Investigating the Relationship Between Gingivitis and General Health in Women with Multiple Sclerosis

Abstract

Background: Multiple sclerosis is a chronic inflammatory disease characterized by demyelinating lesions in the brain, spinal cord, and optic nerve.

Objectives: Due to the high prevalence of MS, this study aimed to investigate the relationship between gum health and general health in women with MS.

Methods: This study was conducted under the ethical approval code IR.MEDILAM.REC.1404.015. Patients diagnosed with MS were recruited after obtaining informed consent from all participants. Data collection instruments: A demographic checklist was used, Gingival indices were graded as follows, General Health Questionnaire (GHQ-28) and Oral Health Impact Profile (OHIP-14) was employed. The researchers collected data through face-to-face interviewing for questionnaire completion and clinical examinations for gingival inflammation assessment. Data analysis was performed using SPSS software version 19.

Results: The findings showed that the overall M(SD) score of general health of patients in non-pregnant women was 60.48 (6.73), in pregnant women it was 62.85 (4.18), and the overall score of women with MS was 15.35 (2.19). Also, regarding the M(SD) score related to the OHIP-14 score tool, it was shown that in non-pregnant women it was 35.03 (6.68), in pregnant women it was 35.71 (7.22), and the overall score of women with MS was 35.09 (6.69). also, the overall gingivitis status of patients in the normal range was 27.6%, in the mild range it was 49.4%, in the moderate range it was 18.4%, and in the severe range it was 4.6%. Also, in the pregnant women group, 17.5% had moderate inflammation and in the non-pregnant women group, 28.6% had moderate inflammation.

Conclusions: it is proposed that faculty members from the Reproductive Health department conduct necessary educational interventions for the prevention of oral and dental diseases. Furthermore, in the event of any existing pathology in these patients, the Periodontology department should undertake the requisite diagnostic and therapeutic measures in this regard.

Keywords:

Gingivitis, General health, Multiple sclerosis

References

Borji M, Taghinejad H, Salimi AH. The effect of motivational interviewing on fatigue in patients with multiple sclerosis. Archives of Neuroscience. 2018;5(3):63436. https://doi.org/10.5812/archneurosci.63436.

de Moura JA, da Costa Teixeira LA, Tanor W, Lacerda ACR, Mezzarane RA. Prevalence of multiple sclerosis in Brazil: An updated systematic review with meta-analysis. Clinical Neurology and Neurosurgery. 2025:108741. DOI: 10.1016/j.clineuro.2025.108741

Khan G, Hashim MJ. Epidemiology of multiple sclerosis: global, regional, National and sub-national-level estimates and future projections. Journal of epidemiology and global health. 2025;15(1):21. PMID: 39928193 PMCID: PMC11811362 DOI: 10.1007/s44197-025-00353-6

Lemmens CM, Vanhommerig JW, Knottnerus BJ, Uitdehaag BM, Mostert JP, de Jong BA. Prevalence and incidence of multiple sclerosis in the Netherlands. Multiple Sclerosis and Related Disorders. 2025;93:106207. PMID: 39657510 DOI: 10.1016/j.msard.2024.106207

Haki M, Al-Biati HA, Al-Tameemi ZS, Ali IS, Al-Hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore). 2024;103(8):e37297. PMID: 38394496 PMCID: PMC10883637 DOI: 10.1097/MD.0000000000037297

Tahmasbi Arashloopour H, Khajavi D, Faraji F. Studying the Effectiveness of a Combined Motor and Cognitive – Behavioral Intervention Program on Balance and Balance Confidence in people with Multiple Sclerosis (PwMS). Journal of Arak University of Medical Sciences. 2025;28(2):91-8, DOI : 10.61882/jams.28.2.91. doi: 10.61882/jams.28.2.91

Moghadam S, Khoshakhlagh H, Rezaei Jamaloui H. Comparison of the Effectiveness of Memory Specificity Training and Mental Visual Imagery on Autobiographical Memory and Episodic Future Thinking in Women with Multiple Sclerosis. Journal of Health and Care. 2025;27(2):125-39, DOI: ‎ 10.61882/jhc.27.2.125.doi : 10.61882/jhc.27.2.125

Taskov D, Ivanova S, Topalov N, Barkalova-Atanasova A, Yordanov N, Yurukov M, et al. Prevalence and Associations of Poor Sleep in Patients with Relapsing-Remitting Multiple Sclerosis on Disease-Modifying Therapy. Journal of Clinical Medicine. 2025;14(21):7837. https://doi.org/10.3390/jcm14217837

Howard J, Trevick S, Younger DS. Epidemiology of Multiple Sclerosis. Neurol Clin. 2016;34(4):919-39. DOI: 10.1016/j.ncl.2016.06.016

Magyari M, Sorensen PS. The changing course of multiple sclerosis: rising incidence, change in geographic distribution, disease course, and prognosis. Curr Opin Neurol. 2019;32(3):320-6. PMID: 30925518 DOI: 10.1097/WCO.0000000000000695

Sabin J, Salas E, Martín-Martínez J, Candeliere-Merlicco A, Barrero FJ, Alonso A, et al. Perceived illness-related uncertainty among patients with mid-stage relapsing-remitting multiple sclerosis. Mult Scler Relat Disord. 2024;91:105861. DOI: 10.1016/j.msard.2024.105861

Taskov D, Ivanova S, Topalov N, Barkalova-Atanasova A, Yordanov N, Yurukov M, et al. Prevalence and Associations of Poor Sleep in Patients with Relapsing-Remitting Multiple Sclerosis on Disease-Modifying Therapy. Journal of Clinical Medicine. 2025;14(21):7837. https://doi.org/10.3390/jcm14217837

Pirmani A, De Brouwer E, Arany Á, Oldenhof M, Passemiers A, Faes A, et al. Personalized federated learning for predicting disability progression in multiple sclerosis using real-world routine clinical data. npj Digital Medicine. 2025;8(1):478. DOI: 10.1038/s41746-025-01788-8

Vaivade A, Erngren I, Carlsson H, Freyhult E, Emami Khoonsari P, Noui Y, et al. Associations of PFAS and OH-PCBs with risk of multiple sclerosis onset and disability worsening. Nature Communications. 2025;16(1):2014. https://doi.org/10.1038/s41467-025-57172-3

Manchery N, Henry JD, Nangle MR. A systematic review of oral health in people with multiple sclerosis. Community Dentistry and Oral Epidemiology. 2020;48(2):89-100. DOI: 10.1111/cdoe.12512

Covello F, Ruoppolo G, Carissimo C, Zumbo G, Ferrara C, Polimeni A, et al. Multiple Sclerosis: Impact on Oral Hygiene, Dysphagia, and Quality of Life. International Journal of Environmental Research and Public Health. 2020;17(11):3979. DOI: 10.3390/ijerph17113979

Khalid Almas B. Multiple sclerosis and oral health: an update. New York State Dental Journal. 2013;79(3):16. PMID: 23767394.

Sexton C, Lalloo R, Stormon N, Pateman K, van der Mei I, Campbell J, et al. Oral health and behaviours of people living with Multiple Sclerosis in Australia. Community Dentistry and Oral Epidemiology. 2019;47(3):201-9. DOI: 10.1111/cdoe.12445

Kapel-Reguła A, Chojdak-Łukasiewicz J, Rybińska A, Duś-Ilnicka I, Radwan-Oczko M. Oral State and Salivary Cortisol in Multiple Sclerosis Patients. Biomedicines. 2024;12(10):2277. DOI: 10.3390/biomedicines12102277

Malek S, Esfahanian V, Torabzadeh M. Comparison of the Concentration of Inflammatory Cytokines TNF-α and Interleukin-1β in Saliva of Healthy Subjects and Patients with Gingivitis and Chronic Periodontitis. JOURNAL OF MASHHAD DENTAL SCHOOL,[online]. 2020;44(2):166-73, doi : 10.22038/jmds.2020.45990.1875.

Ahmadinia A, Mojrian N. Association between Obesity and Periodontal Diseases in the Iranian Population in Gorgan City in 2015-2016. Journal of Mashhad Dental School. 2022;46(3):199-210, 10.22038/jmds.2022.54132.2072.

Niwano Y, Shishido S, Shirato M, Kohzaki H, Nakamura K. Therapeutic Potential of Proanthocyanidins in Dentistry: A Focus on Periodontal Disease and on Dental Implants in Osteoporotic Patients. Antioxidants. 2025;14(7):850. https://doi.org/10.3390/antiox14070850

Twetman S, Belstrøm D. Effect of Synbiotic and Postbiotic Supplements on Dental Caries and Periodontal Diseases—A Comprehensive Review. International Journal of Environmental Research and Public Health. 2025;22(1):72. DOI: 10.3390/ijerph22010072

Broomhead T, Gibson B, Parkinson CR, Vettore MV, Baker SR. Gum health and quality of life—subjective experiences from across the gum health-disease continuum in adults. BMC Oral Health. 2022;22(1):512. DOI: 10.1186/s12903-022-02507-5

Shaw S, Khan J. Risk of dental caries and periodontal disease among older adults and elderly persons with diabetes in India: a population-based cross-sectional study. BMC Oral Health. 2025;25(1):737. DOI: 10.1186/s12903-025-06067-2

Shah RC, Shah H, Chaudhary N, Singh RP, Sodani V, Pawar A. Cross sectional survey to assess the self perception of oral health status reported by IGNOU students versus clinical diagnosis. Journal of Dental Specialities. 2018;6(1). https://doi.org/10.18231/2393-9834.2018.0008

Albisher GM, Alghamdi HM, AlAbbadi SH, Almukhyzim NI, Al Fayez RA, Alamrani HA, et al. Oral health knowledge among private primary school teachers in Riyadh city, Kingdom of Saudi Arabia. Archives of Pharmacy Practice. 2021;12(3-2021):121-4.

Vallejo MA, Jordán CM, Díaz MI, Comeche MI, Ortega J. Psychological assessment via the internet: a reliability and validity study of online (vs paper-and-pencil) versions of the General Health Questionnaire-28 (GHQ-28) and the Symptoms Check-List-90-Revised (SCL-90-R). Journal of medical Internet research. 2007;9(1):e540. DOI: 10.2196/jmir.9.1.e2

Kokkinis N, Galanaki E, Malikiosi-Loizos M. Factor structure and internal consistency of the Greek version of the General Health Questionnaire–28 (GHQ-28). Mental Health & Prevention. 2017;7:21-7.

Hjelle EG, Bragstad LK, Zucknick M, Kirkevold M, Thommessen B, Sveen U. The General Health Questionnaire-28 (GHQ-28) as an outcome measurement in a randomized controlled trial in a Norwegian stroke population. BMC psychology. 2019;7(1):18. DOI: 10.1186/s40359-019-0293-0

Ballouk MA-H, Altinawi M, Al-Kafri A, Zeitounlouian TS, Fudalej PS. Propolis mouthwashes efficacy in managing gingivitis and periodontitis: a systematic review of the latest findings. BDJ open. 2025;11(1):5. DOI: 10.1038/s41405-025-00294-z

Rijal AH, Ghimire P, Lamichhane S, Adhikari S, Humagain M. Evaluation of a Nepalese-Language Version of the Oral Health Impact Profile Scale Applied to Periodontal Disease (OHIP-14-PD): A Reliability and Validation Study. Int J Dent. 2025;2025:7031395. doi: 10.1155/ijod/7031395. PMID: 41127680; PMCID: PMC12539986.

Wojszko Ł, Banaszek K, Gagacka O, Bagińska J. Oral Health Impact Profile (OHIP) as a Tool for the Assessment of the Oral Health-Related Quality of Life—A Scoping Review. Dentistry Journal. 2025;13(11):490. doi: 10.3390/dj13110490. PMID: 41294471; PMCID: PMC12650987.

Al-Gamal E, Hyarat SY, Al Jaried L, Rama E, Ahmad M, Long T. Fatigue and health-related quality of life in patients with multiple sclerosis. Journal of Research in Nursing. 2025;30(2):141-54. doi: 10.1177/17449871241290435. Epub ahead of print. PMID: 40191838; PMCID: PMC11969484.

Faraclas E, Lynn J, Lau JD, Merlo A. Health-Related Quality of Life in people with Multiple Sclerosis: How does this Population Compare to Population-based Norms in Different Health Domains? Journal of Patient-Reported Outcomes. 2022;6(1):12. doi: 10.1186/s41687-022-00415-4. PMID: 35107657; PMCID: PMC8810961.

Kiropoulos LA, Rozenblat V, Baes N. Inflammatory proteins related to depression in multiple sclerosis: A systematic review and meta-analysis. Brain, Behavior, & Immunity - Health. 2025;43:100939. doi: 10.1016/j.bbih.2024.100939. PMID: 39867847; PMCID: PMC11758135.

Young CA, Langdon D, Rog D, Chhetri SK, Tanasescu R, Kalra S, et al. Prevalence, treatment and correlates of depression in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2024;87:105648. doi: 10.1016/j.msard.2024.105648. Epub 2024 Apr 26. PMID: 38713965.

Washington F, Langdon D. Factors affecting adherence to disease-modifying therapies in multiple sclerosis: systematic review. Journal of neurology. 2022;269(4):1861-72. doi: 10.1007/s00415-021-10850-w. Epub 2021 Oct 21. PMID: 34676448; PMCID: PMC8940867.

Jahantash AH, Babadi Oregani E, Sadeghipour Roodsari M, Behnaz M, Namdari M. Evaluation of Oral Health-related Quality of Life in Patients with Multiple Sclerosis. Journal of Mashhad Dental School. 2021;45(4):336-48, DOI: 10.22038/jmds.2021.56054.2024.