Multiple sclerosis (MS) can directly and indirectly affect your mouth and oral health. Oral symptoms, including mouth sores and gum pain, are more common in people with MS than in the general population. 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 learn how they can develop. Read on to learn more about how MS can cause mouth sores and gum pain and how you might prevent these symptoms.

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 inflammation related to MS can directly affect nerves in the mouth and face — including your gums. Such inflammation often results in pain, sensory changes, 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 and unusual sensations in the lower jaw, teeth, and gums. Something as innocent as brushing your teeth can trigger TN symptoms.

Can MS Cause a Sore Mouth?

Yes, trigeminal neuralgia and other MS-related nerve damage can cause your mouth to feel sore. Symptoms of TN and other nerve damage can vary, but many people report feeling pain, soreness, or burning in their teeth, gums, or lower or upper jaw.

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 and coordination issues — You might have trouble walking to the sink to brush your teeth or coordinating your hand movements.
• 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 — Muscle weakness can make simply getting to the bathroom and standing at the sink a struggle, or make it hard to grip your toothbrush.
• 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 MS treatment options 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.

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 or mouth problems associated with DMTs for MS include:

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

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

• Amantadine — Dry mouth, dysphagia (difficulty swallowing)
• Amitriptyline — Dry mouth
• Baclofen — Dry mouth, dysgeusia

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 disorders. People with MS are more likely to develop other autoimmune conditions. And some of those autoimmunediseases count mouth sores and gum pain among their possible symptoms.

Some autoimmune disorders that cause oral problems include:

• Crohn’s disease
• Behçet’s disease
• Sjögren’s disease
• Sarcoidosis

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 healthcare 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 preventive 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 checkups and cleaning appointments
• Creating an oral health routine that suits your needs

Some of the changes that 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.
• 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 your MS treatment provider. They can identify problems early and sort out the best way to deal with your mouth sores and gum pain.

Talk With Others Who Understand

On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.

How do you manage MS mouth symptoms such as gum pain or discomfort? Let others know in the comments below.