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OralHealthandMultipleSclerosisEleonoreD.Paunovich,DDS,MS,FASGD,DASCDDirector,ClinicalOralHealthProgramsGeriatricsandExtendedCareSouthTexasVeteransHealthCareSystemClinicalProfessor,DepartmentofComprehensiveDentistryUniversityofTexasHealthScienceCenterSanAntonio,TexasVAMSCentersofExcellencePatientConferenceCall–1.800.767.1750,43157#May14,2021LearningObjectivesDescribetheimpactofMultipleSclerosisonoralhealthIdentifywaystomanageMSsymptomsandsideeffectslikemovementdifficulty,swallowingproblems,facialpain,anddrymouthwhiletakingcareofyouroralhealthDiscusspreventivestrategiesthatcanaidingoodoralhygieneforMSpatientsSwallowingDifficultyCaries/PeriodontaldiseaseOral/FacialpainMedicationsideeffectsOralManifestationsMultipleSclerosismotorfunctionsensoryfunctioncognitivefunctionmedicationsConnectionbetweenmultiplesclerosisandoralhealth?MusclecontrolfailureDifficultymaintainingoralhealthDifficultyaccessingcareduetotheirsymptomsMultipleSclerosis
OralHealthTherapeuticStrategies
TransferassistancefromwheelchairtodentalchairManagementofswallowingdifficultyManagementofspastic/involuntarymovementsManagementoffacialpainManagementofdrymouthandotheroralsideeffectsofmedicationstransferboardstransferbeltswheelchairliftOralHealthTherapeuticStrategiesPatientSeating
MultipleSclerosis
SwallowingProblemsExtraeffortchewingorswallowingEatingveryslowlyPackingfoodsintothecheeksDroolingFluidleakingfromthenoseafterswallowingIncreasedcongestioninthechestaftereatingASPIRATIONRISKASPIRATIONPNEUMONIAOralHealthTherapeuticStrategies
SwallowingProblems
DailyoralhygienecarecaregiverassistanceasneededCheckdenturefitandstabilityRoutineprofessionaldentalvisitscariesandperiodontaldiseasereduceriskofloosingmoreteethDentalvisitssemi-supinetouprightchairposition-protectairwayUseofarubberdamlimitwateruseshort-lastinglocalanesthesiaextra-oralmouthpropssecured,ratchet,HuFriedymoltpropintra-oralmouthproprubberbiteblock,extendedfoamhandlephysical,gentlehand-holdingstabilizationofheadOralHealthTherapeuticStrategies
Managementofspastic/involuntarymovementMultipleSclerosis
Oral/FacialPainFacialpainTrigeminalNeuralgiaFacialPalsymaybethefirstmanifestationofMS“electricshock〞bytouchingcheek,toothbrushingorchewingpainlastsforseconds,severe;returnsseveraltimes/daynumbnessoflowerlip/chin,withorwithoutpainweakness/paralysisoffacialmusclesOralHealthTherapeuticStrategiesManagementofOral/FacialPain
Medicalmanagementcarbamazepine,phenytoin,baclofen,gabapentin,clonazepamDentalmanagementruleoutdentaletiologyocclusalorthotics,triggerpointinjectionsSurgicalmanagementperipheralnerveblock/ablation,gasserianganglionprocedures,microvasculardecompression,gammaknife
MDconsultre:diseaseprogressionMultipleSclerosis
OralSideEffectsofMedsDrymouthUlcersBurningtongue/mouthAlteredtasteCheilitisOralthrushSteroidsACTHInterferonsImmunosuppressorsPatientadvice:watermistingleticemeltinmouthavoidmouthrinseswithalcoholhumidifysleepingareasrestrictcaffeineintakereducetobaccouseuselipbalm,xylitolgum,sugar-freelemondropsOralHealthTherapeuticStrategies
XerostomiaManagement
Tasteinabilitytotasteacids/sugarsusedtostimulatesalivaryflowTexturepastassoupsliquidsupplements(Ensure)OralHealthTherapeuticStrategies
XerostomiaManagement
MeticulousplaquecontrolismandatoryCarieslikelyanywhereplaquecanaccumulateReinforceinstructionatfrequently(q3mos)Antibacterialrinses
Maximizefluoridestrategies
Patientappliedrinsebeforebedtimetabletbrush,swabProfessionallyappliedfluoridevarnishXerostomiaManagement
MaintainOralHygiene
Caries/PeriodontaldiseaseMultipleSclerosisOralManifestationsmotorfunctionsensoryfunctioncognitivefunctionmedicationsPainInfectionToothlossplaqueremovalBrushtwicedaily–afterbreakfast,beforebedtimefluoridetoothpasteflossdailybrushtonguedailyeatawellbalancedmeal–limitsweetsreplacetoothbrushevery3-4monthsroutinedentalvisits–reportbleedinggums,jawpain,sensitiveteethimmediatelyOralHealthPreventiveStrategiesDailySelf-CareOralHealthPreventiveStrategies
ToothBrushingandFlossingTipsWeak/poorgrip?lookfortoothbrusheswithhandlescheckwithyourdentistforhelpwithmodifyingtoothbrush.flossatnightifpossible…tootiredatnight,theninthemorningisokconsiderelectrictoothbrushesandflossingdevicesaskforhelpfromfamilymemberorcaregiverTiredorweak?SittobrushandflossStartoutbybrushingwithwateronly,afterthoroughbrushing,thenusetoothpasteHandtremors?UseaweightedtoothbrushUseweightedglovesOralHealthPreventiveStrategies
ToothBrushingandFlossingTips
OralHealthPreventiveStrategies
FlossingFlosstypesWaxedandUnwaxedDentalTapeYarn,gauzestripTuftedfloss(Superfloss)FlossthreadersHoldersRubbertipsstimulatorInterdentalbrushWhatcancaregiversdoforMSpatients?MotivateandencourageindependencyRegularlygiveoralhygieneBringforregularcheck-ups---buildarelationshipwithadentistRadiustoothbrushCollisCurveTwinBrushPlaqueVac
OralHealthPreventiveStrategiesToothbrushing
RotaryModifiedUltrasonic
OralHealthPreventiveStrategies
FlossingFlosstypesWaxedandUnwaxedDentalTapeYarn,gauzestripTuftedfloss(Superfloss)FlossthreadersHoldersRubbertipsstimulatorInterdentalbrush
OralHealthPreventiveStrategiesDentureCare
removefullorpartialdenturesdailycleanthevestibulepullopenthecheektoincreasevisibility.useamoistcloth,finger,cottonswab,oralargesponge-tippedswab(Toothette)sweepfromthebackofthevestibuleforwardtoremovelargeparticlesofdebrisbrushandcleandenturesdailyremovedenturesfrommouthbeforebedtimeandplaceindenturesoakingcleansingsolutionMultipleSclerosis
OralHealthPreventiveStrategies
EarlycomprehensiveoralrehabFrequentprofessionalvisitsMonitorcaries/periodontaldiseaseriskMonitorsalivaryfunctionEducatecaregiversInfectionPainPreventMultipleSclerosis
DentalManagement
Formoreinformation…..
SpecialCareinOralHealth,NationalInstituteofDentalandCraniofacialResearchOralhealthcareforpatientswithspecialneeds/Dentalcareeveryday:acaregiver’sguideDentalhealth:thebasicfacts–NationalMultipleSclerosisSocietyDisclaimer:Dr.Paunovichhasnorelevantfinancialinterestorotherrelationshipwith:(1)themanufacturer(s)ofanycommercialproduct(s)and/or(2)theprovider(s)ofcommercialservicesdiscussedinthiseducationalactivityaswellasanycommercialsupportersoftheactivity.Formoreinformation…..FischerDJetal.Multiplesclerosis:anupdatefororalhealthcareproviders.OralSurgOralMedOralPatholOralRadiolEndod,2021;108(3):316-27MultipleSclerosis–OralCareforPersonswithDisabilitiesAmericanDentalAssociation:AcademyofGeneralDentistry:NationalFoundationofDentistryforthehandicapped:SpecialCareDentistry:Formoreinformation…..
WheelchairTransferGuideDisposableMouthPro
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