Need a filling? It may be your MEDICINE that’s ruining your teeth

ASTHMA INHALERS

Problem: Cavities
Asthma inhalers usually contain an aerosol form of medication known as beta agonists, which work by relaxing the muscles surrounding the airways, making it easier to breathe. However, studies in Australia and Scandinavia have linked the drug to an increased risk of tooth decay, because of its slightly acidic content.
The key is to make sure the medication doesn’t touch the teeth. ‘If used properly in an inhaler, there is no reason why the drug should do so,’ says Stephen Spiro, professor of respiratory medicine at University College London.

However, the drug is also available in powdered form, also in an inhaler, which may contain lactose, a milk sugar, to improve its taste. And if residue from the powder is left on the teeth, it could contribute to decay.

‘Changes begin with brown areas, no bigger than a pinprick, on the inside of the teeth,’ explains Dr Mervyn Druian, of the London Centre for Cosmetic Dentistry. ‘Teeth begin to feel rougher if you run your tongue along them, and more sensitive. Without meticulous dental hygiene these can develop into cavities.’

After using your inhaler, rinse your mouth with water. And as well as careful brushing and flossing, see your hygienist three times a year. They will apply fluoride paste to strengthen teeth and use a product such as BioXtra to stimulate salivary flow and make it harder for decay to develop.

ANTIBIOTICS
Problem: Discolored teeth
The antibiotic tetracycline can cause brown stripes on the teeth when given to children whose teeth are still developing (before the age of eight). For this reason it is not prescribed to pregnant women.

‘When children are still growing, tetracycline combines with calcium in their teeth, producing the stain,’ explains Dr Druian. ‘Unfortunately the stains, though not harmful, are permanent, so check with your doctor if they prescribe antibiotics for your children.’

Tetracycline is sometimes used to treat acne and this can cause teeth to darken if used for several months. Teeth whitening treatments may help restore their natural colour.

High doses of antibiotics can also cause oral thrush — an infection triggered by a yeast called candida. Though antibiotics will kill harmless bacteria in the mouth, they won’t kill candida, which may then multiply. For the same reason, using antibacterial mouthwash too often — several times a day — may also cause thrush.

Thrush appears as white spots in the mouth, which join together to form larger spots. These are not usually painful but the mouth can feel generally sore.
Occasionally, antibiotics can trigger erythema multiform, a hypersensitive reaction leading to sores and blisters in the mouth (and also a rash of red and pink rings on the hands and legs). Although this should clear spontaneously, it may need treatment with steroids.

ANTIHISTAMINE PILLS
Problem: Dry mouth
Antihistamines are taken to treat allergic health conditions such as hay fever. They work by blocking histamine — a chemical released by the immune system to help protect cells against infection. This prevents the body producing the signs of allergy such as itching and sneezing.

‘However, in blocking the receptors — the docking sites on the cells — for histamine, the drug can have an effect on receptors elsewhere in the body, such as those on the tongue and in the mouth,’ explains Stephen Foster, a community pharmacist from Kent who specialises in allergies and respiratory conditions.
‘This in turn affects the salivary glands, blocking their release of saliva, causing dry mouth. As well as being uncomfortable, dry mouth can lead to gum disease; the gums pull away from the teeth, and form “pockets” that become infected. Teeth eventually loosen and can even fall out.’

‘Saliva protects the surface of the teeth as it contain agents that can fight harmful bacteria,’ explains Professor StJohn Crean, dean of the School of Dentistry and Medicine at the University of Central Lancashire

‘As sugary foods are acidic and can cause damage to the teeth, it’s important to limit these to meal times; and rather than finishing a meal with something sweet, try to finish meals with something savory such as a piece of cheese, which will neutralise acid in the mouth immediately.’
Chewing sugarless gum and sipping water may help provide temporary relief.

BLOOD PRESSURE TABLETS
Problem: Gum overgrowth
High blood pressure pills known as calcium channel blockers (for instance, amlodipine) can cause the gums to overgrow, which can be uncomfortable, unsightly and can make it difficult to clean teeth properly. This can, in turn, lead to inflammation of the gums (gingivitis), which if not treated can affect tooth-supporting tissues and lead to tooth loss. It happens over a period of three months or so in varying degrees.

The problem itself won’t go away unless there is a change of medication. If you can’t do this, it’s vital to be fastidious about oral hygiene. You may need guidance from your dentist or hygienist about the best way to clean your teeth, depending on the level of growth.

Blood pressure tablets can also cause what is known as a lichenoid drug eruption. This is where, as a reaction to the medication, the lining of the mouth becomes sensitive, leading to little white ulcers developing in the cheeks and lips.

‘Treatment may involve steroid spray or medication to reduce inflammation, while rinsing with mouthwashes that contain local anaesthetic may give temporary relief, too,’ adds Professor Crean.

OSTEOPOROSIS DRUGS
Problem: Infected jaw bone
Oral bisphosphonates, the drugs commonly prescribed for osteoporosis can, ironically, cause bone damage and infection in the jaw.
The drugs, such as Fosamax (also known as alendronate), work by blocking the action of the cells that remove bone tissue.

However, sometimes as a side-effect, the drug can affect the blood supply to the bone supporting the teeth, causing the jaw to become weak, brittle or infected — a condition called bone necrosis.

Between 1 and 6 per cent of those taking bisphosphonates will develop the problem. Symptoms include pain, swelling and loose teeth.

Don’t stop taking your medication without consulting your doctor. Antibiotics and removing dead tissue through surgery can help treat the problem. Good oral hygiene is vital, including regular brushing and flossing. And tell your dentist if you take these tablets as it’s best to avoid major surgery such as removing teeth.

CONTRACEPTIVE PILL
Problem: Inflammation and bleeding gums
Some progesterone-only birth-control pills can lead to bleeding and inflammation of the gums.

Gum disease is caused by a build-up of plaque, a sticky substance that contains bacteria. Plaque releases acids that damage tooth enamel and attack the gums, causing inflammation. Regular acid assaults on enamel can also lead to holes in teeth (cavities).

The inflammation may be greater for women on the Pill, says dentist Dr Jeremy Hill of the Ware Centre of Dental Excellence in Hertfordshire.

‘One reason is that they increase levels of hormones such as progesterone, much in the same way as pregnancy does. It is thought these hormones cause an exaggerated reaction to dental plaque, triggering inflammation.

‘This is also why pregnant women may have inflamed gums that bleed when brushed.’
Changing to a Pill with a lower concentration of progesterone may help. Dr Hill adds that while there is no treatment for the inflammation, good dental care will minimize it. ‘It may also be useful to use antiseptic mouthwash that will help to prevent plaque forming.’

ANTIDEPRESSANTS
Problem: Dry mouth, bleeding
Antidepressants can cause dry mouth because they inhibit the molecules that activate the salivary glands. A particular type of antidepressant — the selective serotonin reuptake inhibitors (SSRIs), which include Citalopram — can also make the mouth more prone to bleeding. This is because they affect levels of platelets, the cells which help the blood clot.
‘So if you are on antidepressants and happen to be having dental surgery, you are likely to bleed more,’ says Professor Crean. ‘You must tell your dentist if you are on antidepressants. He or she will then make sure they stitch the area after they have removed the tooth rather than just taking it out.’

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