Issues‎ > ‎Vol 5, issue 2‎ > ‎


Prevalence of Orofacial Manifestations of Multiple Sclerosis in Patients Admitted Hospital in Sulaimanyah – Iraq

*Shanaz M. Gaphor, **Zana A. Muhammad, ***Saman AR. Muhammad

*Professor of Oral Medicine, Program Director at  Kurdistan Board of Medical Specialties (KBMS), Sulaimani, Iraq.
**Consultant Neurologist,  College of Medicine, Head of Neurology Dept- University of Sulaimani, Sulaimani, Iraq. 
***Board Candidate of Oral and Maxillofacial Medicine at KBMS, Sulaimani, Iraq. 

Submitted: 13/07/2018; Accepted: 28/12/2018; Published 31/12/2018



Objective: Multiple sclerosis (MS) is a confirmed autoimmune disease that begins most commonly in young adult years with pathological involvement of many areas of the central nervous system (CNS). This pathology reflects an abnormality in the orofacial area; this study intends to elaborate manifestations at the orofacial area.    

Methods: This cross-sectional study that was done in Shar hospital in Sulaimanyah-Iraq, which included one hundred patients previously diagnosed with multiple sclerosis who were interviewed regarding manifestations of multiple sclerosis. A specially designed questionnaire developed for data, data entered and analysis by (SPSS software 24th edition). Chi-square test was used for analyzing variables.

Results: Females were predominant 68%. At the time of diagnosis 86% of patients were below the age of 40 years. The predominant symptom was eye involvement (50%) with no sex difference(P=0.73), but age-dependent(p=0.04). Other manifestations were numbness of tongue (46%), numbness of face (40%), facial palsy(25%), dysphagia (12%), they were no statistically significant.  No patients reported trigeminal neuralgia at the beginning of the disease.

Conclusions: Based on this study dentists and physicians could participate in the diagnosis of multiple sclerosis by doing a proper referral.

Keywords: Multiple sclerosis, Facial palsy, Dysarthria, Numbness. 


1. Miler J. Demyelinating disease. In Rowland Pl, editor: Merritt’s neurology 10th ed. USA: Lippincott Williams & Wilkins; 2000:773-96. 
2. Michelle TF, Stephen CK. Neurological Disorders. In Robert BD, Joseph JL, John CM, Scott LP, editors: Bradly’s neurology in clinical practice. 7th ed. USA:  Elsevier; 2016. 1159 p.
3. Scully C, medical problems in dentistry. 6th ed.UK, Elsevier, 2010. 334p.
4. Files DK, Jausurawong T, Krajina R, Danoff R. Multiple sclerosis. Prim Care. 2015;42(2):159-75.                                                                                                                                                                                                                                                          
5. Nancy JH, Murray TJ, Stephen CR. Multiple sclerosis a guide for the Newly Diagnosed. 3rd ed, USA: Demos medical publishing; 2007. 2 p. 
6. Gallud L, Bagan JV, Cervelló A, Jiménez Y, Poveda R, Gavalda C. Multiple sclerosis as first manifestation in oral and facial area: presentation of four cases. Med Oral Patol Oral Cir Bucal. 2006; 11(2):141-5 
7. Ferroli P, Farina L, Franzini A, Milanese C, Broggi G. Linear pontine and trigeminal root lesions and trigeminal neuralgia. Arch Neurol. 2001; 58(8):1311-2. 
8. Critchley EP. Multiple sclerosis initially presenting as facial palsy. Aviat Space Environ Med. 2004;75(11):1001-4. 
9. Mitchell JP, Beer J, Yancy A, Saint-Louis LA, Rosberger DF. Lateral rectus muscle palsy, facial numbness and ataxia as the initial manifestation of multiple sclerosis. J Nati Med Assoc. 2008; 100(5):572-4. 
10. Gafson A, Giovannoni G, Hawkes CH. The diagnostic criteria for multiple sclerosis: From Charcot to McDonald. Mult Scler Relat Disord. Elseiver. 2012;1(1):9-14. 
11. Minguetti G. Resonance magnética na esclerose múltipla: análise de 270 casos. Arq Neuropsiquiatr. 2001;59(3):563-9. 
12. Sacramento TO, de Araujo RP, Araujo DB, Cardoso ES, Arriaga ML. Orofacial changes in patients with multiple sclerosis treated in Brasil. Int J Med Sci.  2011;3(5):139-43.  
13. Cardoso E, Fukuda T, Pereira J, Seixas J, Miranda R, Rodrigues B, et al. Clinical and epidemiological profile of multiple sclerosis in a reference center in the State of Bahia, Brazil. Arq Neuropsiquiatr. 2006;64(3B):727-30. 
14. Stephen LH, editor, .Andrew SJ, associate editor. Harissons Neurology in clinical medicine 3rd ed.USA: McGraw-Hill Education; 2013, 477p. 
15. Fokazawa T, Moriwaka F, Hamada k. Facial palsy in multiple scleroses. J Neurol. 1997;244(10): 631-3. 
16. Flint S, Scully C. Isolated trigeminal sensory neuropathy: a heterogenous group of disorders. Oral Surg Oral Med Oral Pathol 1990;69(2):153-6. 
17. Hartelius L, Runmarker B, Andersen O. Prevalence and characteristics of dysarthria in a multiple-sclerosis incidence cohort: relation to neurological data. Folia phoniatr logop. 2000; 52(4):160-77. 
18. Darley FL, Brown JR, Goldstein NP. Dysarthria in multiple sclerosis. J Speech Hear Res. 1972;15(2):229-45. 
19. Guan XL, Wang H, Huang HS, Meng L. Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci. 2015;36(5):671-81. 
20. Chemaly D, Lefrancois A, Perusse R. Oral and maxillofacial manifestations of multiple sclerosis. J Can Dent Assoc. 2000;66(11):600-5. 

Creative Commons License © The Authors, published by University of Sulaimani, College of Dentistry