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Providing Evidence-based Oral Health Care to Individuals Diagnosed with Degenerative Disorders, Part 1: Multiple Sclerosis
Clinical Signs and Symptoms of MS

Course Author(s): Melanie Simmer-Beck, RDH, PhD

Clinical Signs and Symptoms of MS

MS is a complex disease with multiple signs and symptoms; fatigue, difficulty with memory and concentration, pain, spasticity, tingling/numbness in the limbs, electric shock with head movements, muscle weakness, double vision, abnormal eye movements, difficulty walking or inability to walk, loss of balance, tremors or paralysis in limbs, and trouble with bladder or bowels.1-4,9 When the brainstem is involved, individuals may experience altered sensations in the face such as trigeminal neuralgia.2 Initial signs and symptoms of MS are fluctuating, transient, and frequently appear during young adulthood. They range in severity from relatively benign to completely disabling depending upon the region of the CNS affected and the degree of disruption that has occurred.1,16 Table 1 summarizes the most common symptoms of MS.17 Eight of the symptoms, designated with a *, significantly affect the provision of oral health care. These symptoms will be discussed in further detail. Dental professionals may be the first providers to treat individuals with MS prior to diagnosis; therefore, the providers’ awareness of initial symptoms is critical.

Table 1. Symptoms of Multiple Sclerosis17
Bladder dysfunctionAt least 80% of people with MS experience this, can be managed with medications.
*Cognition Approximately50% of people with MS will develop cognition problems. Refers to high-level brain functions such as the ability to: learn and remember information, organize, plan, problem-solve, focus, maintain and shift attention, understand language, accurately perceive the environment, and perform calculations.
ConstipationA loss of control of the bowels, can include diarrhea and other problems of the stomach.
DepressionStudies have suggested that the severest form of depression (clinical depression) is more frequent among people with MS than it is in the general population or in persons with other chronic, disabling conditions.
Dizziness (vertigo)Feeling off balance or lightheaded, sometimes having a sensation that they or their surroundings are spinning (vertigo).
DysesthesiasAbnormal sensations, neurologic in origin, such as pruritis (itching), "pins and needles," burning, stabbing, and/or tearing pains.
*DysphagiaSwallowing problems stemming from damage to the nerves controlling the small muscles in the mouth and throat, food and liquids can pass into the airway and lungs causing the individual to cough and choke, increases the likelihood of developing aspiration pneumonia.
*Emotional changesStems from a reaction to the stresses of living with a chronic, unpredictable illness and from neurologic and immune changes caused by the disease. Can include bouts of severe depression, mood swings, irritability, and episodes of uncontrollable laughing and crying (pseudobulbar)
*FatigueMay be the most prominent symptom in individuals not experiencing activity limitations, can significantly interfere with an individual’s ability to function.
Numbness, tingling, and weaknessFrequently the first symptom experienced by those eventually diagnosed as having MS, can occur on the face, body, or extremities (arms and legs).
*Pain syndromesOver 50% of individuals with MS experience "clinically significant pain" at some time and are troubled by chronic pain.
Problems with gaitDifficulties with walking, a common mobility limitation.
Sexual problemsStem from damaged nerve pathways that illicit sexual response and from MS symptoms such as fatigue, spasticity, and psychological factors relating to self-esteem and mood changes.
*SpasticityStems from stiffness and a wide range of involuntary muscle spasms (sustained muscle contractions or sudden movements). Can vary from mild (the feeling of tightness of muscles) to severe (painful, uncontrollable spasms of extremities-legs, joints, and lower back).
*Trigeminal NeuralgiaA painful condition that occurs when the trigeminal nerve is aggravated. Symptoms range from a chronic ache to an acute intense stabbing pain to the jaw or face.
Vision problems (optic neuritis)A sudden onset of double vision, poor contrast, eye pain, or heavy blurring, the first symptom of MS for many people.
Walking (gait) difficultiesA secondary symptom stemming from one or more primary symptoms of weakness, spasticity, loss of balance, sensory deficits, and fatigue.
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