The symptoms of multiple sclerosis (MS) and some drug treatments can make it harder to get to the dentist or keep your teeth and gums healthy. Sometimes fairly simple changes can make things easier.
How can MS symptoms affect oral health?
Some MS symptoms might cause you to shorten your brushing routine or give flossing a miss. For example:
- fatigue – cleaning teeth twice a day can be a big drain on precious energy – cleaning teeth twice a day can be a big drain on precious energy
- weak grip – making it hard to brush for very long or hold the brush the right way
- problems with coordination, sensation, or tremor – all making it harder to brush effectively
- mood changes, including depression – affecting the motivation to keep teeth clean
- trigeminal neuralgia – brushing can trigger that pain in your facial nerve (read more about trigeminal neuralgia)
What we eat and drink
Sometimes the easiest calories to hand are sugary ones, especially when cooking is difficult. A dietitian can help you find alternatives.
If you’ve been prescribed high calorie supplements, these often have a lot of sugar in them. Let your dentist know so they can help you guard against problems.
A dietitian can check you’re getting enough vitamin C in your diet – good for gums and teeth. Though there’s no evidence that high doses help more than what you can get from a healthy diet.
Drink plenty of water – a dry mouth helps bacteria that cause tooth and gum problems.
Can drug treatments affect my oral health?
Drug treatments can have an impact in different ways:
- Side effects - for example, giving you a dry mouth or oral thrush.
- Interactions with treatments your dentist suggests.
- Tooth decay – some drugs are taken as sugary syrups. You might be able to get a sugar-free version instead.
Make sure your dental team knows about any drug treatments or complementary therapies you’re using. They might need to take extra precautions.
Tips for looking after your mouth and teeth
- To save energy, try an electric toothbrush. They can also make things easier if someone else carefully helps you brush.
- If you find it hard to grip, try a brush with a longer, wider or angled handle – it might help you brush more effectively. Electric toothbrushes often have chunkier grips.
- If cleaning between teeth is difficult, small interdental brushes might be easier than flossing. Or you could try flossers with different shape handles.
- Don’t rely on just mouthwash all the time. It doesn’t remove food and plaque in the same way.
- Give up smoking – it makes you more likely to get a dry mouth, stained teeth, gum disease and oral cancer. Stopping could also help your MS.
- Regular appointments with a dental hygienist can help prevent problems with teeth and gums.
Getting advice from my dentist
A dentist can advise you on cleaning techniques, toothpastes, floss, brushes and mouthwashes that are right for you.
They can also give tips to anyone else who helps you brush – bring them along to the dentist with you if you can.
The Oral Health Foundation can help with questions about dentists, teeth and gums, and how to find dental services during COVID-19.
How do I deal with a dry mouth?
We get a dry mouth if we don’t have enough saliva (spit). Saliva keeps your teeth, tongue and gums clean. Some common drug treatments can cause dry mouth:
- lots of drugs for bladder problems
- some antidepressants
- some that treat muscle spasms
If you’ve got a dry mouth, you’re more likely to get tooth decay, infection and gum disease. To protect your teeth and gums, a dentist might suggest:
- frequent visits to a dental hygienist
- saliva replacement products (could be a spray, a solution you swish round your mouth, a gel or lozenges)
- special dry mouth toothpaste
- high fluoride toothpaste to give extra protection
And you could try:
- chewing sugar-free gum
- frequent sips of water
- sucking sugar-free pastilles
- using a humidifier at night
- avoiding mouthwashes which contain alcohol
How can I deal with oral thrush?
Oral thrush is caused by a fungus in your mouth called candida. It’s in most people's mouths, and it only causes problems when it grows out of control. That’s when we call it thrush.
How do I know if I’ve got oral thrush?
Signs of oral thrush include:
- white patches in your mouth
- a burning feeling in your mouth
- if you wear false teeth, a very red area underneath them
Why did I get oral thrush?
Thrush might be more likely if:
- you have a dry mouth
- you find it hard to keep your mouth clean
- you’ve taken steroids to treat an MS relapse
- you’ve recently taken antibiotics
- you use the disease modifying therapy glatiramer acetate (Copaxone)
- you leave your false teeth in overnight
How can I manage oral thrush?
Your dentist or doctor can prescribe antifungal medication to treat thrush in your mouth.
They can also check if there’s an underlying cause that needs treating. If you’ve got false teeth, make sure the surface is clean. If you can, leave them out overnight.
Going to the dentist when you’ve got MS
The right dentist can treat you but also refer you on to other care professionals if you need specialist services.
Whether you’ve already got a dentist or you’re looking for one, there are some things you might find useful to bear in mind.
Is the dental surgery accessible?
Other people with MS in the area might have good tips about which surgeries are easiest to use – find a local group of the MS Society on our website or by calling the MS Helpline.
Your MS nurse or the dentist you’re with now can also help you find somewhere.
If you can’t find a surgery that’s accessible to you, you might use community dental services instead. This could mean seeing a dentist at a hospital, a health centre, or in a mobile clinic. Using a community dental service could give you more time and space at the appointment.
Some dentists do home visits, though this does limit the treatments they can give.
- step-free access
- suitable parking
- wheelchair access if you need it (in the treatment room and the waiting room)
Is the dentist’s chair accessible?
Even if the surgery is accessible, think about how easily you can use the dentist’s chair. Especially if you’d usually use a wheelchair for appointments.
Do you use a transfer board or a hoist to move to another chair?
- Check if they have these available at the surgery (but be aware that most don’t).
- You might be able to bring your own, but check this out with the surgery too. Even if there’s space, they probably won’t be trained to help you transfer. If you usually have someone to help you move, see if they can be with you at the dentist.
If your wheelchair reclines, you might be able to have check-ups and treatment without moving chairs.
If you can't transfer between chairs, and your wheelchair doesn’t recline, this might limit the treatment you can have in that surgery. Talk to your dentist about other ways you can get the dental care you need.
What adjustments could my dentist make?
You might want to speak to your dental team about:
- Arranging appointment times that suit your needs – usually in the morning when you have more energy? In the afternoon when it’s easier to get there on public transport?
- Allowing for breaks in appointments if they need to be long.
- Any actions they could take to make sure things are accessible – like making sure they tell you if the lift is out of order, or being there to meet you with a temporary ramp to get up a step.
- Making follow-up appointments in the treatment room instead of having to use energy waiting at reception.
Ask them to add useful details like these to your notes so you don’t have to explain things every time.
At your dental appointment
Your dentist needs to know if someone helps you look after your mouth and teeth. If there is someone, the dentist might want to speak to you both (if that’s OK with you).
Before the appointment, you and the person who helps you might want to chat through any concerns or questions you have for the dentist – so you get the most out of your time.
Explain how MS affects you to your dentist
You’ll know much more about how MS affects you than your dental team.
- Tell them you have MS and the symptoms you get. Mention if you think your symptoms could make it difficult to sit in the chair, or have treatment. For example, if you get muscle spasms, or if you might need to use the toilet at short notice. And let them know if your MS makes it harder to keep your mouth clean.
- Let them know about any drug treatments or complementary therapies you use.
- Agree a signal with your dental team that you can give during your treatment in case you want to stop because you don’t feel well or need a rest.
- If you’re sensitive to light you might find the dentist's light uncomfortable. The dentist will probably have tinted safety glasses you can wear, or take sunglasses with you.
Do I have to pay for my dental care?
This depends on where in the UK you live. For example, NHS check-ups are free for everyone in Scotland, but only for certain people elsewhere.
Across the UK, most people have to pay for dental treatments (like fillings or crowns) – but the rules and prices vary. Check your area:
- England - nhs.uk
- Wales - 111.wales.nhs.uk
- Scotland - nhsinform.scot
- Northern Ireland - nidirect.gov.uk
If you can’t get free NHS dental care, ask your dentist what things cost. There might be different prices for NHS treatment and private treatment.