Multiple Sclerosis and Oral Health: Swallowing Problems, MS Tongue, and Dry Mouth

Multiple sclerosis (MS) affects nerves in the brain and spinal cord that control movements and sensation. This neurological disorder can cause muscle weakness and numbness that affect your ability to move around and complete daily tasks.

But MS symptoms don’t just affect your limbs. They can affect every part of the body, including your mouth. “The muscles that control the jaw and mouth can weaken, or have spasms, causing problems with speech, chewing, swallowing, and oral health,” says Michael Levy, MD, PhD, a Mass General Brigham neuroimmunologist who cares for patients at Massachusetts General Hospital.

How MS affects oral health

A survey conducted in Australia found that people with MS had more oral health problems than those without MS. About 1 in 5 respondents rated their oral health as fair or poor.

Dr. Levy shares several ways MS affects oral health.

Tongue issues (MS tongue)

Some people with MS lose sensation in their tongue. Some health care providers refer to MS-related tongue issues as “MS tongue.” Loss of sensation or numbness can make it difficult to move your tongue when you speak, chew, or swallow. Tongue numbness may also diminish sense of taste.

“When you can’t feel your tongue, you may unintentionally bite down on it when chewing or speaking,” says Dr. Levy. Repetitive biting can cause tongue sores. You may also develop mouth sores from biting the inside of your cheeks.

MS and swallowing problems

As many as 1 in 3 people with MS experiences difficulty swallowing (dysphagia). “It can be especially challenging to swallow liquids, including saliva,” says Dr. Levy.

Swallowing problems are often due to:

• Weakened mouth and throat muscles, especially as the disease advances

• Signals not reaching the nerves that automatically control swallowing

• Numbness in the mouth that makes it difficult to feel foods and drinks

• Tongue numbness that makes it harder to push food or drinks into the food pipe (esophagus)

People with swallowing problems often benefit from working with speech-language therapists. These experts teach exercises that strengthen muscles involved in swallowing. They also teach techniques that make swallowing easier, such as thickening liquids or holding your head in different positions.

MS and dry mouth

MS, as well as some medications to treat symptoms, can affect saliva production, causing dry mouth (xerostomia). Some people with MS also have Sjogren’s syndrome, an autoimmune disease that causes dry mouth.

Saliva moistens food when you chew, making it easier to swallow and digest. It also helps get rid of food residue and bacteria in the mouth. Lack of saliva increases the risk of tooth decay, as well as mouth, lip, and tongue sores.

“Changing medications for MS symptoms that cause dry mouth may help,” says Dr. Levy. Over-the-counter or prescription sprays, mouth rinses, lozenges, and other products can stimulate saliva production. Artificial saliva substitutes keep the mouth moist.

MS and jaw pain

Muscle spasms can cause you to clench or grind your teeth (bruxism). Clenching can lead to jaw issues, such as temporomandibular joint (TMJ) pain. TMJ can lock up the jaw joint, making it painful or difficult to open your mouth to eat or speak. “Mouthguards help by taking pressure off the jaw and preventing grinding,” says Dr. Levy.

MS and thrush

Thrush is a yeast infection that affects the mouth and throat. It occurs when Candida, a fungus that lives in the mouth and on skin, grows out of control. Dry mouth, as well as steroid medications, antibiotics, and disease-modifying drugs, can allow this fungus to multiply, leading to thrush.

Milky white, raised lesions may form on your tongue, inside of your cheeks, roof of your mouth, and back of your throat. These sometimes-painful lesions may affect sense of taste and make it difficult to swallow. Antifungal medications clear up this yeast infection.

Managing oral health when you have MS

Muscle weakness and overall fatigue can make it more challenging to hold a toothbrush, floss, and properly care for your teeth and gums. Let your MS care team know if you have oral hygiene problems. They may be able to change MS medications or prescribe antifungal medications for thrush. An occupational therapist can help find ways to make dental care easier.

“Make sure your dentist knows you have MS and which medications you’re taking,” says Dr. Levy. Your dental team may recommend more frequent cleanings and dental exams.