Having recently experienced the highs of pregnancy and childbirth along with the lows of a nagging lung infection, I can really sympathize with people who battle asthma and chronic obstructive pulmonary disease (COPD) on a daily basis. These conditions can really distract us from and dampen even the most joyful events in our lives. It doesn’t help, also, that treatment of asthma and COPD involves medication which can put us at risk of dental problems, such as tooth decay, erosion, gum disease and fungal infections (candidasis).
Asthma is a chronic inflammatory condition of the airways. It is estimated that it currently affects over 300 million people worldwide and this number is growing at an alarming rate. Treatment of this condition involves reducing and controlling inflammation as well as widening the airways (bronchodilation). There are short and long-term medications and treatments for asthma and most of them involve the use of inhalers. This route of asthma medication puts the mouth at risk as some of the medication inevitably ends up sticking to the mouth.
Anti-inflammatory medications used to treat asthma are usually corticosteroids. These drugs are usually in powder form and contain lactose sugar, which is meant to improve the taste. They also have an acidic pH. Long-term use of high-dose, inhaled corticosteroids can reduce bone mineral density. They can also render the patient immunocompromised.
Bronchodilator drugs cause a decrease in salivary rate and an increase in caries-causing bacteria. Together with mouth breathing this decreased salivary rate causes people to feel very thirsty.
There are four main dental problems associated with asthma and the medication used for its’ treatment: tooth decay, tooth erosion, periodontal disease and fungal overgrowth.
Tooth Decay (Caries)
Reduced salivary flow and reduced quality of saliva are side effects of both kinds of medication used for asthma. Therefore, tooth decay-causing bacteria prevail in the mouth.
The low pH of some medications, together with reduced salivary pH contribute to dental erosion. Some sufferers possibly consume a lot of acidic drinks to counteract the strong feeling of thirst, so this erosion can be quite severe, especially in children.
Asthma sufferers have a high incidence of GastroOesophageal Reflux (GOR) and this condition significantly lowers the pH of saliva in the mouth. If your dentist notices any wear on your teeth, you should speak to your doctor about GOR and receive appropriate treatment if you are affected.
Periodontal (Gum) Disease
Mouth breathing and asthma often go together. This dries out the gums and reduces their natural defense mechanism against gum disease causing bacteria.
Where corticosteroids are used in treatment, patients can become immunosupressed and the medication can even reduce bone density. This way, both the onset and progression of gum disease can be promoted.
Asthmatic children have more calculus (tartar) then non-asthmatic children, they tend to have more calcium in their salivary glands. If not cleaned regularly, this can affect their gum health.
Immunosuppression through long term use of high dose corticosteroids can lead to fungal overgrowth and discomfort.
What can be done to prevent dental problems?
Luckily, not everyone who is being treated for asthma will develop dental problems. This risk can be even further reduced if patients follow instructions and learn to use their inhalers, spacers and nebulisers properly.
The best and easiest advice is:
- See your dentist and hygienist regularly for examination and cleaning
- Rinse out your mouth with water, bicarbonate or Fluoride rinses after using a corticosteroid inhaler
- Using a spacer may reduce residue of medication in your mouth
- Drink plenty of water and avoid acidic drinks
- Make sure you are assessed for GOR and treated appropriately
Acknowledgement: This blog post was made possible thanks to the wonderful and detailed article of Thomas et al. Asthma and Oral Health: A Review. Australian Dental Journal 2010; 55:128-133