Tips to take care of your teeth
Although MS can make dental hygiene challenging, good oral health is a vital part of disease management.
by Matt Alderton
Your mouth is marvelous. Without it, you couldn’t eat, drink, breathe or speak.
But the mouth can just as easily harbor harmful microbes that can cause tooth decay and gum disease.
“Dental cavities and periodontal disease are bacterial infections,” says dentist Larry Coffee, DDS, founder of the Dental Lifeline Network, a national nonprofit that arranges pro bono dental care for people with age-related, medical or physical challenges. “The bacteria thrive in dental plaque, which needs to be removed daily with basic oral hygiene. If that plaque isn’t removed, then you’re left with a film of bacteria on your teeth, and that bacteria can do a lot of damage.”
MS and oral health
People with MS may be more vulnerable to oral infections because of the use of disease-modifying therapies (DMTs) to manage relapsing forms of MS.
“When our immune system is being quieted by medications to control various diseases, including MS, then our innate resistance to the spread of bacterial infections is reduced. So, the site of any bacterial infection, including the teeth and gums, can become a site for systemic spread,” explains Coffee, who says untreated cavities and gum disease can lead to chronic pain, eating difficulties and malnutrition, tooth loss and perhaps even sepsis in immunocompromised individuals.
Coffee says medications to treat MS symptoms, like incontinence and fatigue, or comorbidities like heart disease and depression can cause other complications as well. “Reduced saliva production, creating a ‘dry mouth,’ can be an unpleasant side effect of some drugs. Because saliva is buffering, lack of it increases the risk of dental cavities and gum disease.”
The key to good oral health is good oral hygiene — brushing your teeth and flossing. “If bacterial plaque is thoroughly and thoughtfully removed from every surface of every tooth every day, the likelihood of developing dental problems is very remote,” Coffee says.
And yet, basic oral hygiene for people with MS isn’t always as easy as it sounds.
“MS affects each individual differently, but it can affect many different systems within the body,” says Dori Cohen, an occupational therapist and certified multiple sclerosis specialist at Cooperman Barnabas Medical Center in New Jersey. “In some individuals, it may impact sensory or motor function in their facial region as well as in the upper and lower extremities. In some severe cases, it can also impact ability to swallow efficiently. All of that can make it really difficult for some people with MS to complete and tolerate the act of brushing their teeth.”
People with MS can manage their oral health challenges through a combination of education, dedication and ingenuity, according to Coffee and Cohen, who suggest the following practical strategies for taking care of your teeth:
Clean every surface of every tooth.
The best way to manage oral infections is to prevent them in the first place, according to Coffee, who says the key is thorough and daily teeth cleaning. A “thorough” cleaning, he says, encompasses all five surfaces of every tooth: the outside surface that faces your cheek, the inside surface that faces your tongue, the biting surface and the two side surfaces. You should clean the outside, inside and biting surfaces of your teeth with brushing at least twice per day for two minutes each time, and the side surfaces at least once per day with flossing.
Make sure you use a fluoridated toothpaste, stresses Coffee, who says fluoride helps protect teeth from the harmful effects of bacteria. His toothpaste of choice also
includes baking soda and peroxide, which have anti-microbial properties that make them ideal cleaning agents.
If you’re particularly prone to tartar and cavities, mouth rinses also might be a good idea, Coffee suggests. There are fluoride rinses that can strengthen your teeth, for example, and antimicrobial mouthwashes that can fight bacteria. Your dentist can help you determine whether you should be using a mouth rinse and which kind.
Coffee says it’s also important to remove dentures daily, brush them and soak them overnight in a cleaning solution. If you struggle with weakness or trembling, handling them over a sink filled with water can reduce the risk of breaking them should you drop them.
Consistency is key. If you have trouble remembering to brush and floss — approximately half of people with MS have cognitive issues that might affect their memory — consider using written notes, checklists or alarms, Cohen suggests.
Finally, consider chewing sugar-free gum in between brushings, Coffee says. Doing so can keep bacteria at bay by increasing saliva production, which is particularly important in people who suffer from dry mouth.
If MS affects your strength, endurance or motor skills, you might find it difficult to brush your teeth. Making a few simple modifications to your toothbrush can help, according to Cohen. For example, you might be able to enlarge the grip of your toothbrush by inserting it into a tennis ball or wrapping it in a piece of foam. When they’re cut to the right size, foam pool noodles and hair rollers work great. You also could use a bicycle handlebar grip, a washcloth or dish towel secured with plastic bands, or even duct tape.
Although it’s usually more expensive than DIY solutions, you also can buy adaptive grips online, or switch to an electric toothbrush. “Electric toothbrushes can sometimes be easier to hold,” notes Cohen, who says toothpaste also can be a source of frustration for people with MS. “There are many different types of toothpaste bottles. Typically, the large caps that flip open are easier for people to manage than the tiny screw-off tops. And flexible tubes are easier to squeeze than hard bottles.”
You also can purchase tube-squeezing aids that make toothpaste tubes easier to manipulate, or even toothpaste tablets that you pop like pills and chew with your front teeth to make a paste.
While you can’t modify dental floss in the same way that you can modify a toothbrush, there are plenty of alternatives available, according to Coffee. Interproximal toothpicks — plastic toothpicks with serrated edges designed to clean in between teeth — might be easier to use than traditional dental floss, for example. Or you could invest in a power flosser, which uses pressurized water to clean in between your teeth and has the same large handle as an electric toothbrush.
If the challenge is your body instead of your equipment, consider changing positions. If you struggle with tremors, for example, something as simple as resting your arm on a countertop while you’re brushing might help, Cohen says.
Revise your routine.
Your toothbrush, toothpaste and floss aren’t the only things you can switch up. You might also want to modify your schedule, Cohen says. If you tend to have more energy in the morning, for example, you might want to start flossing when you wake up instead of when you go to bed, at which point you’re more likely to skip it altogether due to MS-related fatigue. If your days tend to be busy, on the other hand — if you often have medical appointments and other commitments that keep you on the move, for example — you might rather floss at night when you’re more likely to remember your routine.
While you’re at it, you might want to rethink your environment. “Most people think oral hygiene takes place standing up at your bathroom sink, but it doesn’t have to. It can happen at your kitchen sink, if that’s easier for you to access,” Cohen says. “Or if standing is hard for you, you might sit down while you brush your teeth — on the toilet, on a shower chair or on a stool. That way, you don’t have to waste energy, and you can concentrate a little more on coordinating your upper extremities if that’s difficult for you.”
You could even brush your teeth from the comfort of your bed. “You just need some sort of surface to put everything on; some sort of water, like a cup of water, a water bottle or a basin; and a place to spit,” Cohen adds.
Assemble an oral health team.
If you have a carepartner who helps with other tasks, it might be advantageous to request their help with brushing and flossing, too, according to Coffee. He recommends bringing carepartners to dental appointments so dentists and hygienists can instruct them on the proper ways to care for your teeth.
“If you meet with a dentist or hygienist and show them how you’re brushing your teeth, they can tell you what you’re not doing well,” notes Coffee, who stresses the importance of at least twice-annual teeth cleanings for anyone who isn’t practicing perfect oral hygiene on a daily basis. “If plaque is not removed, minerals in the saliva will begin to adhere to it, which creates a hard deposit known as tartar, or calculus. While bacterial plaque can be removed very effectively with brushing and flossing, calculus cannot. It has to be scraped away from the teeth by a professional.”
For people with MS, it might be just as important to see an occupational or physical therapist as it is to see a dentist. Coffee suggests your dentist and physical therapist could collaborate with you to design an oral hygiene routine that works with your MS challenges.
Even neurologists and psychologists can be part of your oral health team. “A lot of people with MS are more likely to have depression or other mood-related changes. And sometimes that can play a role in motivation,” Cohen says. “So, talking to clinicians who can help you keep your mood in a good, positive place is also important.”
On that note, the benefits of good oral health can be mental as well as physical: Unlike MS, the causes and effects of which are so often out of one’s hands, most oral infections are entirely controllable. And that can be empowering.
“With impeccable oral hygiene, dental diseases are exceedingly preventable,” Coffee concludes.