Oral Manifestations of Multiple Sclerosis: A Systematic Review

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by diverse clinical manifestations, including the potential involvement of the oral cavity. Oral symptoms in MS patients may arise both as direct consequences of the disease and as side effects of pharmacological treatments. These manifestations, such as xerostomia, periodontal disease, and dental sensitivity, can significantly affect quality of life and may be underrecognized in clinical practice. Aim: To systematically assess the presence and relevance of oral manifestations in patients with MS, and to identify correlations between these symptoms and clinical parameters such as MS phenotype, disease duration, and disability level. Materials and Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was conducted in PubMed and Scopus on 17 March 2025, using terms related to "multiple sclerosis" and "oral manifestations". Inclusion criteria were limited to observational studies published in the last ten years, focusing on oral symptoms in MS patients. Furthermore, the quality of the studies was assessed following the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and the JBI Critical Appraisal checklist for analytical cross-sectional studies. Results: Ten studies met the inclusion criteria. The most frequently reported oral manifestations were hyposalivation, gingival inflammation, increased DMFT and plaque indices, dental sensitivity, and oral pain. Several studies found statistically significant associations between oral dryness and MS phenotype (p < 0.05), and between periodontal health and degree of disability (p < 0.05). However, heterogeneity in methodology and lack of longitudinal studies were noted as limitations. Conclusions: This review highlights a clear relationship between MS and several oral health disturbances, particularly xerostomia and periodontal disease. The findings underscore the need for multidisciplinary care approaches and further studies with standardized protocols to better understand oral-systemic interactions in MS.