{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:38:15Z","timestamp":1792827495046,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations. Case presentation: A 49-year-old female patient diagnosed with long-term relapsing\u2013remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis. Conclusions: Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient\u2019s dental status over the years.<\/jats:p>","DOI":"10.3390\/diseases10030062","type":"journal-article","created":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T04:54:41Z","timestamp":1662699281000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Oral Health Status and Multiple Sclerosis: Classic and Non-Classic Manifestations\u2014Case Report"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3766-2887","authenticated-orcid":false,"given":"C\u00e9u","family":"Costa","sequence":"first","affiliation":[{"name":"Escola Superior da Sa\u00fade, Universidade Fernando Pessoa, 4200-253 Porto, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento Fernando Pessoa, FP-I3ID (FP-BHS), 4249-004 Porto, Portugal"},{"name":"Grupo de Patologia Experimental e Terap\u00eautica, Centro de Investiga\u00e7\u00e3o, Instituto Portugu\u00eas de Oncologia do Porto, 4200-072 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Santiago","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade Fernando Pessoa, 4200-150 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3633-397X","authenticated-orcid":false,"given":"Sofia","family":"Pereira","sequence":"additional","affiliation":[{"name":"Escola Superior da Sa\u00fade, Universidade Fernando Pessoa, 4200-253 Porto, Portugal"},{"name":"Instituto de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento Fernando Pessoa, FP-I3ID (FP-BHS), 4249-004 Porto, Portugal"},{"name":"Grupo de Patologia Experimental e Terap\u00eautica, Centro de Investiga\u00e7\u00e3o, Instituto Portugu\u00eas de Oncologia do Porto, 4200-072 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Rita","family":"Castro","sequence":"additional","affiliation":[{"name":"Instituto de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento Fernando Pessoa, FP-I3ID (FP-BHS), 4249-004 Porto, Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade Fernando Pessoa, 4200-150 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6157-2390","authenticated-orcid":false,"given":"Sandra Clara","family":"Soares","sequence":"additional","affiliation":[{"name":"Instituto de Investiga\u00e7\u00e3o, Inova\u00e7\u00e3o e Desenvolvimento Fernando Pessoa, FP-I3ID (FP-BHS), 4249-004 Porto, Portugal"},{"name":"Faculdade de Ci\u00eancias da Sa\u00fade, Universidade Fernando Pessoa, 4200-150 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/S1474-4422(14)70256-X","article-title":"Pathological mechanisms in progressive multiple sclerosis","volume":"14","author":"Mahad","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_2","first-page":"1","article-title":"Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy","volume":"19","author":"Ghasemi","year":"2017","journal-title":"Cell J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/B978-0-444-52001-2.00011-X","article-title":"Multiple sclerosis: Diagnosis, differential diagnosis, and clinical presentation","volume":"122","author":"Gelfand","year":"2014","journal-title":"Handb. Clin. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"428","DOI":"10.3390\/neurolint13030042","article-title":"Walking with UAN.GO Exoskeleton: Training and Compliance in a Multiple Sclerosis Patient","volume":"13","author":"Sesenna","year":"2021","journal-title":"Neurol. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1212\/WNL.0000000000000560","article-title":"Defining the clinical course of multiple sclerosis: The 2013 revisions","volume":"83","author":"Lublin","year":"2014","journal-title":"Neurology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41572-018-0041-4","article-title":"Multiple sclerosis","volume":"4","author":"Filippi","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"693","DOI":"10.2174\/1381612822666161214153108","article-title":"Multiple Sclerosis and Neuroinflammation: The Overview of Current and Prospective Therapies","volume":"23","author":"Bjelobaba","year":"2017","journal-title":"Curr. Pharm. Des."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Gentile, M.T., Muto, G., Lus, G., L\u00f6vblad, K.-O., Svenningsen, \u00c5.F., and Colucci-D\u2019Amato, L. (2022). Angiogenesis and Multiple Sclerosis Pathogenesis: A Glance at New Pharmaceutical Approaches. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164643"},{"key":"ref_9","first-page":"600","article-title":"Oral and Maxillofacial Manifestations of Multiple Sclerosis","volume":"66","author":"Chemaly","year":"2000","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.tripleo.2009.05.047","article-title":"Multiple sclerosis: An update for oral health care providers","volume":"108","author":"Fischer","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/ene.12103","article-title":"Association between multiple sclerosis and chronic periodontitis: A population-based pilot study","volume":"20","author":"Sheu","year":"2013","journal-title":"Eur. J. Neurol."},{"key":"ref_12","first-page":"441","article-title":"Oral health status and temporomandibular disorders in multiple sclerosis patients","volume":"29","author":"Kovac","year":"2005","journal-title":"Coll. Antropol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/cdoe.12512","article-title":"A systematic review of oral health in people with multiple sclerosis","volume":"48","author":"Manchery","year":"2020","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/adj.12510","article-title":"Managing the oral side effects of medications used to treat multiple sclerosis","volume":"62","author":"Cockburn","year":"2017","journal-title":"Aust. Dent. J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Covello, F., Ruoppolo, G., Carissimo, C., Zumbo, G., Ferrara, C., Polimeni, A., and Vozza, I. (2020). Multiple Sclerosis: Impact on Oral Hygiene, Dysphagia, and Quality of Life. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17113979"},{"key":"ref_16","first-page":"ZC43","article-title":"Impact of Alcohol Dependency on Oral Health\u2014A Cross-sectional Comparative Study","volume":"11","author":"Priyanka","year":"2017","journal-title":"J. Clin. Diagn Res."},{"key":"ref_17","first-page":"17","article-title":"Effect of tobacco on periodontal disease and oral cancer","volume":"9","author":"Zhang","year":"2019","journal-title":"Tob. Induc. Dis."},{"key":"ref_18","first-page":"271","article-title":"Multiple sclerosis: Oral health, behaviours and limitations of daily oral hygiene\u2014A questionnaire study","volume":"53","author":"Niewiadomska","year":"2019","journal-title":"Pol. J. Neurol. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1136\/ard.51.4.499","article-title":"Measurement of whole unstimulated salivary flow in the diagnosis of Sj\u00f6gren\u2019s syndrome","volume":"51","author":"Speight","year":"1992","journal-title":"Ann. Rheum. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1159\/000087387","article-title":"Historical descriptions of multiple sclerosis","volume":"54","author":"Pearce","year":"2005","journal-title":"Eur. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1177\/1971400916665385","article-title":"Is size an essential criterion to define tumefactive plaque? MR features and clinical correlation in multiple sclerosis","volume":"29","author":"Patriarca","year":"2016","journal-title":"Neuroradiol. J."},{"key":"ref_22","first-page":"378","article-title":"Diagnosis and treatment of temporomandibular disorders","volume":"91","author":"Gauer","year":"2015","journal-title":"Am. Fam. Physician"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1111\/adj.12593","article-title":"Management of temporomandibular joint disorders: A surgeon\u2019s perspective","volume":"63","author":"Dimitroulis","year":"2018","journal-title":"Aust. Dent. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/cdoe.12445","article-title":"Oral health and behaviours of people living with Multiple Sclerosis in Australia","volume":"47","author":"Sexton","year":"2019","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_25","first-page":"53","article-title":"Dental care in multiple sclerosis: An overlooked and under-assessed condition","volume":"11","author":"Fragoso","year":"2010","journal-title":"J. Disabil. Oral Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.revsto.2016.07.006","article-title":"Articula\u00e7\u00e3o temporo-mandibular, oclus\u00e3o e bruxismo [articula\u00e7\u00e3o temporomandibular, oclus\u00e3o e bruxismo]","volume":"117","author":"Orthlieb","year":"2016","journal-title":"Revue de Stomatologie Chirurgie Maxillo-faciale et de Chirurgie Orale"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1179\/crn.2011.026","article-title":"Bruxism and temporal bone hypermobility in patients with multiple sclerosis","volume":"29","author":"Williams","year":"2011","journal-title":"Cranio"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"505","DOI":"10.2147\/IJGM.S22255","article-title":"Bone loss and fractures in multiple sclerosis: Focus on epidemiologic and physiopathological features","volume":"4","author":"Dionyssiotis","year":"2011","journal-title":"Int. J. Gen. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41432-021-0159-1","article-title":"Is there an association between multiple sclerosis and oral health?","volume":"22","year":"2021","journal-title":"Evid. Based Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/prd.12297","article-title":"The role of inflammation and genetics in periodontal disease","volume":"83","author":"Loos","year":"2020","journal-title":"Periodontology 2000"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/2042098613505614","article-title":"Pregabalin: Latest safety evidence and clinical implications for the management of neuropathic pain","volume":"5","author":"Toth","year":"2014","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.ceca.2014.01.005","article-title":"Ca2+-dependent K+ Channels in Exocrine Salivary Glands","volume":"55","author":"Melvin","year":"2014","journal-title":"Cell Calcium"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3109\/00365529509093266","article-title":"Omeprazole and Dry Mouth","volume":"30","author":"Teare","year":"1995","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_34","first-page":"4610","article-title":"Oral and craniofacial manifestations of multiple sclerosis: Implications for the oral health care provider","volume":"19","author":"Zhang","year":"2015","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1352458516650741","article-title":"The importance of a multi-disciplinary perspective and patient activation programmes in MS","volume":"22","author":"Feys","year":"2016","journal-title":"Mult Scler."},{"key":"ref_36","first-page":"14S","article-title":"Multidisciplinary Management of a Patient with Multiple Sclerosis","volume":"32","author":"Wallin","year":"2015","journal-title":"Fed. Pract."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/3\/62\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:28:02Z","timestamp":1760142482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/3\/62"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["diseases10030062"],"URL":"https:\/\/doi.org\/10.3390\/diseases10030062","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,9]]}}}