Providing Evidence-based Oral Health Care to Individuals Diagnosed with Degenerative Disorders, Part 1: Multiple Sclerosis
Medications to Manage the Symptoms of Multiple Sclerosis

At the present time, there is no cure for MS. However, in addition to having effective strategies to modify the course of disease, medications are also available to treat exacerbations, manage symptoms, improve function and safety, and provide emotional support. Collectively, these therapies can enhance the quality of life for people living with MS. Table 4 provides an exhaustive list of medications commonly prescribed to manage MS symptoms and adverse effects relevant to dental providers. There are numerous adverse effects that could impact the provision of oral health care.^19,38 Some of the most common adverse effects are xerostomia, taste perversion, and caution with local anesthetic.

Conventional therapies are typically only partially effective and as illustrated in table 4, they have many side effects. Therefore, in addition to utilizing western medicine to manage the symptoms of MS, it is not uncommon for individuals to subscribe Eastern medical philosophy. Roughly 75% of patients diagnosed with MS employ complementary and alternative medicinal (CAM) therapies for palliative treatment.³⁹ There are numerous alternative therapies; relaxation techniques, hyperbaric oxygen therapies, acupuncture, cold baths, bowel, parasite and/or liver cleansings, amalgam and/or root canal removal and chelation therapy, special diet, cannabis, and vitamin, antioxidant and mineral supplementation.^39,40 At the present time CAMS are not typically approved by the FDA, their safety is unknown, and the evidence to support the benefits and risks of CAMs is inconclusive.^40,41

Cannabis (universally known as marijuana), is one of the only CAMs approved, in certain forms, by the FDA.⁴¹ There is strong evidence to support the use of oral cannabis extract to effectively manage pain and spasticity in patients with MS.⁴¹ Cannabis use may increase stress responses to local anesthesia, therefore, dental professionals must consider the possibility of marijuana use when addressing pain management options for patients diagnosed with MS and vital signs should be taken prior to administering local anesthesia.⁴² Cannabis can also cause xerostomia, fiery red gingivitis, white gingival patches, papilloma, and candidiasis.¹⁹

Removal of amalgam fillings followed by chelation therapy is an invasive CAM that dental providers need to be aware of. Chelation therapy is controversial and dangerous due to the risk of potential kidney damage. For years, amalgam fillings (containing mercury) have been considered hazardous and alleged to cause central nervous system disorders. It is not unusual for patients to believe amalgams are the cause of MS and request for them to be removed in conjunction with chelation therapy. There is no published scientific research that supports the benefits of this therapy for individuals with MS. The ADA, FDI World Dental Federation, and FDA consider amalgam to be safe.^43-45 The National Multiple Sclerosis Society categorizes the removal of dental amalgam as “ineffective” and chelation therapy as “ineffective and dangerous.”⁴⁶