MS Essentials Factsheet

March 2010

Oral health and MS

MS (multiple sclerosis) does not directly make you any

more likely to get dental diseases than other people. But
people with MS sometimes have difficulties in
maintaining good oral hygiene and accessing care. This
can increase the risk of dental health problems.1,2,3

Why is oral health By 'oral health', we mean the health of the mouth, teeth,
tongue and gums. Good oral health is important for
important? eating, swallowing, smiling and talking. Prevention is the
most important part of oral care, and regular visits to
the dentist are essential to help you maintain good oral
health and to avoid decay, dry mouth and fungal
infections.

How might MS affect Stiffness, weakness or muscle spasms can all affect
someone's ability to brush or floss their teeth properly,
my oral health? or to receive treatment.4,5 Long-term medications can
also make it more difficult to maintain oral health, either
because they cause dry mouth or ulcers, or because
they are sugar-based, causing tooth decay.4 It can also
be more difficult to go to see a dentist if you have
problems getting about. There's more on this later in the
factsheet.

Some people with MS can have a severe facial pain,

known as trigeminal neuralgia. This can be mistaken for
toothache. If you have facial pain, it is important to
discuss it with your GP as well as your dentist, as it
could avoid any unnecessary dental work. The
Trigeminal Neuralgia Association has more information:
www.tna.org.uk or call them on 01883 370214.

Oral health © MS Society 2010

Dry mouth Dry mouth is when you don't have enough saliva to keep
your mouth wet. Tooth decay, infection and gum disease
are more common in people with a dry mouth, so it is
essential to consult your dentist if this is an issue for
you.

Saliva is important for lubricating food and starting the

process of digestion. It helps keep the mouth (teeth,
tongue and gums) clean, by protecting against infection
and neutralising acids. It also helps with clear speech
and swallowing.

There are a number of medications, including diuretics

and anti-depressants, that can reduce the production of
saliva. This can make eating, talking, wearing dentures
and oral hygiene more difficult.4,5 Smoking also
increases the risk of a dry mouth.6

There are various products available to manage dry

mouth. High street chemists will be able to order them
for you - few will keep them in stock in the store. Your
GP can also prescribe some.

Oral thrush Oral thrush is caused by a fungus called candida. It is

present in most people's mouths but, in certain
circumstances, it can cause an infection in the mouth. It
most commonly affects people who wear dentures. But
other people are also at higher risk of developing the
condition: people with dry mouth; people who have
difficulty keeping their mouth clean; and people who
take steroids. Using some antibiotics can also result in
the development of oral thrush.7 Your dentist will be able
to give you advice on how to deal with it if this is a
problem for you.

Nutrition If you are not getting enough essential elements and

vitamins in your diet, this can affect your oral health.
Many experts consider vitamin C particularly important
for good oral health - though there is no evidence that
high doses are more effective than the standard
recommended amount.8 The Eatwell website,
www.eatwell.gov.uk, has tips on diet and nutrition. You
may also find the MS Society's publication Diet and
nutrition useful.

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Oral health © MS Society 2010
Smoking and Smoking cannabis can affect the nerve endings in the
mouth, masking any sensitivity that may be occurring.9
cannabis Cannabis is illegal in the UK. Smoking in general can
also increase a person's risk of developing gum disease
or tooth loss.10

Amalgam fillings In the past, it has been suggested that the removal of
dental amalgam is therapeutic for MS. Amalgam, which
is composed of mercury as well as silver, copper, tin
and zinc, is used in 80 to 90 per cent of tooth restora-
tions. It is claimed that the immune system and nervous
system are damaged by small amounts of solid mercury
and mercury vapour released from the amalgam. There
is no evidence that mercury causes MS or that the
removal of dental amalgam improves the course of MS.11
Furthermore, it has been estimated that amalgam
accounts for only 10 per cent or less of mercury intake.

Dental amalgam removal is generally expensive, though

there are few risks associated with it. On rare occasions,
it may cause injury to nerves or tooth structure. Many
dentists are sympathetic to concerns a person with MS
may have, and will often use alternatives to amalgam for
fillings.

Advice on attending It is likely that you will know much more about MS than
your dentist. It is important that you tell your dentist that
a dental practice you have MS and how it affects you. Also tell them if you
are taking any medication (and update them each time it
changes), or if you have any specific symptoms that may
interfere with dental treatment, such as spasms.
Establish a signal that you can give the dentist to stop
treatment if you feel unwell, or need a rest.

Not all dental practices are fully accessible, and you

may find it particularly difficult if you are looking for a
dental practice that is both accessible and willing to
take NHS patients. You should check with the practice
whether they have the facilities you need, such as
suitable parking or toilets.

If you are sensitive to light, you might find the dentist's

light uncomfortable. To avoid this, they will often have
special glasses that you can wear.

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Oral health © MS Society 2010
 Dentists are unlikely to have 'transfer boards' in their
surgery, so if you are a wheelchair user and you need
help transferring to the dental chair, you should arrange
for your carer to attend the dentist with you. If you are
unable to transfer and your wheelchair will not recline,
this may limit the treatment you can receive, so it's
worth arranging this before your appointment.

If your carer helps with your oral health, your dentist will
need to know this so that they can discuss things
properly with both of you - if you are happy for them to
do so. It might be helpful to discuss any concerns about
your oral health with your carer before the visit.

Most practices will be able to arrange appointment

times that fit in with your needs, such as problems with
fatigue or arranging transport. It is important to tell the
receptionist if you will need extra time to get into or out
of the surgery. All this information can be added to your
records, so that you don't have to go into detail every
time you make an appointment.

Overcoming and Brushing

avoiding problems - If you have difficulty brushing your teeth or dentures,
ask your occupational therapist or dentist about
adaptations that can be made to your toothbrush.

- Electric toothbrushes can also help.

- Carers can help you to brush your teeth or dentures if

you have difficulty doing it effectively.

Mouthwash and flossing

- Ask your dentist if you would benefit from using a

fluoride or chlorhexidine mouthwash.

- If you are having problems using floss, ask your

dentist about interdental brushes, as they may be easier
to use.

Dry mouth

- Chew sugar-free gum (rather than sucking mints or

other sweets) to increase saliva flow, or have frequent
sips of water.

- Ask your dentist if you would benefit from the use of a

saliva substitute.

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Oral health © MS Society 2010
 Nutrition

- Snacks containing sugar, high energy supplements or

meal replacement drinks can increase the risk of decay.

- Reduce your intake of sugar in drinks and foods,

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limiting it to mealtimes as much as possible.

- Drinks containing acid, such as carbonated drinks,

fruit juices or wine, can affect your teeth by causing
erosion of the enamel.12 Again, try to limit them to
mealtimes.

How do I find a The best source of information can be to ask those who
live nearby where they go and if the practice is
dentist? accessible. Your local MS Society branch might have
this information. For details of your local branch, contact
the Information Team (contact details at the end of this
factsheet). Alternatively, ask your MS nurse or dentist to
suggest an appropriate practice.

If you are already registered:

- If you can no longer access the practice you normally

attend, you should ask the dental staff how you can
continue to receive regular dental care. Your dentist
should be able to suggest another dental practice that is
accessible, treat you in your own home ('domiciliary
care') or, alternatively, offer to refer you to the
community dental services in your area.

- It is important not to let your NHS registration lapse. If

you have not attended the dentist for 15 months, under
NHS regulations you will no longer be registered at this
practice - your contract with this dentist automatically
expires. The dentist does not have to inform you that
you are no longer registered as an NHS patient, and is
not obliged to re-register you as a patient with the
practice under an NHS contract.

If you are not registered:

- Your local PCT (England), health board (Scotland and

Wales) or health and social services board (Northern
Ireland) may be able to provide you with a list of
accessible practices.

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Oral health © MS Society 2010
 - If you are not registered with a dentist and need
dental treatment urgently, you should contact NHS
Direct on 0845 4647 (in England or Wales). If you are in
Scotland, you can contact NHS 24 on 08454 24 24 24 or
the NHS Helpline on 0800 22 44 88. They will be able to
locate a dentist for emergency treatment. However, the
NHS may not have information on how accessible a
practice is, so you may have to telephone them directly
to ask.

Do I have to pay for Not everyone has to pay for dental treatment. If you live
anywhere in the UK and come under any of the following
NHS dental categories you are entitled to free NHS dental treatment:
treatment?
- You are aged 18 or under, or 19 and in full-time
education

- You are pregnant or you have had a baby in the last 12

months

- You or your partner get Income Support, income-

based Jobseeker's Allowance, or income-related
Employment and Support Allowance

- You or your partner are in receipt of Pension Credit

Guarantee Credit

- You or your partner hold a current NHS (HS in

Northern Ireland) tax credit exemption certificate

- You or your partner hold a valid HC2 certificate (health

service charges certificate).

You may be entitled to some help with the cost of NHS

dental treatment if you or your partner holds a valid HC3
certificate.

To apply for an HC2 or HC3 certificate, you will need to

complete form HC1 - available from your Jobcentre Plus
office or by calling 0845 850 1166 or 0845 610 1112. You
may also be able to get one from your local hospital,
dentist, optician or doctor.

In addition to these exemptions, the basic dental

examination is free for everyone in Scotland, and for
people aged 25 and under, or 60 and over in Wales.

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Oral health © MS Society 2010
If I am not exempt England and Wales
If you live in England or Wales, there are three standard
from the charges, charges, or 'bands', depending on the treatment you
how much do I pay need. These are reviewed and adjusted every April:
for NHS treatment?
Band 1 - including examination, diagnosis, X-rays, scale
and polish: England £16.50, Wales £12.00

Band 2 - all necessary treatment covered by the Band 1

charge, plus additional treatment such as fillings, root
canal treatment and extractions: England £45.60, Wales
£39.00

Band 3 - all necessary treatment covered by the Band 1

and Band 2 charges plus more complex procedures
such as crowns, dentures or bridges: England £198.00,
Wales £177.00

(prices correct at March 2010)

If you need urgent care, you pay the Band 1 charge,

whatever the treatment.

Scotland and Northern Ireland

If you live in Scotland or Northern Ireland, you will pay
80 per cent of the total cost of the treatment, up to a
maximum of £384. Most treatment will cost far less than
this.

Useful organisations NHS online and telephone advice

and other For help with finding your nearest dentist. You may not
information be able to tell if the building is accessible, so if in doubt
call the surgery to ask.

England and Wales

Telephone 0845 4647
www.nhs.uk/servicedirectories (England)
www.nhsdirect.wales.nhs.uk/localservices (Wales)

Scotland
Telephone 08454 24 24 24
www.nhs24.com

Northern Ireland
www.hscni.net

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Oral health © MS Society 2010
HM Revenue and Customs

To find out about your eligibility for tax credits

Helpline 0845 300 3900
Textphone 0845 300 3909
taxcredits.hmrc.gov.uk

Benefit Enquiry Line

For people with disabilities, their carers and

representatives. Confidential advice and information on
benefits and how to claim them. They can also send out
an extensive range of leaflets and claim packs, and help
you to complete a claim form over the phone.
Telephone 0800 88 22 00 (England, Wales and Scotland)
Telephone 0800 220 674 (Northern Ireland)

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Oral health © MS Society 2010
References 1 Cnossen, M. W. (1982) Considerations in the dental
treatment of patients with multiple sclerosis. Journal of
Oral Medicine, 37, 62-4.

2 Griffiths, J. E. and Trimlett, H. J. (1996) Dental status

and barriers to care for adults with multiple sclerosis.
International Dental Journal, 46 (4 Supp 2), 445.

3 Wilson, K. I. (1992) Treatment accessibility for

physically and mentally handicapped people: A review of
the literature. Community Dental Health, 9(2), 187-92.

4 Fiske, J. et al. (2002) Multiple sclerosis and oral care.

Dental Update, 29(6), 273-83.

5 Greenwood, M. and Meechan, J. G. (2003) General

medicine and surgery for dental practitioners. Part 4:
Neuorolgical disorders. British Dental Journal, 195 (1),
19-25.

6 Watt, R. G. et al. (2003) Prevention. Part 2: Dietary

advice in the dental surgery. British Dental Journal,
195(1), 27-31.

7. www.nhs.uk/conditions/oral-thrush---adults
(Accessed 16.2.10)

8 Fontana, M. (1994) Vitamin C (ascorbic acid): clinical

implications for oral health - a literature review.
Compendium, 15(7), 916-29.

9 Darling, M. R. and Arendorf, T. M. (1992) Review of the

effects of cannabis smoking on oral health. International
Dental Journal, 42, 19-22.

10 www.dentalhealth.org.uk/faqs/browseleaflets.php
(Accessed 16.2.10)

11 Polman, C. H. et al. (2006) Multiple sclerosis - the

guide to treatment and management, New York, Demos
Medical Publishing.

12 Rugg-Gunn, A. J. (1993) Nutrition, diet and dental

public health. Community Dental Public Health, 10(2),
47-56

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Oral health © MS Society 2010
Further copies of this Download from www.mssociety.org.uk/publications
factsheet or other MS If you don't have access to a printer and would like a
Society information printed version of this factsheet, or any other MS
Society publication or DVD, call the Information Team on
020 8438 0799 (weekdays, 9am-4pm) or email
infoteam@mssociety.org.uk

MS Helpline
The MS Helpline offers confidential emotional support
and information to anyone affected by MS, including
family, friends, carers, newly diagnosed or those who
have lived with the condition for many years. Calls can
be made in over 150 different languages, via an
interpreter. Call freephone 0808 800 8000 (weekdays
9am-9pm, except bank holidays) or email
helpline@mssociety.org.uk

Authors and Disclaimer: We have made every effort to ensure that the
information in this publication is correct. We do not
contributors accept liability for any errors or omissions. The law and
government regulations may change. Be sure to seek
local advice from the sources listed.

Suggestions for improvement in future editions are

welcomed. Please send them to
infoteam@mssociety.org.uk

Written by Wendy Baird and Sarah Westlake

Edited by Jude Burke

With thanks to Karen Kendall, Megan Burgess and all

the people affected by MS who contributed to this
publication.

© Multiple Sclerosis Society 2010

First edition, May 2008
Reviewed and reprinted March 2010

This title will be reviewed within two years of

publication.

Multiple Sclerosis Society. Registered charity nos.

1139257 / SC041990. Registered as a limited company
in England and Wales 07451571.

FS06/0310

Oral health © MS Society 2010