Oral Health Status and Multiple Sclerosis: Classic and Non-Classic Manifestations—Case Report

Abstract

Background: Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations. Case presentation: A 49-year-old female patient diagnosed with long-term relapsing–remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis. Conclusions: Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient’s dental status over the years.

It Is Time for a Multidisciplinary Rehabilitation Approach: A Scoping Review on Stomatognathic Diseases in Neurological Disorders

“…Since a standardized protocol for the evaluation and treatment of SD/TMD in neurological disorders is still lacking, herein, we have reported some evidence-based clinical advice about the administration of multidisciplinary conservative approaches for neurological patients who have SD/TMD: -Parafunctional activities, such as bruxism and day clenching, have been found in PD and MS patients [11,19,22,23], causing muscle pain and harmful effects on tooth enamel. Currently, there are no treatment methods to make these alterations stop.…”

“…The general quality of the included studies ranged from low [19][20][21][22]24,25,27,28] to moderate [27,29]. It should be considered that the low quality of the selected evidence is likely related to the great heterogeneity among studies for the methodologies, diagnostic tools and rehabilitation treatment administered.…”

“…It should be considered that the low quality of the selected evidence is likely related to the great heterogeneity among studies for the methodologies, diagnostic tools and rehabilitation treatment administered. Additionally, we excluded one study from the risk of bias assessment [19], since it is a case report.…”

“…MS patients can manifest three common orofacial alterations: facial palsy, trigeminal neuralgia and/or paresthesia. However, Costa, C. et al [19] described an unusual pattern of SD in a MS patient, which included tooth hypersensitivity, hyposalivation associated with caries, halitosis and bruxism. The latter tends to increase when occlusion is impaired, also contributing to head and neck pain.…”

Multiple Sclerosis—A Demyelinating Disorder and Its Dental Considerations—A Literature Review with Own Case Report

“…Patients with TMJ disorder generally present with pain originating around the TMJ, such as in the pre-or post-auricle area, and is transferred onto the orofacial and neck region, including temporal, occipital, malar, and cervical regions. The pain can involve either side or bilateral with varying severity [51][52][53][54][55][56]. Dysarthria is another common manifestation in MS.…”