Oral Health in Amyotrophic Lateral Sclerosis: Feasibility of Oral Screening and Determinants of Poor Outcomes

Introduction: Oral hygiene represents a modifiable risk factor for systemic health and pulmonary complications yet is not routinely addressed in ALS care. This study aimed to examine the relationships between oral health, disease severity and determinants of health in people living with amyotrophic lateral sclerosis (pALS), and to identify key predictors of oral hygiene outcomes. Methods: Individuals with ALS completed an oral hygiene and bulbar screening during their multidisciplinary appointment. Disease demographics, determinants of health, oral health outcomes and bulbar disease outcomes were collected. Descriptives and one sample t-tests were performed to compare oral hygiene outcomes with healthy reference values. Multiple regression analyses were conducted to assess the relationship between disease demographics and oral health. Results: Sixty-two pALS aged 64.0 (+/− 10.8), 40% female, 31% Hispanic/Latino and 37% bulbar onset disease were enrolled. Compared to healthy reference values, plaque index (M = 1.45, SD = 0.52, p < 0.0001), gingival index (M = 1.25, SD = 0.46, p < 0.0001) and bleeding on probing (M = 35.26%, SD = 26.1, p < 0.0001) were elevated in pALS. Lack of dental insurance was a significant predictor of bleeding on probing (BOP) (p = 0.001), plaque (p = 0.006) and gingival scores (p = 0.001). ALSFRS-R (p < 0.03) was also predictive of greater plaque, and care partner status (p < 0.04), and age (p < 0.02) were predictors BOP. Ethnicity and dysphagia severity were not significant predictors. Discussion: Oral health screenings conducted during routine multidisciplinary visits identified periodontal disease in pALS, representing a feasible and immediately actionable pathway to improve oral care outcomes in pALS.