ALS is a progressive neurodegenerative disease that affects motor neurons in the brain and spinal cord. It causes the motor neurons to gradually degenerate and die, resulting in muscle weakness and atrophy. Over time, this leads to increasing paralysis as more motor neurons are damaged. While the exact causes are unknown, excitotoxicity from glutamate and mutations in genes like SOD1 are thought to be involved in the neurodegeneration. The main treatment is riluzole, which extends life by a few months. Other therapies focus on managing symptoms and maintaining function and quality of life for as long as possible. Regular dental care is important for oral health and to reduce risks of pneumonia. Adaptations may be needed to accommodate physical

1. AMYOTROPHIC
LATERAL SCLEROSIS
(ALS)

2. What is ALS?
Progressive neurodegenerative
disease in which the motor
neurons gradually degenerates
and after some time, they
eventually die.

3. Upper Motor Neuron -
evolving from layer five of
motor cortex to descend
via the pyramidal tract to
synapse with motor neuron
Lower Motor Neuron -consisting of
anterior horn cells in spinal cord
and their brainstem homologues
innervating bulbar muscle.
Loss of function in:
*Although at its onset, ALS may involve selective loss of function of only upper or lower motor neurons,
it ultimately causes progressive loos of both categories of motor neurons.

4. MOTOR NEURONS
Motor neuron is a type of
nerve that can be found in
the spinal cord, brain, and
brain stem. It provides a
connection between
voluntary muscle of the
body and nervous system

5. Causes Movement will not be
supported
Muscle weakens and
becomes thinner, inability to
control movement
Motor neurons
get affected
No action
potential
In ALS, MN get affected and so messages
cannot be initiated or transferred to the
muscles, this means movement will not
be supported in the muscles leads to
weakness of the muscles and they also
get thinner.
-As the condition reaches its later stages,
more and more MN are damaged and
more voluntary muscles fail to function
then a person will be unable to move
their limbs and body eventually leads to
complete paralysis

6. PATHOPHYSIOLOGY
Familial – 5-10%
Sporadic – 90-95%

7. PATHOPHYSIOLOGY
It is unknown why the motor neuron
degenerate in ALS but researchers suggested
certain possibilities which are:
1. EXCITOTOXICITY
2. GENE MUTATION

8. PATHOPHYSIOLOGY
•EXCITOTOXICITY – Excitotoxic
neurotransmitters such as GLUTAMATE

9. PATHOPHYSIOLOGY
• GENE MUTATION –
SOD1 (superoxide
dismutase) is mutated in
some familial cases of
ALS. SOD1 which is a
cellular defense against
excitotoxicity which
detoxifies free radicals.

11. Summary of pathophysiology
Glutamate
Calcium
influx
Degradation
of neurons
Death of
neurons
Denervation of
motor neurons
No action
potential
transmitted

12. !!! The denervation of
the nerves now
causes the clinical
manifestations

13. Clinical manifestations
Early stage
• Dysphagia(bulbar onset)
• Dysarthria(bulbar onset)
• Emotional lability (bulbar
onset)
• Spasticity(limb’s onset)
• Fasciculation's(limb’s onset)
• Cramps (limb’s onset)
• Muscle weakness
(limb’s onset)
• Atrophy (limb’s onset)

14. Progression
• Dyspnea
• Loose the ability to walk, or use
hands and arms
• Loose the ability to speak, and
swallow

15. Late stage
• Dementia
•Respiratory failure
•Aspiration pneumonia
•Occulomotor nerve of extra ocular muscle
is affected
•May resemble locked in syndrome

18. TREATMENT
•NO curative agent
•RILUZOLE- the only drug approved by the
FDA

19. THERAPY
• Physical Therapy
-involves exercises
• Speech Therapy
-text -to-speech applications

24. Dental health for ALS patients

25. Why keep the mouth clean?
-Maintain comfort
-Reduce halitosis
-Reduce risk for gum disease, which can further
endanger your health
-Reduce the risk of pneumonia (infection in the
lungs from bacteria in the mouth)
-Help manage saliva which can reduce drooling or
stimulate saliva flow

26. Physical changes that may occur with ALS might make it
difficult to keep the mouth clean. These include
1. Changes in hand/arm function
2. Changes in function of the mouth, lips, cheeks, and
tongue
3. Changes in function of the swallowing muscles
4. Changes in mobility
5. Changes in breathing

27. Dental hygiene
-Brush w/ soft bristle
- floss
-use tools that may help

28. During Dental Procedure
-use bite block
-semi supine position
-use strong suction
-have a short break

29. Maintenance
-get regular check ups
-nutritional counseling