Getting on getting over: ... when MS dims your smile. No, we're not talking about depression. Sharon Brown is focusing on preventing dental problems that may be a side effect of MS.

Keeping that grin glistening may take extra-grim bristling when MS is in the picture! MS and tooth decay may seem like an odd combination, but there's definitely a connection according to experts. Common MS problems including fatigue, dry mouth caused by certain drugs, and simple lack of coordination can all become roadblocks to keeping teeth healthy, said Dr. Timothy L. Vollmer, director of the MS Research Center at Yale.

"Patients on drugs that cause dry mouth as a side effect need to be aware that dry mouth is more than just an inconvenience," he said. "It contributes to tooth decay and gum disease and should be discussed with a dentist as part of a person's comprehensive management of MS."

Depression can also have a negative impact on dental health because people often stop taking care of themselves and their teeth when they're depressed, said Dr. Paul Burtner, an associate professor of dentistry at the University of Florida College of Dentistry. In addition, any loss of fine motor skills can make oral hygiene more difficult. (Dr. Burtner has developed an online continuing professional education course specifically addressing the dental needs of people with disabilities. While the course is designed for dentists, anyone can log on. Go to <www.dental.ufl.edu/ faculty/Pburtner/ Disabilities/ frtitle.htm>.)

So what should we be considering when staring at our pearly whites in the mirror in the morning? Plenty, said Dr. Chris Chard, a Florida dentist. "The mouth is a pretty dirty place. While there's research going on to create vaccines against the two main bacteria involved in decay, right now the only way to stop it is through hygiene and saliva," Dr. Chard said.

Saliva

"Saliva, and plenty of it, is really important for healthy teeth," Dr. Chard said. "As you swallow, you flush down the bacteria. Just as important, saliva actually has chemical properties that keep the pH in the mouth in balance--and that balance prevents tooth decay as well."

There are hundreds of medications on the market today that have dry mouth as a side effect--including many used by people with MS. Fortunately, there are ways to keep those saliva glands pumping--or at least give them a boost.

Ask your dentist about artificial saliva and mouthwashes. PerioGard mouth rinse has ingredients designed to stay on the teeth to help kill bacteria, Dr. Burtner said. He also recommends Colgate Total toothpaste because it has an antimicrobial agent that kills the bacteria that cause cavities and gum disease. Other sahvaproducing agents include certain prescription drugs (ask your doctor), and--surprise--chewing gum.

"Just watch out what kind of gum," Dr. Chard warned. "Gum with xylitol (like Trident) stimulates saliva, but regular gum containing sugar defeats the purpose because the sugar left in the mouth causes tooth decay again."

Hygiene

Good dental hygiene is still the best defense, but it can be difficult for some of us. Some of us can't hold brushes effectively and some of us forget things. Talk to your dentist, but don't be surprised if these issues are new to him or her. According to Dr. Burtner, only a few dental schools train dentists to accommodate people with disabilities. You don't have to wait for dental training to improve. Instead, consider buying some help.

According to Dr. Chard, electric toothbrushes just plain do a better job. In addition, he said, "They make people spend more time brushing." And electric toothbrushes tend to have large handles, making them easier to grip. A manual toothbrush can also be made more gripable by fastening a washcloth around the handle with a rubber band.

People with MS also benefit from manual floss holders. "Or," Dr. Chard said, "have someone do it for you. It's not difficult to learn how to floss someone else's teeth, and someone else can often do it better. You may also consider having professional cleanings more than twice a year."

And don't forget to invent a memory jogger to remind you to brush after meals. Put a sign on the dishwasher. "Did you brush your teeth," for example. Or set your kitchen timer to ring 45 minutes after you sit down to eat. Then work with your dentist to battle the problems that can result when MS and teeth come together.

The skinny on dental-care products

Electric Toothbrushes

Braun Oral-B 3D Excel--This one goes in every possible direction: up and down, side to side, back and forth, and round and round. The bristles bend as well, to keep people from putting too much pressure on the teeth.

Braun Oral-B Oxyjet 3D Center--combines the Oral-B 3D Excel with an Oxyjet oral irrigator. The brush has two speeds and includes a timer so you don't over-brush. The Oxyjet uses high-speed water and air to clean between teeth. There is a knob that allows you to change the water jet speed.

Oralgiene--A personal favorite, this electric toothbrush is truly "idiot-proof" and incredibly easy to use. You bite into a double-sided brush, which reaches both sides of the tooth, then glide the brush from one side of the mouth to the other. The brush head is large enough to reach below the gum line, sweeping out tarter and plaque.

The Rota-dent--This one comes most highly recommended by dentist Chris Chard. "We think the bristle design and the rotation of the head are optimal for plaque removal. It is similar to what a dental hygienist uses to clean teeth," he said. Available only through your dentist, the Rota-dent comes with a kit containing various types of heads. One, with a pointed brush tip, is particularly helpful for people with braces.

Sonicare--The best feature of this product is the two-minute timer. It pauses every 30 seconds to remind the user to move to a different quadrant of the mouth, an ingenious way to ensure complete brushing. You may buy a "tester" Sonicare, which lasts for one month, to see if you really want to make the investment. The tester comes with a $10 certificate and a free head if you end up buying it.

Manual toothbrushes

Oral-B--products come in a wide variety of shapes and sizes. The handles are easy to build up with a washcloth and rubber band. The newer brushes have bristles that lose their color when the brush needs to be replaced.

Oral-B CrossAction--has a variety of bristle types, including specially designed "Power Tip" bristles to reach back teeth and long bristles at the sides to get rid of plaque between teeth.

Radius--is an excellent manual brush. It has a built-up handle in place, so no washcloths are needed. There's a model for lefties, and the bristle head is about three times larger than standard, making it almost impossible to miss a tooth surface.

Remedent--This brush includes a tongue cleaner on one end, and a twin headed "gumbrush" on the other. Their slogan is "three heads are definitely better than one," and they' re right, if all three are used. The gum brush is set at an angle to get below the gum line. As nice as the Remedent is, it may be difficult to build up the small handle for those with problems gripping.

Other Products

Fuzzy Brush--has to be one of the more ingenious items on the market. It requires no toothpaste or water. It's basically a tiny toothbrush you can pop into your mouth and chew like gum. It's easy to carry in purse or pocket. Invented by a dentist in Holland, Fuzzy Brush is meant for use when regular brushing is inconvenient.

WaterPik--This old standby has been on the market for 35 years. The water jets clean between the teeth and below the gum in areas where it is difficult to floss or brush. It can be hard to hold, but building up the handle should fix that problem.

WaterPik Electric Flosser--This is the latest product, and it's great for people who can't hold floss. Just stick the floss head between the teeth, turn it on, and it works. The only downside is trying to get the flosser to the back teeth. This takes patience and practice, but it is possible.

Right now, both Fuzzy Brush and the Remedent are easiest to find on the Internet. Go to <www.fuzzybrush. corn> or <www.remedent.com> to order. The others are available wherever dental-care products are sold.

Sharon Brown is author of the Society pamphlet So You Have Progressive MS? and a frequent contributor to InsideMS. She can be reached at [e-mail].