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Mouth Sores and Gum Pain in MS: Causes and Management

Posted on April 10, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Nyaka Mwanza

How MS Causes Oral Pain | MS Meds & Oral Side Effects | Other Causes | Management | Support

Multiple sclerosis (MS) can directly and indirectly affect a person’s mouth and oral health. Oral symptoms, including mouth sores and gum pain, affect between 2 percent and 3 percent of people with MS. Symptoms of MS, its common complications, or even medications used to treat MS can cause or worsen problems in the mouth.

If you’re living with MS, it’s important to recognize common oral symptoms and how they may develop. Read on to learn more about how people with MS can manage (and hopefully prevent) mouth sores and gum pain.

How Can MS Cause Mouth Sores and Gum Pain?

The relationship between MS and oral health runs in a cycle. Infections, inflammation, and some injuries — all of which can occur in the mouth — may trigger MS flares in some people. And no matter the cause, when MS symptoms show up, they can make it hard for a person to properly and regularly brush and floss. In turn, poor dental hygiene leads to inflamed sores, oral infections, irritated gums, and more. And the cycle goes on and on.

Inflammation

The systemic inflammation related to MS can directly affect nerves in the mouth and face — gums included. Inflammation can also affect the bones, nerves, mucous membranes, and skin in and around the mouth. Such inflammation often results in pain, sensory changes, mouth ulcers (oral lesions), and other issues.

Nerve Damage

In MS, autoimmune attacks on the central nervous system (CNS) damage the myelin that protectively coats neurons (nerve cells). This damage results in lesions that can develop on the brain, spinal cord, and optic nerve.

Neuropathic pain, also called neuralgia, is pain caused by nerve damage or pressure. As many as 1 in 4 people with MS experience neuropathic pain. This pain ranges from dull and throbbing to sharp and stabbing.

Trigeminal neuralgia (TN), or tic douloureux, is a common neuralgia that can develop in people with MS. (One Italian study of 130 people with MS showed they were 20 times more likely to develop TN than the general population.) The trigeminal nerve connects the brain with the face and communicates sensations of pain, temperature, and touch. Damage to this nerve results in TN, and the condition creates severe pain in the lower jaw, teeth, and gums. Something as innocent as brushing your teeth can trigger TN symptoms.

MS Symptoms and Oral Health

Multiple sclerosis symptoms can limit or prevent proper oral hygiene and contribute to mouth sores and gum pain. Symptoms of MS can sabotage good oral health in several ways:

  • Balance issues — Things like vertigo (dizziness) and lightheadedness can stop a person from standing up and walking to the sink easily.
  • Depression — One of the most common symptoms in people with MS, depression impacts the energy and motivation needed to keep up good oral hygiene.
  • Fatigue — This MS symptom affects around 78 percent of people with the condition and can make even the smallest task, like flossing, exhausting.
  • Muscle spasticity — Spasms and sudden stiffness that occur in arms, hands, or facial muscles make tooth brushing and flossing difficult.
  • Muscle weakness — Sometimes called “jelly legs,” muscle weakness can make simply getting to the bathroom and standing at the sink a struggle.
  • Numbness and tingling — These MS symptoms can easily lead someone to accidentally bite their tongue and the insides of their cheeks.
  • Sensory changes — Becoming extremely sensitive to touch, temperature, and flavor can make tooth brushing agonizing. It might even cause a person to find the taste of toothpaste newly intolerable.

Periodontal (gum) disease and dental caries (cavities) are more common in people with MS compared with the general population. Why? The above challenges of MS make good oral hygiene hard to manage.

MS Medications and Oral Side Effects

Several drugs used to manage MS come with possible side effects that can cause or contribute to oral sores and pain. One group of researchers in Australia set out to confirm just that. They combed through drug guides and databases looking for listed and flagged side effects for common medicines for people with MS. The results? They saw that yes, some disease-modifying therapies (DMTs) and drugs used to manage MS symptoms came with oral side effects.

Thinking about switching MS treatment?
Learn the potential risks and side effects.

Still, not everyone reacts to the same medication in the same way. Some side effects pop up regularly. Others rarely occur at all. One person might experience none of the potential side effects linked to a medication. Another person might wrestle with a handful of them. Besides that, always remember: When a medication’s fact sheet mentions a long list of side effects, it doesn’t mean you will get every last one of them.

Some of the gum and/or mouth problems associated with DMTs for MS include:

  • Alemtuzumab (Lemtrada) — Mouth pain, dysgeusia (strange taste in the mouth), oral herpes (cold sores)
  • Teriflunomide (Aubagio) — Toothaches, dysgeusia
  • Glatiramer acetate (Copaxone) — Cavities, dysgeusia, dry mouth, bleeding gums, mouth sores
  • Interferon beta-1a (Avonex) — Toothaches
  • Natalizumab (Tysabri) — Cavities
  • Mitoxantrone (formerly sold as Novantrone) — Oral mucositis (inflamed tissue that leads to mouth sores and pain)

The Australian team of doctors also found oral side effects listed for some medications used to treat MS symptoms. Some of those drugs include:

  • Baclofen (now sold as Ozobax, formerly sold as Lioresal) — Dry mouth, dysgeusia
  • Amantadine (Symmetrel) — Dry mouth, dysphagia (difficulty swallowing)
  • Amitriptyline (Elavil) — Dry mouth

Corticosteroids (or simply steroids) like prednisone are often used to treat MS flares. Steroids raise a person’s risk for developing fungal infections, including oral yeast infections (candida). This is especially true when steroids are taken for a long time.

What Else Could Cause Gum Pain and Mouth Sores in MS?

Oral sores and gum pain can crop up as symptoms in other health conditions, including autoimmune (AI) disorders. People with MS are more likely to develop other AI conditions. And some of those AI diseases count mouth sores and gum pain among their possible symptoms.

Some AI disorders that cause oral problems include:

Managing Gum Pain and Mouth Sores in MS

Managing and treating gum pain and mouth sores largely depends on their root cause (or causes). If you have oral symptoms that don’t go away — or get worse — let your health care provider know. They can determine the cause and recommend appropriate treatment and prevention plans.

Prevention

The old adage “Prevention is better than cure” applies to people with MS who have mouth and gum problems. And the best preventative measure? Making good oral hygiene a priority.

Maintain good oral health by:

  • Informing your dentist and neurologist about your condition so they can coordinate care
  • Attending regular dental check-ups and cleaning appointments
  • Creating an oral health routine that suits your needs

Some of the changes make it easier for someone with MS to maintain good oral hygiene include:

  • Switching from a manual to an electric toothbrush
  • Padding the handle of your toothbrush to make it easier to hold
  • Sitting down while you brush your teeth to conserve energy and help your balance
  • Keeping dental care basics next to your bed to avoid the walk to the bathroom

Symptom Management

There are many ways to treat and control mouth sores and gum pain. Those options include both simple, at-home solutions and medical ones.

Consider addressing your oral ulcers and gum pain with these tips:

  • Use topical numbing agents, like anbesol.
  • Avoid any foods — like spicy dishes — and drinks that aggravate your mouth.
  • Rinse your mouth regularly with an alcohol-free antiseptic rinse.
  • Use a protective paste to minimize irritation.
  • Treat oral herpes outbreaks with an antiviral medication.

Manage dry mouth by:

  • Chewing sugar-free gum or sucking on sugar-free candies
  • Staying hydrated with lots of water and other clear, sugar-free beverages
  • Using mouth moisturizers (offered as gels and mouth rinses)

Communicate honestly and regularly with your dentist and/or MS treatment provider. That helps to identify problems early and sort out the best way to deal with your mouth sores and gum pain.

Find Your Team

On MyMSTeam, the social network for people with MS and their loved ones, you’ll find more than 184,000 members. Here, the MS community comes together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Do you get mouth sores or experience gum pain with MS? What tips do you have to manage symptoms and keep up with oral hygiene? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

References
  1. European Review for Medical and Pharmacological Sciences — International Journal of Environmental Research and Public Health
  2. Multiple Sclerosis — College of Dental Hygienists of Ontario
  3. Dental Health: The Basic Facts — National Multiple Sclerosis Society
  4. What Is an Immune-Mediated Disease? — National Multiple Sclerosis Society
  5. Pain — Multiple Sclerosis Society (UK)
  6. Neuropathic Pain - ‘The Invisible Illness’ — MS Trust
  7. Trigeminal Neuralgia — MS Trust
  8. Oral and Craniofacial Manifestations of Multiple Sclerosis: Implications for the Oral Health Care Provider — European Review for Medical and Pharmacological Sciences
  9. Vertigo and Dizziness — National Multiple Sclerosis Society
  10. Emotional Changes — National Multiple Sclerosis Society
  11. Oral Health Risks of Multiple Sclerosis — Decisions in Dentistry
  12. Vision Problems — National Multiple Sclerosis Society
  13. Central Nervous System (CNS) — MS Trust
  14. Managing the Oral Side-Effects of Medications Used To Treat Multiple Sclerosis — Australian Dental Journal
  15. Multiple Sclerosis and Dentistry: A Contemporary Evaluation — Turkish Journal of Neurology
  16. Candidiasis — College of Dental Hygienists of Ontario
  17. Dry Mouth (Xerostomia) — Cleveland Clinic
  18. Oral Health — Multiple Sclerosis Society UK
  19. Autoimmune Comorbid Conditions in Multiple Sclerosis — TouchReviews in Neurology
  20. Oral Manifestations of Systemic Disease — American Academy of General Dentistry
  21. Behçet’s Disease Is Associated With Multiple Sclerosis and Rheumatoid Arthritis: A Korean Population-Based Study — Dermatology

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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