Physical Disorders
Degenerative Neuromuscular Disorders: 

Amyotrophic Lateral Sclerosis
 
 
 
 
 
 

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's Disease, is a degenerative nervous system disease causing a loss of motor neurons in the cerebral cortex, brain stem and spinal cord with resultant muscular atrophy, weakness, and spasticity. Significant sensory symptoms are absent. The disease is unremittingly progressive; patients survive 3 to 5 years or less. The etiology is unknown and there is no known cure.

This disease affects 2 to 7 individuals per 100,000 and the mean age of onset is 50 to 60 years.

Weakness begins in the upper extremities often unilaterally. 

Patients may have difficulty placing and removing a removable prosthesis. Complete dentures should be avoided since oral muscle function will diminish.There are severe effects on respiration and deglutition.

Appropriate treatment goals include:

 
• keep patient free of acute disease
• maintain oral function
• retain esthetic to maximize patient self image
• enable patient to care for their own oral health

Treatment plans must consider limitations of motor skills. The preventive dental program may require involvement of family member or nurse.

Clinical considerations:

 
• patients with severe ALS require short appointments
• patient may have to be transferred from wheel chair to dental chair
• these individuals develop severe respiratory problems due to the disease's effect on the muscles that control breathing; and deficits in protective airway reflexes develop - rubber dam may be useful if the patient can breath through the nose
• should not place patient in a supine position (to protect airway); can be placed at 45 degrees 

Patients with ALS may be receiving one or more of the following medications:

• muscle relaxants
• anti-epileptics

Previous Page

Next Page