Oral and Craniofacial Manifestations of Multiple Sclerosis

Several neurologic disorders and painful conditions happen in MS and orofacial region may be affected by these disturbances. The disease and the drugs used to treat or control it can affect the oral status and oral health care. One research evaluates 500 patients with MS anda frequency of 88.6% for craniofacial manifestations was reported in this research. So multidisciplinary team is needed and dentist plays a significant role in the healthcare of these patients. Orofacial region can show initial signs and symptoms of neurologic disturbances. Intermittent unilateral facial numbness or pain (neuropathic or neuralgic pain), facial palsy (19%) or spasm (6-11%) and dysphagia(26.6%) arethe most common symptoms in orofacial region. Also, myofascial and neck pain has been seen and may due to a high frequency of temporomandibular disorders (58.2%) in MS patients. Trigeminal neuralgia (TN) is the first manifestation of MS In 0.3% of cases andit is observed in 7.9% of MS patients. TN frequently affects the maxillary and mandibular division and rarely (<5%) affects the first branch of the trigeminal nerve. In addition, some case reports show other orofacial problems, like glossopharyngeal neuralgia (0.5%),paroxysmal cluster-like pain and trigeminal autonomic cephalgia. furthermore headache can be observed in MS patients with a frequency of 13 to 64%. Also drugs taken by MS patients may lead to oral side effects like opportunistic infection, xerostomia, mucositis andgingival hyperplasia. In addition, orofacial pain may affect quality of life and the ability to do daily activities, such as effective oral hygiene. In conclusion, oral health care providers may faced with initial signs and symptoms in undiagnosed patients and have an important role inthe management of orofacial problems of MS