Multiple Sclerosis Dental Implants
Multiple Sclerosis (MS) is a progressive, degenerative disease that affects the central nervous system and alters nerve function. MS impairs the material, known as the myelin sheath, safeguarding the nerve cells and as a result, messages traveling between the brain and body are slower or become blocked.
While the cause of Multiple Sclerosis is not known, a combination of environmental factors, genetic predisposition, systemic inflammation, and immune system response is suspected. The influenza virus, common colds, smoking, and vitamin deficiencies are also believed to contribute to MS development. Anyone can be affected by Multiple Sclerosis, but the disease is most common with white women between the ages of 20 to 45.
As Multiple Sclerosis progresses in the central nervous system, individuals experience changes in sensory, motor, and cognitive functions. Fatigue, motor impairment, vision problems, and pain are common physical symptoms of MS. Severe symptoms could include bowel and bladder issues, depression, memory and concentration problems, and sexual dysfunction. Frequently, facial pain, partial facial paralysis or spasms, and difficulties with swallowing and speech are reported.
Multiple Sclerosis: Risks to Oral Health
Multiple Sclerosis patients face a number of oral health challenges because of the physical effects of the disease and their reduced immune response. With reduced motor function inhibiting oral hygiene practices, MS patients are at higher risk for developing cavities, gingivitis, and periodontitis. Compared to patients without MS, those with the condition generally have more extensive periodontal disease and a higher number of missing, decayed, or filled teeth. As such, customized dental treatment plans and oral hygiene practices must be implemented.
Physical disability is often a barrier to proper selfcare for Multiple Sclerosis patients. Should manual dexterity become compromised, modifying the toothbrush handle or switching to an electronic toothbrush can help remove biofilm from the teeth. In cases where strength, balance, and/or dexterity are concerns, a caregiver could provide physical support by holding the patient’s hand or elbow. If oral hygiene is inadequate, short, frequent cleanings at the dentist can also improve oral health.
Assessing the risk of cavities, including existing restorations, fixed or removable appliances, hard tissue defects, xerostomia, fluoride exposure, reduced dexterity, facial pain, and diet, can be useful in determining a MS patient’s specific oral treatment requirements. Nutritional counseling can be particularly helpful in reducing the risk of developing cavities. Patients at high risk for cavities should be put on a fluoride treatment regimen that includes a varnish application and prescription fluoride products to use at home.
A common side effect of Multiple Sclerosis medications is xerostomia (dry mouth) and if the patient is taking immunosuppressants, they could be at an increased risk for infections and cancers. If experiencing xerostomia, the patient may need saliva substitutes. Dry mouth could also limit restoration options should the patient experience tooth loss due to decay.
MS symptoms can also make it difficult for patients to stay relaxed for prolonged periods of time. As such, even routine dental exams or cleanings can cause symptoms such as stress, fatigue, and muscle spasms to arise. Stress and anxiety related to dentist visits could cause MS patients to completely avoid the dentist, further exacerbating dental issues. For patient comfort, dental appointments should be shorter and if possible, in the morning when MS symptoms are minimal.
Dental Implants for MS Patients
Given challenges associated with adequate oral selfcare and the increased risk for developing cavities and periodontal disease, tooth loss may be a reality for Multiple Sclerosis patients. Traditionally, removable dentures have been the go-to option for restoring a set of missing teeth. However, for patients with advanced MS, wearing a partial or full set of dentures can be difficult. Poor muscle control will make it more difficult to maintain the fit of the denture and since dry mouth is common, talking and eating will become more challenging.
A great alternative for restoring lost teeth that avoids the pitfalls of conventional dentures is dental implants. Unlike traditional dentures that simply rest on the patient’s gums for support, dental implants are permanently secured in the jaw. To serve as replacement tooth roots and the foundation upon which a prosthesis will be mounted, small titanium posts are surgically imbedded into the patient’s jawbone. Through a process known as osseointegration, the implants fuse with the bone to create a sturdy base upon which an abutment (connecting device) and prosthesis are mounted.
While dental implant surgery can be performed in a dentist or oral surgeon’s office on an outpatient basis, several months of healing will be needed between placing the implant and mounting the restoration. This healing is required to allow proper fusion between the jawbone and implant and typically lasts two to three months. However, patients with underlying medical conditions affecting their immune systems, such as Multiple Sclerosis, may require additional time to properly heal.
Other Considerations
As would any patient missing teeth, Multiple Sclerosis patients likely want to resolve their dental concerns as soon as possible. When determining if dental implants are appropriate, MS patients should consider the following when evaluating their treatment options:
- Duration of Treatment: Given that prolonged periods sitting in the dentist’s chair can be uncomfortable, MS patients should be aware that multiple visits will be required to obtain dental implants. Visits for an initial consultation, surgery to place the implants, mounting the prosthesis, and follow us to monitor healing, will all be needed over a course of several months. And because surgery is required, complications or infections are always possible which could require additional time and dentist visits to address.
- Cost of Treatment: Compared to conventional dentures, dental implants tend to cost more initially. Additionally, may dental insurance carriers consider dental implants to be an elective procedure rather than medically necessary. As such, the cost of dental implants is often only partially covered or not covered at all. With costs ranging from $3,000 for a single implant to over $30,000 for a full set of teeth, cost can be prohibitive for patients. Patients should verify their insurance coverage prior to dental implant surgery to determine what their out-of-pocket requirements will be.