Oral health status and oral care challenges among patients with Amyotrophic Lateral Sclerosis (ALS)

Background: Amyotrophic lateral sclerosis (ALS) causes progressive motor and orofacial muscle decline, impairing independent oral hygiene and increasing risks of caries, periodontal disease, and xerostomia. Despite these vulnerabilities, oral health remains understudied in this population.

Aim: To assess oral health status and identify barriers to hygiene and dental care among ALS patients in Albania.

Methods: This cross-sectional study enrolled 75 patients with confirmed ALS from neurology and rehabilitation centers in Tirana (January–December 2025). Disease severity was quantified using the ALS Functional Rating Scale-Revised (ALSFRS-R). A structured caregiver questionnaire, validated via a 10-participant pilot, collected data on oral care routines, dietary habits, and perceived obstacles. Clinical oral examinations were performed on a subset of 30 patients using the Oral Hygiene Index-Simplified (OHI-S) and Gingival Index (GI). Statistical comparisons between groups with regular versus inconsistent caregiver support utilized chi-square and t-tests, with significance set at p<0.05.

Results: The majority (68%, n=51) could not brush independently, and 53% (n=40) brushed less than once daily. Clinical exams revealed poor oral hygiene (mean OHI-S: 2.8±0.9) and moderate gingival inflammation (mean GI: 1.9±0.7). Dental caries were present in 43% (n=13) of examined patients, while xerostomia was reported by 61% (n=46) overall. Patients receiving regular daily caregiver-assisted care (n=42) had significantly better OHI-S scores (2.3 vs. 3.4, p<0.05) compared to those with inconsistent support. Major barriers included limited access to dental services (76%, n=57) and inadequate caregiver training in oral hygiene techniques (82%, n=62).

Conclusion: This study provides evidence that consistent caregiver-assisted oral care and these findings  support the integration of structured oral hygiene training into caregiver education programs and the need for improved dental care accessibility to prevent infectious complications and enhance quality of life.