Kendre Kamm

Dental Hygiene III

June 1, 2018

Disabilities Research Paper

Multiple Sclerosis is a disorder that has personally impacted my life and altered the ability of a

family member to do normal everyday activities. I am always open to learning more and more about this

debilitating disease and its effects on the body.

Multiple Sclerosis was discovered by Dr. Jean Martin Charcot in 1868 and has been continuously

studied until the present day. This disease is more common in women than in men. It is not contagious

and is not known to be associated directly with inheritance. Individuals acquire this disease over time and

may not be present with MS during their early ages of life.

Individuals are commonly diagnosed between the ages of 20-40 years old. More than 2.3 million

people across the nation are diagnosed with this “hidden” disease with the name of multiple sclerosis. It

picked up the name “hidden” disease because signs and symptoms can be missed quite frequently making

it difficult to diagnose. The population affected are mostly young adults.

Multiple sclerosis is defined as a disorder of the central nervous system associated with a

neuromuscular disorder /disease of muscular control. It affects the body physically in many ways. This

disease slowly degenerates the individual weakening the muscles over time, decreasing their motor skills,

coordination/balance, and numbness of extremities. Temperature plays a major role in the body’s ability

to function because if they are hot their muscles become weaker and they may become tired and worn out

very quickly. With the paresthesia and lack of pain perception, a person may not be aware of injuries,

cuts, sores etc. on their feet or hands. Depending on the severity of nerve damage the person may not

know when things are too hot to eat or drink which can become dangerous.
 Although there is no cure for this disease, there are medications that can help with symptoms and help

gain function of muscle control and other motor skills. Rebif is a popular injectable medication prescribed

to those diagnosed with multiple sclerosis. Its goal is to slow down the progression of multiple sclerosis

and to help prevent exacerbation or flare-ups of the disease. Ampyra is another recommended medication

to help boost coordination and motor skills. A simple task such as walking down the hallway can become

extremely difficult to those with this disorder but there are a plethora of medications on the market to help

build up motor skills to simply help them walk. Many medications listed for multiple sclerosis treatment

are to help with bladder control and bowel dysfunction. Antidepressants are frequently used because of

this debilitating disease and can mentally affect those diagnosed. Elavil is a widely used medication used

to treat painful paresthesias of the arms or legs, for example, they may experience burning sensations,

feeling of pins and needles, or spontaneous stabbing pains caused by damaged pain conduction pathways

of the brain and spinal cord. Pain control medications like morphine or other opioids are almost always

taken in addition to the other meds to subside any pain the individual may experience.

There are many medications on the market for treating symptoms of MS but many of those have

side effects that come along with it. Coming directly from an outside source who currently is diagnosed

with multiple sclerosis, she reports that morphine and opioids often cause constipation and dry mouth.

She is constantly drinking water or chewing gum to keep her mouth from drying up. Ampyra has

commonly reported side effects including nausea, headache, dizziness, lack of balance and more. This

medication has multiple oral complications/ side effects such as pain in the back of the throat, irritation of

the nose and throat, and burning, tingling, itchiness of the tissues. Steroids can sometimes be taken by

patients with MS but can make the healing process take longer.

This disease is progressive and severity ranges among the individuals. This disease is commonly

known to have a state of remission around 60-65 years old. Stated directly from an outside source who is

66 years old, “I have been all up and no downs, I am stable and have been since I turned 60 years old”.
Most of the medications prescribed are taken to prevent exacerbation or flare-ups of the disease which

could including vision loss, sudden severe muscle weakness, and imbalance.

Like most autoimmune diseases, MS does affect the oral cavity as well. How does this disability

affect the oral cavity physically? Dental treatments are about the same as other people the only

accommodation needed to be aware of would be severe xerostomia. This disease also causes numbness or

lack of pain perception throughout the body whether its hands, fingers, feet, toes, tongue, lips, etc. This

could be harmful to the patient if they happen to bite their tongue or fracture a tooth because they might

not be aware of it or feel pain in that specific area. Inflamed tissues due to improper oral hygiene may not

be obvious to the due to the lack of pain perception. The use of local anesthetics is not known to cause

problems or have any contraindications for those diagnosed with Multiple Sclerosis.

Multiple sclerosis can increase a patient's risk for developing caries or possible periodontal

disease because of the multiple medications they are taking that have side effects of dry mouth halting the

production of saliva in the oral cavity. This disease makes the individual immunocompromised making

them more susceptible to infection. Diet can be affected depending on their ability to cook and prepare

food so if they are unable to prepare their own meals we might see a lack of nutrients and more decay in

patients who cannot cook for themselves.

Xerostomia is a highly reported side effect also due to the medications and can also present

patients with halitosis, or bad breath. Steroids can sometimes be taken by patients with MS and those can

make healing take longer so the tissues may take longer to heal if they are infected in any way.

The need for a caretaker can depend on the severity of the disease. It is different for every

individual because some lose most of their muscle control and functioning along with their balance and

coordination skills which can affect everyday living. Walking, cleaning, cooking, errands etc. may be a

struggle for those with limited ability to control their muscles. Coordination is a necessity for simple tasks

like bathing, home care, and proper oral hygiene.

 Since multiple sclerosis affects the motor skills causing weak muscles, spasticity, and poor

coordination brushing and flossing can be challenging and modifications might be needed to ensure

proper oral hygiene. Switching from a manual to an electric toothbrush can benefit the individual in many

ways because of the thicker handle making it easier to grip, the automatic small, circular motions for the

appropriate BASS brushing technique, and with the newer electric brushes a lot of them are on a

self-timer to allow enough time for all surfaces to be cleaned efficiently. Soft bristle brushes are also

recommended. Poor oral hygiene can lead to infection which can conjointly worsen multiple sclerosis

symptoms.

Dental auxiliary aids can also be helpful to those who struggle with home care. Foam grips for the

toothbrush allows for an easier grip, floss threaders can help clean those hard to reach areas of the mouth

if they cannot use their fingers to properly clean interproximally, water picks may be useful as well to

flush out food or bacteria that may harbor around the teeth, mouth rinses to prevent growth of bacteria and

control plaque or specific dry mouth rinses like Biotene to counteract xerostomia.

Appointments can be scheduled normally like any other patient although if they have a caretaker

it might take them a little longer to arrive at the appointment if they need transportation and need the use

of a wheelchair or walker. If unable to get out of their wheelchair and into the dental chair,

accommodation can be made. Fluoride treatments are necessary at every appointment because of their

greater risk for caries. Shorter appointments might be requested if the individual is in a lot of pain and

may be scheduled for multiple visits to complete the treatment. While scheduling appointments with

patients diagnosed with MS we need to be thinking of the physical and emotional state they may be in and

times of relapse may not be a good time. Discussing with the patient about how they are feeling and how

home care is going is a good opportunity to check their progression of not only their oral health but the

body’s effect on the disease as a whole.

 References:

National Multiple Sclerosis Society. (2018, June 15). Retrieved July 1, 2018, from

https://www.nationalmssociety.org/

Hebl, L. (2017) Oral Pathology Powerpoint

Wynn, R. (2017) ​Drug Information Handbook For Dentistry.​ Wolters Kluwers.

Claiborne, D. M., RDH, BSDH, MS. (June 2012). Medication Use and Xerostomia. ​Dimensions

of Dental Hygiene,10(​ 11), 34-38. Retrieved from

http://www.dimensionsofdentalhygiene.com/2012/11_November/Features/Medication_U

se_and_Xerostomia.aspx

Moore, T. A., RDH, MS, EdD. (March 2016). Caring For Patients With Special Needs.

Dimensions of Dental Hygiene,14(​ 3), 58-61. Retrieved from

http://www.dimensionsofdentalhygiene.com/2016/03_March/Features/Caring_for_Patien

ts_With_Special_Needs.aspx