Going to the dentist can be complicated when you have MS

MS symptoms and mobility issues make routine visits a challenge

Benjamin Hofmeister avatar

by Benjamin Hofmeister |

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One thing I learned during my Army medic training is that I’m not particularly squeamish — with most things, that is.

I have a theory that everyone has at least one thing that will turn their stomach. Every medical provider I’ve met either knows exactly what can make them gag, or they just haven’t encountered it yet.

I encountered mine early on, and it turned out to be anything involving the human mouth. Out of everything I saw or put my hands on, it was my brief foray into dentistry that made me queasy.

I sometimes assume that everyone is like me and doesn’t like looking any deeper than a person’s smile. On one hand, that makes me meticulous about brushing. On the other hand, it has the potential to make me reluctant to schedule routine dental care. Thankfully, I’ve only ever put off dental visits due to my tendency to procrastinate. But even if I were to project my idiosyncrasies onto my dentist, that wouldn’t be my biggest problem. As with so many things in my life, that distinction belongs to multiple sclerosis (MS).

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How MS symptoms can affect dental care

Visiting the dentist when you have a disease like MS can be complicated, but it’s not impossible. Like traveling, finding and navigating an accessible bathroom, or visiting any other healthcare professional, going to the dentist comes with a few extra steps and considerations.

Perhaps the biggest issue for me is mobility. Even before I used a wheelchair, there were plenty of things to consider when it came to navigating a dentist’s office. Whether I used a cane or rollator, or just dealt with foot drop and a limp, hopping up on the exam chair was problematic. Space in the treatment room is a huge issue with any mobility aid, but especially with a wheelchair. My dentist has to schedule me in their largest room just to accommodate mine, especially since I can’t transfer to the exam chair. Fortunately, my wheelchair tilts and reclines, but many don’t.

Another issue is spasticity. My intrathecal baclofen pump keeps my legs relaxed, and no one is spending a lot of time by my feet, anyway, so I’m not too worried about kicking someone. My hands and arms are fairly well behaved, too. They are prone to some hyperreflexia (overactive reflexes) from time to time, but it’s actually my mouth I’m concerned about.

I have spasmed during a yawn, causing my teeth to clamp shut on my tongue or cheek. It hasn’t happened yet, but I live in fear that some sort of stimulus will cause me to spasm and bite down on an instrument or, heaven forbid, someone’s finger.

I also occasionally have a jaw spasm when I’m choking, which is a problem all on its own. I have swallowing and choking issues regardless, but add in a spray of water and a reclined position, and they seem to increase tenfold.

I’m one of the lucky few MS patients who doesn’t have pain caused by the disease, but I wonder if that pain is made worse by dental procedures. I wonder the same thing about anesthesia. Has anyone with MS discovered that they are more or less resistant to a general anesthetic?

Fatigue affects every single aspect of my daily life, and it has to be factored into dental exams. You’d think I’d know better by now, but I’ve gone to the dentist thinking it wouldn’t cost me any “spoons” (a metaphor for daily energy expenditure) because I’m just lying there with my mouth open. Those of you who are wiser know that this is not the case. I’ve left an exam and cleaning feeling as though I just walked a mile in the sun, so plan accordingly.

Finally, I have a lot of problems with hand strength and dexterity. This causes me difficulty when it comes to preventive care like flossing and brushing. There are flossing tools available, and I’ve found that an electric toothbrush works best for me, even though the small flush button can be hard to push. I’d welcome any advice on this issue.

As with so many things, good communication is key when going to the dentist as someone living with multiple sclerosis. That communication begins with the initial call to set up your appointment, but it doesn’t end there. Odds are that the person who scheduled your appointment won’t be the same person you see in the exam room. Prepare to repeat yourself — or just make a T-shirt that says, “I bite, I choke, and I get tired easily.”

Make two and I’ll buy one from you.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Karin Sønderby avatar

Karin Sønderby

Jeg kan ledt følge dig.....fra DK

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Benjamin Hofmeister avatar

Benjamin Hofmeister

"I can easily follow you…..from DK"

Thank you for reading Karin! It is very therapeutic when a reader tells me that they feel the same way. It lets me know that none of us are alone.

Tak fordi du læste med Karin! Det er meget terapeutisk, når en læser fortæller mig, at de har det på samme måde. Det fortæller mig, at ingen af ​​os er alene.

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Lisa Kandel avatar

Lisa Kandel

Even after more than eight hours of sleep, I am exhausted. On good days, I can make it to around 3:00 p.m. okay. I do know my problems in the dental chair are because of my imbalance. I give the dentist a heads up before he puts the chair back. Movement of any kind can set off my "seasickness" pretty easily. Thank you for your articles. They are always appreciated.

Stay blessed!

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thank you Lisa! Establishing good communication with your dentist or any health care professional is absolutely vital. Thank you for reminding us all about that.

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Frances avatar

Frances

Always enjoy reading your articles. By any chance,
can you recommend a dentist in the Dobbs Ferry, Hastings and/or Irvington, NY area?

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thank you so much for reading Frances! I'm afraid I can't help with dentists in that area. Maybe one of the other readers can.

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Dee Smith avatar

Dee Smith

I have swallowing issues, so visiting the dentist stresses me out! I’m always worried about choking on my saliva and the water they flush my mouth with! Being reclined doesn’t help. I let them know ahead of time that I may need to sit up a few times and that I will need extra suctioning of fluids from my mouth.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

I had a return visit yesterday to get a couple fillings replaced and we worked out hand signals ahead of time for when I needed to sit up, or needed more suction.

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Linda Foland avatar

Linda Foland

I went to the dentist recently and they dug out a tooth. On piece of the root was embedded in my sinus so I had to see a oral surgeon who dug that out. I ended up on several antibiotics then boom....I had a angry flair because of a tooth surgery. My whole body locked up. Nothing like having control of your body. Dead weight. I ended up in the hospital with high dose steriods for 6 days. I'm better but still very weak. I also had pneumonia and a uti. Just because of a tooth. I will really think about dentists visits in the future.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Well, you definitely made me want to have religiously regular Dental checkups with that story. LOL

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Rhonda Danielson avatar

Rhonda Danielson

An alternate toothbrush -Mishwauk club. With diminished dexterity and strength, I find this form of toothbrush much easier to manipulate. I also don't have to worry about a battery running out and I don't have to worry about extra sensitivity in my mouth and gums. Besides, it is naturally antimicrobial so no extra mouthwash and no spitting. Since you don't have to use toothpaste if you don't want to when brushing your teeth, there's no spitting involved, you can simply swallow your saliva.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thank you for that Rhonda! I had never heard of that but intend to look it up as soon as I can. I imagine others reading your comment will as well!

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Michael Hetue avatar

Michael Hetue

I also have PPMS. I was djagnosed late in my life at 64 years old. I too suffer from all the things you do. I have been taking AMPRIDINE 10MG 2 times a day and it has helped me walk. I am still not in a wheelchair and have to use a walker or rollator to walk.. I have been using a Bionic Sleeve on my right leg made by a company called CIONIX from California. It stimulates your leg with Electrodes. I have had great success with it. Check it out. Thank you for writing your info and happy life.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thank you for the comment Michael! I started taking dalfampridine when I could still walk and have continued taking it after I lost the ability to walk because it shows action on finger dexterity and cognition.

Since I can't walk or stand without assistance, I don't know that a cionic sleeve would help me much. I do use e-stim to activate my leg muscles and it helps a great deal.

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Laurie Warner avatar

Laurie Warner

I agree with everything you said. What also bothers me is the new technique to clean the tarter off. I think it is something like ultrasonic? It vibrates through my whole body and exhausts me. I found an old-fashioned dentist that uses the original scrape-the-tarter off. Problem solved — well, at least that problem.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks Laurie! They mainly use a manual scraper to clean my teeth, but this last time they did bring out the ultrasonic one for one spot and I felt the same way as when I'm at the barbershop and the Clippers make me Twitch. Fortunately it was very brave and I didn't have any problems, but it's definitely something to be aware of.

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Kim A. avatar

Kim A.

You are so articulate! I enjoy your columns so much, but sorry for your situations. Luckily had most heavy duty dental work done before MS put the hammer down but do worry about choking sometimes when tipped back. 21 year MS old timer here.
Sigh. We must continue on, mustn’t we?

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks Kim! Yes I suppose we must.

Thanks also for saying that I'm articulate. Now that I'm using voice to text, you should see what it makes of my Southern accent sometimes.

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Bess Coleman avatar

Bess Coleman

Your t-shirt idea is hilarious. I want one. Thanks for your article. Lots of things to consider. I wish you well.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks Bess! I think I could design a complete line of snarky MS t-shirts, but the market would be small. On the Dental One, I should probably put the word "unintentionally' in small print beside I bite. I don't know that would hold up in court but I would like people with tooth marks on their finger to know that I didn't do it on purpose.

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Polly reynolds avatar

Polly reynolds

I have had great success with a water pick

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for that Polly! I had not considered a water pic, but I will now.

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Lylea Parlour avatar

Lylea Parlour

‘dentists need find out the best way to serve their patients with MS such as make the restrooms available in the waiting room.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

You are so right Lylea!

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Dee Griffin avatar

Dee Griffin

Thanks for the reminder about my MS choking risk.
Will need to mention it to my new dentist at next week's dental appointment.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thank you for that comment Dee! It didn't come to my mind either until I was having a routine exam and water ran down my throat. After that, I remembered to mention it and the dental assistant made sure to provide nearly constant section.

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Jackie Curtis avatar

Jackie Curtis

My daughter just got thr baclofen pump in May of this year. Both legs bent backwards, legs getting better but still bent but not like they were. She could really use a wheelchair that tilts and reclines

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Hi Jackie, they tell them recline functions are marvelous. My chair also elevates but I would trade that in a heartbeat for the other functions. I think anyone who spends all day in an electric wheelchair must have those functions. I can't really transfer without help and the ability to be comfortable in my wheelchair is priceless.

As for the baclofen pump, it really changed my life. I wouldn't recommend one to anyone that can control their spasticity in any other way, but if they couldn't, I would definitely recommend they talk to their doctor about one.

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Judith avatar

Judith

Wheelchairs make career impossible

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Yes they do! Well, maybe not impossible but very difficult sometimes.

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Heather Cushing avatar

Heather Cushing

Going to the dentist has always been a challenge for me. I was fortunate to find an office which recognized I was arriving in a wheelchair and transfers were difficult. They were able to make the chair at a level that worked. Once in the chair I was always positioned upside down for the work to be done. Always close my eyes to overcome anxiety. Because I had older fillings twelve needed to be replaced over the course of several months. I found a dentist who used a dam so everything being removed didn’t go down my throat. I also didn’t have numbing done with regular Novocain whiich has epinephrine. Then came the need for an implant which required anesthesia. The surgeon was a bit heavy handed with it so it took awhile to recover. Yes, all of these procedures were exhausting but they were needed rather than waiting for an emergency. Thank goodness now I only need cleanings twice a year! And I’m grateful to have a loving husband who helps me.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for that Heather! I had never considered a dental dam. I forgot to ask for one yesterday when I was at the dentist but did mention the choking and the dental assistant took Extra Care with suction.

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Sharice avatar

Sharice

I find using a bite block helps with fatigue. You have to ask for one, and sometimes remind the dentist even if you just asked for one, but they make a huge difference for me.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for the advice Sharice! I was back at the dentist yesterday to have a couple fillings replaced and remembered request a bite block if necessary. We never had to use it, but we kept it on hand just in case.

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Beverly avatar

Beverly

This article was very enlightening. I shared it with family in hopes they would get a better understanding of the different things my body goes through, daily.
Thank you

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Thanks for the comment Beverly! Here's hoping the column did help your family better understand. I do the same thing with stories from other people whether through a blog or podcast Etc. I like being able to say see it's not just me.

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Tom A avatar

Tom A

My nerves and reflexes used to be more excitable, especially during teeth cleaning. I always asked for manual cleaning versus the auto teeth cleaning gizmo.

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Benjamin Hofmeister avatar

Benjamin Hofmeister

Hi Tom, I worry about hyperreflexes as well. I just went to the dentist yesterday and made that clear. Fortunately nothing happened, but everyone in the room was at least aware that it could and took precautions.

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