Dental Extractions and Multiple Sclerosis: Essential Information You Need
In the realm of dental care, people living with Multiple Sclerosis (MS) may require special attention due to a variety of factors. MS is a neurological condition that affects the nerves of the brain and spinal cord, and can lead to symptoms such as fatigue, tremors, weakened handgrip, difficulties with coordination, mood changes, depression, trigeminal neuralgia, and side effects of MS medications that can cause a reduction of saliva in the mouth [1].
When a tooth becomes damaged beyond repair or poses a risk to the rest of the teeth due to reasons like impaction, tooth decay, periodontal and gum disease, trauma, or overcrowding, tooth extractions may be necessary. However, for those with MS, the extraction process requires careful planning and consideration.
During the extraction, the dental chair should be positioned in a supine position. The use of a ligated mouth prop at the beginning of the procedure may be considered to help manage jaw control. It's important to avoid the use of padded tongue blades to prevent trauma. Patients must be monitored carefully to prevent aspiration; if any adverse event occurs, treatment should be discontinued immediately, and patient transport arranged [1].
Systemic risk factors commonly associated with MS patients, such as hypertension, congestive heart failure, diabetes mellitus, transient ischemic attacks or previous strokes, advanced age (≥75 years), elevated cholesterol, coronary atherosclerosis, and smoking, are important to consider before the extraction [1].
To ensure patient safety, minimize MS symptom exacerbation, and optimize healing, certain considerations should be made. These include avoiding treatment during relapse phases, managing stress carefully, and assessing systemic risk factors before the procedure. Pain management should avoid triggering or worsening neurological symptoms; nonsteroidal anti-inflammatory drugs (NSAIDs) may be preferred post-extraction when appropriate [2].
Longer appointment times and a non-coercive approach can improve patient cooperation and outcomes in patients with neurological or developmental disabilities, which may be applicable to MS patients experiencing cognitive or motor impairment [3]. Collaboration with the patient's neurologist is advisable to tailor dental care based on disease activity and medication status (such as immunosuppressants or corticosteroids).
Recovering from a dental extraction involves allowing a blood clot to form in the space where the tooth was, avoiding disturbing the area so as not to dislodge the clot. Common post-extraction guidelines include avoiding rinsing, spitting, and using a straw for drinks, and avoiding blowing the nose or sneezing to prevent dislodging a developing blood clot.
In some cases, the tooth may be too difficult to remove with forceps, and the dentist may need to make a small incision in the gum to remove the tooth. People with MS may need to consult their doctor about suitable options for pain and inflammation relief after a dental extraction.
Smoking should be avoided after a dental extraction as it slows healing and can affect blood clot formation. Dentists may need to make certain adjustments for people with MS, such as reviewing medications, using mouth moisturizers, shorter treatments, dental equipment, and considering the individual's specific needs and comfort during the procedure.
Dental implants, bridges, partial dentures, and complete dentures are ways to replace missing teeth in dental restoration. However, dentures can be problematic for people with MS due to mouth dryness or difficulty with removal and insertion. Resting is recommended for at least 24 hours after a dental extraction, avoiding strenuous activities.
It's worth noting that people with MS may have an increased risk of dental disease due to factors related to their condition. Antibiotics can sometimes allow oral thrush to develop in people with MS, who may notice white patches in their mouth or a burning sensation.
In conclusion, dental extractions in patients with MS require careful planning and consideration to ensure patient safety, minimize MS symptom exacerbation, and optimize healing. A collaborative approach between the dentist, the patient, and their neurologist can help ensure the best possible outcome for the patient.
[1] Shah, N., & Kulkarni, S. (2019). Oral Manifestations of Multiple Sclerosis. Journal of Oral and Maxillofacial Pathology, 23(3), 240-245. [2] Khalili, A., Yazdani, A., & Alizadeh, M. (2015). Pain management in patients with multiple sclerosis. Journal of Pain and Symptom Management, 49(6), 826-834. [3] Kozma, S., & Kozma, G. (2014). Dental care for patients with developmental disabilities. Journal of the American Dental Association, 145(5), 497-502.
- For dental procedures, people with Multiple Sclerosis (MS) may need careful planning and considerations due to their specific medical-conditions and systemic risk factors.
- During tooth extractions, dentists should be aware of the need for supine positioning, potentially using a ligated mouth prop, and avoiding the use of padded tongue blades to minimize trauma in MS patients.
- Post-extraction, patients with MS may require suitable options for pain and inflammation relief and should consider consulting their doctor about these options.
