Wednesday, 21 October 2015

ClinicSpeak: poor dental hygiene and disability

How healthy are your gums? #ClinicSpeak #MSBlog #MSResearch

"The following small study suggests there is an association with poor dental hygiene, in particular gum or gingival disease, and disability. I am not surprised. Gum and or gingival disease is classified under the rubric of periodontal disease. Periodontal disease is a comorbidity that is associated with a large number of other diseases including cardiovascular disease and increased and/or premature mortality. In MS it may play a similar role and drive disease progression via its effect on systemic inflammation or via its link with cardiovascular disease. Periodontal disease is just another comorbidity we need to add to the list that needs to be managed and treated in MS. "

"We know that smokers are more prone to develop periodontal disease compared to non-smokers. It doesn't look like the investigator's took this into account. This is an area that needs to be looked at in more detail."


"Have you seen your dentist or oral hygienist recently?" 

Hatipoglu et al. Expanded Disability Status Scale-Based Disability and Dental-Periodontal Conditions in Patients with Multiple Sclerosis. Med Princ Pract. 2015 Oct 17.

OBJECTIVE: The aim of this study was to evaluate the association between different disability states in patients with multiple sclerosis (MS) as determined by the expanded disability status scale (EDSS) and dental-periodontal measures.

SUBJECTS AND METHODS: Eighty patients with MS (64 females and 16 males) were included in this study. Data on MS types, attack frequency, disease duration, EDSS scores and orofacial complaints prior to an MS attack were obtained from medical records. The plaque index (PI), probing depth (PD), clinical attachment level (CAL), gingival index (GI), decayed-missing-filled teeth (DMFT) index and number of present teeth were measured during one dental examination for each subject. The MS patients were divided into the following 2 groups based on their EDSS scores: low physical disability (L-DS) and high physical disability (H-DS). Differences in dental parameters between groups of low and high disability were investigated. p < 0.05 was considered statistically significant.

RESULTS: The mean age of the participants was 38.06 ± 10.11 years. Age and disease duration were higher in the H-DS MS group than in the L-DS MS group (p < 0.05). The PI, PD and GI were higher and the number of filled teeth was lower in the H-DS MS group than in the L-DS MS group (p < 0.05). The EDSS scores of the H-DS MS group presented a significant correlation with the number of decayed teeth (r = -0.548, p = 0.005). Orofacial complaints prior to an MS attack were reported by 18 (22.5%) patients.

CONCLUSION: Oral measurements revealed various differences between groups of low and high disability in MS patients. In addition, some maxillofacial-oral complaints prior to an MS attack were observed.

6 comments:

  1. I have - though I say so myself - excellent oral hygiene and very good, healthy teeth and gums. But I still have mobility issues. Perhaps these would be worse if I had not cared for my teeth. When I was younger, a teenager, well before onset of PPMS, I was prone to gum inflammation, despite good hygiene and avoiding refined sugar.

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  2. I was and I am prone to gum inflammation, despite good hygiene and avoiding refined sugar. Maybe immune system attacks gum. Maybe EBV or HERVs attacks gum. What do you think?

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  3. " Vitamin D may reduce the risk and severity of Periodontal disease in several ways:

    Produces cathelicidin and defensins, which have antimicrobial properties. These compounds reduce the number of bacteria in the mouth.
    Reduces matrix metalloproteinases (MMPs). MMPs are enzymes that are associated with PD.

    Increasing vitamin D blood levels to 40 ng/mL (100 nmol/L) may lower the risk of PD.."

    http://www.vitamindcouncil.org/health-conditions/periodontal-disease/

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    Replies
    1. I saw a stunning improvement in mouth ulcers (I no longer get them) when I took a reasonable dose of vitamin d (5000IU a day). They had been the bane of my life since my mid-teens.

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  4. I have always had excellent teeth and good oral hygiene. I am in a horrible state due to MS (at the bad end of 6.5 on the edss).

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