How Prescription Medications Affect Your Dental Health
Over 500 types of medication cause dry mouth syndrome. To find out if yours is one of them, read this guide to keeping teeth healthy while on prescription meds.
Image by Ben Harvey on Flickr.
At present, there are over five hundred different medications that are known to cause xerostomia (or dry mouth, in simple terms). They range from drugs designed to treat depression, high blood pressure, cancer, allergies, and even the common cold. While this might not sound like a big problem to most, the reality is that dry mouth leads to decay.
If there is a lack of saliva, the plaque on the teeth cannot be routinely washed away, as usual. The amount of friction and abrasion in the mouth increases and the gum tissue dries out. All of these things are extremely unhealthy for the teeth and oral tissues. If dry mouth becomes a chronic condition, it can significantly raise the risk of developing deep cavities.
However, if it is medication that is to blame for the prevalence of xerostomia, it is reasonable to assume that treatment will be tricky. It is not safe for most patients to stop taking prescribed drugs, so the simplest solution is not a viable one. What is the answer to a problem like this? How do you solve one issue, without making the other worse? This is an important question for patients and dentists alike, but the answer is not always clear.
Generally speaking, the medical recommendation is to prioritise prescription meds over dealing with dry mouth symptoms. You should certainly not stop taking prescribed medication unless the move has been approved by a doctor. As the meds which cause xerostomia are often used to treat very serious diseases like cancer, deciding not to take them can often have much worse consequences than tooth decay.
This is the tricky situation that dentist find themselves in, as they attempt to treat patients in the most effective ways possible. While dry mouth is not an instantly destructive condition – it can take a long time for cavities and deterioration to appear – if left untreated, it greatly weakens teeth. They are more at risk of cracking and fracturing, as well as developing decay. Yet, in some circumstances, the progression of the condition can only be carefully monitored.
Working with Your Dentist to Fight Dry Mouth
The best possible course of action is to tell your dentist as soon as you are prescribed any medications that you cannot get over the counter. If you know that the course of drugs is going to be quite short, you probably don’t have to worry about this. Unless you actually attend a dental appointment or check-up before you finish the course, the exposure is likely to be too brief to cause any damage.
If, however, you are taking drugs for an underlying health condition, you do need to inform your dental specialist. This gives them a chance to build up a picture of your oral health, much as a doctor asks general questions about the whole body when trying to make a diagnosis. They will not make recommendations about your medication, because this is not within their medical jurisdiction, but they may inform you that the likelihood of dry mouth is increased.
During an informal consultation, the dentist will outline the main symptoms of dry mouth and the consequences if it is not controlled. This discussion is not designed to be anxiety inducing in any way. It is just an opportunity for you to stay informed and get a better insight about what is happening in your mouth. The sooner that you are aware of the risks, the quicker you can take steps to reduce them.
For example, chewing sugarless gum can be a simple and easy way to generate saliva. It is not a long lasting fix or a very sophisticated solution, but it does help. You should also try to drink plenty of water, as this will help your mouth to stay hydrated. If you have been diagnosed with dry mouth, it is imperative that you keep a close eye on your oral health. Brush and floss regularly, attend regular dental check-ups, and inform your dentist about any changes.
Some Medications Responsible for Xerostomia (Dry Mouth)
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Antihistamines
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Antidepressants
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Antipsychotics
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Parkinson’s Disease drugs
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Alzheimer’s Disease drugs
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Lung inhalers
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ACE inhibitors
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Beta blockers
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Heart rhythm drugs
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Diuretics
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Seizure drugs
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Anti-anxiety drugs
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Anti-nausea drugs
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Narcotic pain drugs
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Scopolamine
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Anti-spasm drugs
Prescription Drugs and Other Dental Health Problems
Unfortunately, dry mouth is not the only dental health problem that can be caused by prescription medications. It is the most common, but there are a number of additional challenges that may be created by treatments for an unrelated problem. The following section will outline some of these dental problems.
Fungal Infections
In some cases, the inhaler meds used to treat asthma can lead to an accumulation of bacteria on the tongue. Over time, this develops into a yeast infection of the mouth called oral candidiasis. Unlike dry mouth, it is fairly simple to treat. It can be prevented by rinsing the mouth out after using an inhaler.
Swelling of the Gum Tissue
There are a number of medications that cause the gum tissue to work at an accelerated speed. It actually grows at a faster rate than it should and, sometimes, it starts to develop over the teeth themselves. This is quite a painful problem and there is a significant degree of tenderness and swelling. It also increases the risk of developing full scale periodontal disease.
As swollen gum tissue is a great hiding place for bacteria, the mouth must be kept as clean as possible until the symptoms have been treated or subsided. Some of the drugs that can cause gum swelling are seizure medications, immunosuppressant drugs (used for transplants), blood pressure medications, and calcium channel blockers.
For reasons unknown, men are more likely to develop swollen gums as a result of prescription medications. The risk is increased if you also have quite poor dental hygiene and lot of plaque in the mouth. If you take any of the aforementioned drugs, keep an eye on the state of your gums and attend regular dental check-ups.
Inflammation of the Mouth Lining (Mucositis)
This condition is characterised by inflammation of the soft tissues lining the mouth and digestive tract. It is a common consequence of chemotherapy treatments. According to medical scientists, it is likely that certain chemotherapy compounds (for example, methotrexate) set off an intricate series of biological shifts. These changes cause damage to the cells that form the mucous membranes.
Mucositis can be very painful and it is an extremely traumatic thing for a patient to have to deal with while they are already going through cancer treatments. The symptoms include painful swellings inside the mouth and on the tongue. The inflammation can result in bleeding, sores, and persistent ulcers. It becomes difficult to eat and chew once the mouth is inflamed.
There is a slightly increased risk for chemotherapy patients who also consume copious amounts of alcohol, smoke, or have poor dental hygiene. In some cases, the condition may be further exacerbated by an underlying health problem like HIV, kidney disease, or diabetes.
Persistent Oral Sores and Ulcers
A mouth ulcer is a sore that develops inside the mouth or on the surface of the tongue. These little stinging spots of white are quite common and you have probably already had a few. They look like little craters of fleshy creamy coloured tissue. If you poke one with your tongue, it usually produces a very mild tingling or burning sensation.
These ulcers are sometimes referred to as ‘canker sores.’ Generally, they are nothing worry about. They can occur for a number of reasons. You might have bitten your cheek and created a tiny laceration. You might simply be stressed out and feeling under the weather; canker sores are more likely to appear during illness and fatigue.
The only time that oral sores need to be worried about is if they become persistent. You should not be dealing with these ulcers all the time. In a healthy mouth, they appear infrequently and rarely in clusters. However, some chemotherapy medications can create this side effect. The good news is that canker sores are more of an irritation than a serious health problem.
They do not really contribute to more progressive forms of dental decay or illness, but they can be very annoying. And, ultimately, they mean that your mouth has to expend more energy on repair and healing. As we now know, the more resources that the body has to invest in fixing oral issues, the less it has to distribute around the other organs.
Discoloration of the Enamel
Way back in the fifties, dentists discovered that tetracycline antibiotics taken during pregnancy cause the infants to develop stained teeth. The tetracycline infiltrates the calcium used to grow teeth, even while the baby is still inside the womb. The condition is not officially diagnosed until the first baby teeth emerge and the discolored calcium appears.
At first, the teeth are a light yellow colour, but this darkens and worsens if the enamel is exposed to sunlight. The good news is that tetracycline cannot cause this type of problem once all of the teeth have developed. It will only stain the enamel if taken before both sets of teeth (infant and adult) are grown.
These days, the medication is not given to pregnant women, so this is one condition that has been solved. However, there are other drugs that can cause staining and discoloration of the tooth enamel. They include antibiotics used to treat bacterial infections, some forms of antiseptic, antibiotics for acne, and antibiotics designed to treat respiratory problems.
Also, if a person consumes too much fluoride, they develop chalky white and cream coloured patches on their teeth. If this excessive consumption is allowed to continue, the staining may become permanent and get much darker. It is very important that you do not ingest too much fluoride, because it can be toxic in large amounts.
There are a number of over the counter and ‘in office’ whitening treatments designed to remove mild to moderate stains on enamel. If you are concerned about the colour of your teeth, ask your dentist if any of these treatments could be worthwhile. They are usually very cheap, very fast, and guaranteed to lighten the enamel by at least a couple of shades.
In the case of ‘in office’ treatments, this number can be as many as right shades lighter. The whitening treatments are particularly good at removing stains left by coffee and red wine. So, if you are a big fan of either, whitening could help you to protect the quality of your smile. The treatment is pretty much a sure bet unless your teeth are marked by intrinsic stains.
Finding a Viable Solution to Dental Complications
As already described, treating these conditions can be tricky, because it is usually not possible to just recommend that the patient stop taking meds. This can do a lot more harm than good and end up making the person a lot sicker. So, dentists have to think very carefully about the best way to approach oral complications.
Ordinarily, they take a three pronged perspective. The first step involves assessing the overall oral health of the patient, primarily as a way to judge the quality of dental care routines. A good brushing and flossing routine is usually enough to keep symptoms in check until the patient can be taken off the medication. The dentist may recommend the use of an interdental brush for more comprehensive cleaning.
The second step involves providing any non-invasive treatments that might help to control the symptoms. For example, a dentist can perform an affordable dental cleaning to make sure that the gum tissue and teeth are functioning smoothly. For people with dry mouth, professional cleans are highly advised, because they remove stubborn plaque and reach areas that may otherwise not be exposed to any saliva.
It is quite rare for swelling of the gum tissue to require invasive treatment, but if the accelerated growth is placing great pressure on teeth, minor surgery may be required. This is routine procedure and will be performed under anesthetic. You will not feel any pain. There will be a degree of tenderness and soreness after the surgery, but this should subside after a week or two. If you do need surgery, your dentist will talk you through the process first.
And finally, if the dentist believes that it could help, they may liaise with your GP to try and find a way to reduce the medication that is causing all of the problems. In some circumstances, a substitute drug can be found which does not lead to such damaging side effects. You should never change your dose, swap medications, or stop taking prescription drugs unless the move has been approved by your doctor.
Advice for Patients with Diabetes
For diabetes sufferers, even mild medical conditions can quickly turn into serious problems. This is why, if you have diabetes, you need to stay in regular contact with your dentist. You will be more at risk of developing things like cavities, decay, root infections, and abscesses, so you must keep an eye on your oral health.
Alongside diabetes comes more danger of contracting periodontal disease too. This progresses very rapidly if left untreated and degenerates into pockets of infection below the gum line. In time, and without treatment, periodontitis causes tooth loss and irreparable damage to the jawbone itself. But, if it is identified early and the right solution is provided, a large amount of the destruction can be reversed.
If you keep your dentist informed about changes to your medical routine, they will have a much better chance of responding appropriately. You cannot expect to be forewarned about a situation that the specialist was not aware would occur. On the other hand, if you are prescribed medications and you attend dental check-ups regularly, the specialist will be able to spot signs of trouble before they progress.
