Multiple Sclerosis Dental Implants
Multiple sclerosis is a chronic disease that causes the body’s immune system to attack the central nervous system, which includes the brain, the spinal cord, and the optic nerves. The inflammation that results when this occurs damages the fatty sheath of myelin that surrounds and protects the nerve cells and nerve fibers and also damages the nerve fibers and cells themselves, disrupting the ability of the central nervous system to communicate messages and leading to a variety of neurological symptoms. The chronic nature of repeated inflammation associated with multiple sclerosis causes scar tissue to form in the damaged myelin, in a process called demyelination. Each time inflammation and demyelination occur, this is considered a relapse or flare-up of multiple sclerosis and often leads to symptoms that include weakness, numbness or a feeling of pins and needles, a lack of coordination or loss of balance, fatigue, vision loss, bladder and/or bowel dysfunction, cognitive impairment, and impairment in speaking or swallowing. These symptoms can have multiple and diverse side effects, including a higher prevalence of oral health issues in people with multiple sclerosis. Oral health issues may arise due to the inability to adequately care for the teeth and gums, or because of the inflammatory nature of the disease itself, though there is usually a combination of involved factors.
It is estimated that multiple sclerosis affects more than 2 million people around the world. While initial diagnosis of multiple sclerosis usually happens between the ages of 20 and 50, the disease can also occur in children. Multiple sclerosis is two to three times more common among women than men, and it is also more common when family members have a history of the disease. The disease is most common among white people of northern European heritage and occurs more frequently in countries that are farthest from the equator. The cause of multiple sclerosis is unknown, though it is believed to be caused when genetically susceptible people interact with one or more environmental factors. These factors include exposure to certain viruses, like Epstein-Barr virus; lack of exposure to the sun; smoking; and vitamin deficiency. Smoking, especially, can increase the risk of the disease progressing and is known to worsen symptoms in patients with diagnosed multiple sclerosis.
Multiple sclerosis can contribute to dental health complications in multifactorial ways. Many of the symptoms of multiple sclerosis, including numbness or pain in the hands or muscle spasticity, can adversely affect a patient’s ability to properly brush and floss the teeth. This eventually often leads to dental cavities, periodontal diseases, and other issues that can arise from neglect. Unfortunately, chronic periodontitis contributes to systemic inflammation, which is a characteristic of multiple sclerosis; the cyclical, cause-and-effect nature of inflammation increases the importance of maintaining oral hygiene to reduce inflammation in the periodontium. Dentists may be called upon to provide customized self-care instructions or modifications to assist patients with multiple sclerosis in achieving effective oral hygiene. These modifications may include the use of electric toothbrushes or toothbrushes that have been modified for ease of use, alternative methods for interdental cleaning, or fluoride treatments. Dental treatments may involve additional health practitioners like nutritionists, physical or occupational therapists, or speech-language pathologists, depending on the nature of the oral health issue involved.
Patients with multiple sclerosis may also experience problems with their oral cavities, due to certain medications or to muscle spasticity. These problems may include dry mouth, or xerostomia; bruxism, or grinding of the teeth; or problems with the bite. Depression is also a common symptom of multiple sclerosis and can lead to a lack of proper attention paid to hygiene of the mouth and otherwise; additionally, many of the medications used to treat depression can also cause side effects like xerostomia. Xerostomia and bruxism may be treated outside of the dentist’s office, with artificial saliva substitutes and mouth guards, respectively. When patients do visit the dentist, they may report facial nerve pain; if unexplained facial nerve pain is present and a diagnosis of multiple sclerosis has not previously been made, it is important to refer the patient to a physician, as this can manifest as an early symptom of multiple sclerosis.
Especially during a flare-up, patients with multiple sclerosis often find it uncomfortable to sit for extended periods of time, largely due to muscle spasms. These may be exacerbated by stress or fatigue. The primary goal of a dental health professional with a patient who has multiple sclerosis is therefore to keep the duration of the appointment to a minimum while still providing thorough, effective care. Periodontal treatment may be necessary when periodontal disease is present; removal of bacterial plaque and tartar can reverse the earlier stages of periodontal disease, and reducing inflammation in the oral cavity can have beneficial effects on overall systemic inflammation. These periodontal treatments can take time, however, and it may therefore be recommended for patients to schedule multiple shorter visits rather than one longer visit to complete the procedure. Patients with multiple sclerosis may also face difficulties in wearing dentures. Poor muscle control may make it exceedingly challenging to comfortably place and properly fit removable dentures. Many of the medications used to treat the symptoms of multiple sclerosis can also lead to a dry mouth, which increases the difficulty of eating and talking while wearing removable dentures and also commonly leads to health issues in the periodontium. Dental implants can help patients with multiple sclerosis comfortably talk and eat, and they also reduce the risk of dentures slipping or fitting incorrectly. While duration of a dental implant procedure may be unmanageable for patients with multiple sclerosis, performing the procedure over the course of several shorter visits can provide a manageable way for patients with multiple sclerosis to obtain and maintain dental implants and to enjoy the many benefits they can provide. Once placed, dental implants require little maintenance and are designed to be long-lasting; while they must still be cleaned as natural teeth would, they may provide a more manageable option for dental patients who have experienced tooth loss due to complications and symptoms of multiple sclerosis.