Most pwMS are on poly-pharmacy (multiple prescribed medications) both DMTs and symptomatic treatments. The review article below highlights the problem. It identified 18 oral side effects with dryness of the mouth (xerostomia) being the most common, followed by abnormal taste (dysgeusia), difficulty swallowing (dysphagia), mouth ulceration and sinusitis. The anti-cholinergic drugs were the commonest cause of dry mouth, whilst immunosuppressants resulted in more infection related side-effects.
Cockburn et al. Managing the oral side effects of medications used to treat multiple sclerosis. Aust Dent J. 2017 Mar 9. doi: 10.1111/adj.12510.
BACKGROUND: Many medications used to manage multiple sclerosis (MS) affect oral health. This review aimed to identify the oral side effects of the current drugs recommended in Australia to treat MS and make dental practitioners aware of the range of symptoms.
METHODS: The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat MS. For each medication, the generic name, class, route of administration, dosage and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (MIMs) database. Meyler’s Side Effect of Drugs Encyclopaedia was used to identify any additional oral adverse reactions to medications used to treat MS.
RESULTS: Fourteen drugs were identified for the treatment of MS progression and 13 drugs for the treatment of MS symptoms. For these medications, 18 oral side effects were documented: xerostomia was the most common, followed by dysgeusia, dysphagia, mouth ulceration and sinusitis. Anticholinergic drugs caused xerostomia while immunosuppressants resulted in more infection related side-effects.
CONCLUSIONS: Dental practitioners should be aware of the range of symptoms likely to be reported by this population. Clinicians are encouraged to continue providing dental care for their patients who develop MS and refer complex cases to specialists.