissions, with relapses that occur for a few days or weeks and gradually resolve. As patients experience more flare-ups, their central nervous system weakens, causing future relapses to increase in intensity and duration. There is no cure for MS.

While MS can cause a number of symptoms, the complications associated with these symptoms also affect the patient’s dental health. During a flare-up, many patients have little to no control over their muscles, and, over time, their muscles weaken, making it very difficult, if not impossible, for people who struggle with MS to adhere to an effective oral hygiene routine, including regular brushing and flossing. These deficits in oral hygiene encourage the growth of harmful bacteria in the oral cavity, which leads to gum disease and tooth decay, eventually leading to the painful inflammation of gum disease, and gradually leading to tooth loss. Inflammation, a defense mechanism that occurs in the immune system, is one of the primary characteristics of MS. The inflammation that is caused by gum disease can encourage systemic inflammation and promote flare-ups of MS, which, in turn, release biochemicals that increase systemic inflammation, including inflammation in the gums. As this cycle of inflammation perpetuates, it can ravage the body’s immune system while also destroying the oral tissues and encouraging disease in the oral cavity.

Due to this cycle of inflammation, preventative dental care is of the utmost importance for patients with MS. Because of the difficulties associated with brushing and flossing, however, home care may pose insurmountable challenges. In many cases, people with MS also have challenges swallowing, as they cannot sufficiently control their tongues, and they may also produce insufficient saliva. In the absence of saliva, excessive dryness in the oral cavity encourages the development of cavities and the proliferation of bacteria that cause gum disease. Dentists may recommend oral hygiene aids for patients with advanced MS, like power toothbrushes or toothbrushes with modified handles, or they may introduce techniques to make oral care easier, like flossing while lying down. Dentists also may recommend more frequent visits to the dentist for professional cleaning when patients have MS, though these visits should be as brief as possible. Patients with MS may struggle at the dentist’s office, where they may be physically uncomfortable if asked to maintain a specific position for an extended period, and where fatigue or stress might cause muscle spasms to occur.

For all of the aforementioned reasons, it is not uncommon for tooth decay and periodontitis to present in patients with MS, and for a disproportionate number of patients with MS to require dental restorations. Many of these dental restorations also present challenges for patients with MS. Removable dentures are challenging to insert and adjust, and they are likely to irritate existing mouth sores or ulcers that arise as a side effect of many common medications used to treat the symptoms of MS. The dry mouth that comes with MS also makes removable dentures difficult to wear, increasing the challenges associated with eating or talking while wearing removable dentures. The muscle spasticity associated with severe MS can make removable dental appliances difficult to insert and remove, and these appliances can also pose danger; for example, if a patient already has difficulty swallowing, the presence of a removable appliance could interfere even more and could lead to choking or cause the patient to be unable to eat.

Dental implants can be especially beneficial for patients with MS. Dental implants can be used to support a denture, reducing the chances that it will slip or be forced out of place and ensuring that the denture won’t interfere with swallowing or speaking. Most of the time patients with MS can receive dental implants with few or no complications. While certain medications that are often used to treat symptoms of MS can interfere with the healing of the tissues in the mouth, including the gums and bone, you and your dentist can thoroughly review your medical history and discuss suitable alternatives or methods that can make dental implants work for you.

If you and your dentist decide that you are a good candidate for dental implants, be clear with your dentist as you plan your treatment. Many patients with MS prefer to have their dental appointments in the morning, when muscle spasms and other painful symptoms are less likely. Patients who have breathing problems associated with MS should sit at a 45-degree angle, allowing their airways to remain open, and dentists should use assistive materials, like mouth props and rubber dams, as needed. You and your dentist may also decide to place your dental implants in a series of shorter visits, depending on the severity of your MS and your individual preferences. As you are planning treatment, you and your dentist, and your caregiver if you prefer, can discuss possible treatment adaptations and accessibility parameters that will improve your comfort throughout the procedure; be clear about your needs, and be transparent with your doctor about your medical history and concerns.

Patients who have multiple sclerosis are often faced with oral health risks due to loss of dexterity and side effects of some medications; additionally, patients with MS may also have cognitive and emotional factors that need to be considered. If you are a person with MS and you are concerned about your oral health, consult your general practitioner as well as your dentist, and understand what your specific clinical needs are so that you can have a comfortable, successful dental restoration procedure and a future of well-managed oral health.