Side Effects of Drugs that Affect Your Teeth and Gums

Medications that can affect oral health - Overview

Many commonly used prescription and over-the-counter medications have a negative impact on oral health. These could even include vitamins, minerals and herbal medicines.

The clinical pattern of these effects has been identified and hence, it is easier for the dentist nowadays to identify the causative drug.

It is important that the physician and dentist are aware of the medical history and medications being consumed by the patient which will enable them to identify drugs causing the effect and help rationalize the use.

Some medications that can cause tooth damage and risk to the gums include:

• Asthma medications
• Antibiotics
• Antihistamines and Decongestants
• Pain medications
• Antihypertensives
• Aspirin
• Immunosuppressants
• Antidepressants
• Oral contraceptives
• Chemotherapy medications
• Sugar-based medications
• Inhalers, especially those containing steroids, can cause erosion of tooth enamel

What are the Symptoms and Signs of Drug Induced Disorders of Oral Health?

The common symptoms of oral health disorders induced by drugs include:

• Tooth decay
• Dry mouth
• Swelling of gums
• Offensive or bad breath
• Tooth discoloration
• Loose tooth
• Taste alterations
• Mouth ulcers
• Mucosal pigmentation
• Tooth hypersensitivity

What are the effects of Drugs/Medications on Oral Health?

Drugs can affect oral health in various ways:

Tooth Discoloration

This could of two types, Intrinsic and Extrinsic.

• Intrinsic tooth discoloration is caused by drugs which affect mineralization of teeth during their formative years, for example, Tetracyclines like Doxycycline, Minocycline, Ciprofloxacin and Fluorides. These drugs can lead to yellow staining of teeth or gray / black discoloration.
• Extrinsic tooth discoloration is classified into two types, depending on the cause.
• Metallic stains are caused by medicaments containing metal salts, e.g. Iron supplements
• Non-metallic stains are caused by tobacco, beverages, mouth rinses, and some medications.

Tooth Sensitivity

Tooth enamel is damaged by some drugs which make the tooth more sensitive to heat or cold stimulus. Cocaine and Methamphetamine are known to cause damage to enamel in the form of corrosion.

Tooth Malformation

This can be in the form of disorder of root development alone or in combination with tooth dysplasia, e.g. double teeth. Chemotherapy and anticonvulsants are examples of drug-induced causes of tooth malformation. Antihistamines can cause cavities and tooth erosion.

Tooth damage

Grinding of teeth or clenching of jaw are some drug-induced side effects that damage the teeth and lead to loose teeth or toothache. Cocaine is one of the common drugs that cause tooth damage due to grinding of teeth.

Molar Incisor Hypomineralisation (MIH)

It is a condition which affects the enamel of teeth and presents as a creamy or yellow discoloration that usually occurs in the molars and incisors. Some antibiotics like Amoxycillin cause this condition.

Fluorosis

In this condition, thin white lines appear on the teeth of children. In severe cases, brown spots with pitting are seen on the surface of enamel. This condition occurs when fluoride intake is high in children consuming excessive fluoridated water or use fluoridated dental products.

Dry Mouth or Xerostomia

Painkillers, antihistamines, muscle relaxants, antidepressants and many other medications cause "dry mouth" as a side effect. This drying makes the soft tissues irritated and more prone to infections.

Sores in mouth or tongue

This condition is an oral fungal infection, known as oral candidiasis. Some drugs like antiretrovirals (Lamivudine, Emtricitabine) and corticosteroids (Prednisone, Dexamethasone) cause white velvety sores in the mouth or on the tongue. Asthma patients using oral inhalers often suffer from oral candidiasis.

Gum Bleeding

Medications such as anticoagulants, e.g. Warfarin, and Heparin, cause a side effect of reduced clotting time. This can lead to bleeding problems during oral surgery or when treating periodontal diseases.

Taste Altering Medications

Smoking cessation products, respiratory inhalants, cardiovascular drugs, and non-steroidal anti-inflammatory agents cause a metallic or bitter taste in the mouth or affect the ability of mouth to taste. Antibiotics like Amoxycillin, Doxycycline, and Metronidazole cause a metallic taste in mouth, a taste disorder known as parageusia.

Gum Enlargement

This condition is also known as "gingival overgrowth" or "gingival hyperplasia". It is generally caused by immunosuppressant drugs like Cyclosporin, calcium channel blockers like Nifedipine, Verapamil and anti-seizure drugs like Phenytoin.

How do you Treat Drug-Induced Disorders of Oral Health?

• Fluoride preparations are applied to the surface of teeth to strengthen teeth and reduce decay
• Dental filling helps to treat decayed teeth
• In case of gingival overgrowth, the dentist would trim the gum tissue. If the condition is induced by Cyclosporin, Azithromycin can be prescribed to cure the symptoms
• For treating dry mouth, one must avoid spicy food and brush with baking soda and water. Medications like Pilocarpine or Clonazepam may be prescribed to treat the dry mouth or burning mouth condition
• Tooth discoloration can be treated by external dental cleaning or by bleaching
• Dental fluorosis can be prevented in children by preventing them from swallowing fluoride products. Fluoride mouth rinses must be avoided in children
• Oral candidiasis can be cured by consuming probiotics or yogurt. Medications like Fluconazole tablets or Nystatin mouth wash can be used to cure the condition
• Alteration in taste due to medications can be overcome by drinking excessive water with medications. Zinc supplements help when the taste alterations are caused by chemotherapy medications
• Metallic taste caused by some medications can be overcome by brushing teeth with a mixture of baking soda, hydrogen peroxide and toothpaste. Alternatively, mint gums may be chewed after consuming the medication
• To overcome the metallic taste, one must use non-metallic cookware

What care or precautions must one take to reduce the effect of medications on oral health?

The side effects of drugs can be minimized by following certain practices:

• Regular brushing of teeth with a fluoridated toothpaste along with flossing
• Proper cleaning of gums and teeth is important for patients who show gum enlargement, as a side effect of medications
• Asthma patients using inhalers must rinse their mouth after using the inhaler
• When consuming sugar-based medication, rinse mouth with water after taking the medication
• Sugar-free chewing gums may be chewed to increase the flow of saliva and improve the dry mouth feel
• Quit smoking
• Reduce caffeinated drinks like coffee, tea and alcohol
• Drink more water and reduce consumption of sugar-based foods and drinks

References:

1. How medications can affect your oral health - (https://www.ada.org/~/media/ADA/Publications/Files/patient_51.pdf?la=en)
2. Medications and Oral Health - (https://www.mouthhealthy.org/en/az-topics/m/medications-and-oral-health)
3. Oral Health & Medications - (https://www.dhsv.org.au/dental-health/teeth-tips-and-facts/medications)
4. Teeth and medication - (https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/Teeth-and-medication)
5. Oral Conditions That Are Often Caused By Medications - (https://www.mass.gov/files/documents/2016/07/qa/medication-use-oral-health-fact-sheet.pdf)
6. Malformations of the tooth root in humans - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621611/)
7. Medications'' impact on oral health - (https://www.ncbi.nlm.nih.gov/pubmed/15551986)
8. Adverse Effects of Medications on Oral Health - (http://www.maineoralhealthcoalition.org/docs/Krebs%20APPE%203%20-%20Adverse%20effects%20oral%20health.pdf)
9. Fluorosis - (https://www.mouthhealthy.org/en/az-topics/f/fluorosis)

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