Does MS cause dental problems?

Ian Cook discovers MS can impact your teeth – here’s why you need to take extra care

Multiple sclerosis (MS) and teeth are subjects rarely discussed outside a long-lasting debate about amalgam fillings. But is there a bigger story we are missing here?

The reason I ask this question is that I have just had one back tooth (molar) extracted after it spectacularly collapsed while I was flossing one evening. I’d had some problems with the tooth for ages but at the extraction the dentist told me that lack of ‘nerve support’ to my teeth caused by demyelination had probably weakened the big back tooth over the years.

He said this was something he had seen in the mouth of another MSer, probably also as a result of years of demyelination. The dentist went on to explain he had another older patient with MS who, like me, had developed two problematic back molars both of which he had extracted. Worryingly, it sounded like the dentist knew exactly what he was talking about.

MS and dental issues

As if my dentist’s observation wasn’t sufficiently disquieting, a friend and fellow MSer who is about the same age as me (early 60s) has just had all his teeth taken out at the local dental hospital. So can demyelination have an impact on your teeth, and if so, what can you do about it?

The short answer to the first question appears to be yes it can. Although MS is generally regarded as a disease of the central nervous system (CNS), several studies have reported that people with MS can also have demyelination in the peripheral nervous system (PNS) too. The PNS is that part of your nervous system lying outside your brain and spinal cord where nerves receive and send messages to outlying body parts, things like your teeth.

A paper in the 2020 Journal of Neurology, Neuroimmunology and Neuroinflammation was titled, ‘Is MS affecting the CNS only?’ The paper concluded that ‘PNS involvement in MS might be more frequent than is generally assumed.’ Given that nerves in both parts of the nervous system are myelinated, it would seem strange that an auto-immune disease that targets myelin would leave myelinated peripheral nerves alone. Anyway, back to dentistry.

Another paper, ‘Multiple Sclerosis – A Demyelinating Disorder and Its Dental Considerations’ published in 2023 in the journal Brain Sciences said that periodontal diseases (teeth and gums) are more prevalent in MS patients. The article showed a picture of an MSer’s mouth where two molar teeth had been extracted.

Other factors

As well as dental problems caused by less peripheral nerve support to our teeth, we MSers may also suffer other related problems which can put us at significantly greater risk of tooth loss. One of these problems is a dry mouth caused by a poorer flow of saliva. MSers suffer from this problem for the same reasons that we often suffer from dry eyes. The same process that stops us producing enough tears also stops us producing enough saliva, and a moist mouth is hugely important when it comes to good dental health.

Saliva cleans the inside of your mouth, and any food debris left in your mouth is carried away by saliva. A good saliva flow stops food from collecting and ‘fermenting’ in your mouth which causes tooth decay. As well as this, saliva delivers minerals to your teeth and protects against acids breaking down tooth enamel, so saliva is highly important for good dental health.

A 2020 study in the Journal of Dental Medical Problems entitled ‘Salivary profile and dental status of patients with multiple sclerosis’ found significantly lower salivary flow rates in a group of 25 MS patients compared to 25 healthy controls. Interestingly, the same research found the number of cavities and missing molars was significantly higher in the MS patients than people without the condition.

Medication impact

Reading around the subject has made me realise there is far more than just the disease itself causing poor tooth health in us MSers. Medications used to treat MS can also contribute significantly to the onset and symptoms of gum disease and tooth decay. Many MS medications which aim to control MS symptoms have the side effect of dry mouth. Baclofen (anti-spasm), and clonazepam (anti-spasticity) are two medications I take daily, and dry mouth is among their side effects, particularly baclofen, which means I am losing the protection that plenty of saliva gives my teeth.

So, what can be done about all this? Firstly, good dental care is incredibly important for us MSers. Good teeth cleaning habits – things like using an electric toothbrush rather than a manual one, using small interdental brushes and flossing can reduce debris and tooth decay. It is also important to schedule regular dental visits where you can get to see a dentist. Depending on how well you clean your teeth at home, dental appointments may be needed more frequently with the hygienist too.

Extra care

The take-away message I suppose is to recognise MS can affect your teeth and therefore it’s important to keep your teeth clean and your mouth well hydrated. As well as the dentist, remember that the best help is often self-help. Saliva inducing sugar free gum can easily be bought at many shops. Artificial saliva is also available from your GP. This may come in the form of a spray, gel or lozenge. If you suffer from problems standing, sit down while brushing or flossing your teeth. If you have trouble holding a toothbrush, wrap something around the handle to get a better grip.

Following these simple steps may improve your dental and gum health meaning you may avoid the sad situation my friend and fellow MSer has found himself in – having all his teeth taken out at the age of 60 and wearing false teeth.