Multiple Sclerosis

Question 1

Define Multiple Sclerosis

Answer 1

Autoimmune disease that involves demyelination of the corticospinal tract neurons in 2 or more regions of the brain and spinal cord.

Question 2

Multiple Sclerosis: Who is usually diagnosed?

Answer 2

Young adults (20-45 years)

Question 3

Multiple Sclerosis: Female to male ratio

Answer 3

2:1 F:M

Question 4

Multiple Sclerosis: Characterizations

Answer 4

Characterized by multiple motor and sensory disturbances

Question 5

Multiple Sclerosis: What are the four types?

Answer 5

1. Relapsing/Remitting
2. Primary Progressive
3. Secondary Progressive
4. Progressive Relapsing

Question 6

Multiple Sclerosis: Common Presenting Symptoms

Answer 6

Optic neuritis, weakness and/or parasthesias in one or more extremities, unsteadiness of a leg or hand, fatigue, impaired coordination, tremor, spastacity, ataxia, pain

Question 7

Multiple Sclerosis: Sympatoms present as _____ and ____

Answer 7

Attacks and relapses

Question 8

Multiple Sclerosis: Visual Disturbances

Answer 8

Vision problems, blindness, abnormal eye movements

Question 9

Multiple Sclerosis: Motor Disturbances

Answer 9

Muscle weaknesses, affect walking and use of hands, bowel and bladder incontinence, spastic paresis of skeletal muscles

Question 10

Multiple Sclerosis: Sensory Disturbances

Answer 10

Loss of touch, pain to temperature, proprioception, parasthesias of the face (can precede the onset of other symptoms by several years)

Question 11

Multiple Sclerosis: What occurs in 2-4% of Multiple Sclerosis patients?

Answer 11

Trigeminal neuralgia

Question 12

Multiple Sclerosis: When does fatigue occur the most often?

Answer 12

In the afternoons

Question 13

Multiple Sclerosis: What are the anti-inflammatory medications used for medical management?

Answer 13

• IV corticosteroid
• Interferon beta-1a
• Interferon beta-1b
• Natalizumab, ustekinumab, rituximab
• Glatiramer, acetate injection
• Mitoxantrone

Question 14

Multiple Sclerosis: What are IV corticosteroids used for?

Answer 14

Acute attacks

Question 15

Multiple Sclerosis: What is Mitoxantrone used for?

Answer 15

Aggressive disease

Question 16

Multiple Sclerosis: What drugs are used to manage complications?

Answer 16

Balofen, benzodiazepines, dantrolene, tizanidine, oxybutynin, anti-anxiety, anti-depression, medications for chronic pain

Question 17

Multiple Sclerosis: As dentists, what symptoms are we looking for in order to refer to neurologist?

Answer 17

-Abnormal facial pain (like Trigeminal neuralgia), numbness in the extremities, visual disturbances, muscle weakness, young patient

Question 18

Multiple Sclerosis: What kind of dental care should be given to patients experiencing a relapse?

Answer 18

Emergency care only

Question 19

Multiple Sclerosis: What kind of dental care should be given to patients in remission?

Answer 19

This is the optimal time to treat

Question 20

Multiple Sclerosis: Dental Modifications for stable disease

Answer 20

No significant dental modifications needed

Question 21

Multiple Sclerosis: Dental Modifications for Advanced diseases

Answer 21

May need help to transfer patient to chair, patient may have difficulty with oral hygiene, avoid reconstructive, prosthetic procedures

Question 22

Multiple Sclerosis: When should appointments be scheduled?

Answer 22

In the morning

Question 23

Multiple Sclerosis: What is a common symptom caused by medication management in these patients?

Answer 23

Xerostomia

Question 24

Multiple Sclerosis: What types of palliative care can counsel for patients with xerostomia?

Answer 24

-Rinses, gels, hydration, dry mouth lozenges

Question 25

Multiple Sclerosis: What two systemic drugs can be considered for xerostomia?

Answer 25

Pilocarpine and Cevimeline

Question 26

Multiple Sclerosis: What are some oral manifestations that can occur in these patients?

Answer 26

• Dysarthia
• Parasthesia
• Numbess of the orofacial structures
• Trigeminal Neuralgia

Question 27

Multiple Sclerosis: Define Dysarthia

Answer 27

Slow, irregular speech with unusual separation of syllables of words