Teeth and medication

Healthy teeth and gums

Many prescription medications can affect the teeth and gums.

Healthy teeth and gums depend on good oral hygiene, a diet low in added sugar, healthy saliva and visits to the dentist every 6 to 12 months.

It is important that you tell your dentist about any medications you are taking. They can tell you if the medication is likely to affect your teeth and what you can do to help prevent dental issues. Dentists also consider your medications when deciding on the best treatment options for your dental care.

Medicines and developing teeth

A child’s permanent teeth start to form in the jawbones soon after birth. These developing teeth are vulnerable to certain substances including:

• Tetracycline – this antibiotic can give permanent teeth a yellowish or brownish colour if taken while the teeth are developing.
• Fluoride – in measured amounts, this mineral strengthens teeth and is commonly added to water supplies and toothpaste. However, excessive amounts of fluoride can cause white or discoloured spots to form on developing permanent teeth. This is called fluorosis. Young children who often swallow fluoridated toothpaste are at increased risk. Use plain water to gently clean your baby’s teeth until they are 18 months of age. A low-fluoride children’s toothpaste should be used to clean young children’s teeth. Teach your child to spit rather than swallow toothpaste.
• Antibiotics – children who have to take high-dose antibiotics during a period of severe childhood illness can have development defects in the baby and permanent adult teeth which relate to those periods of time.

Talk to your dentist for further information on medicines that can affect the development of your child’s permanent teeth.

Saliva protects your teeth

Many medications and illegal drugs reduce the flow of saliva and cause a condition called dry mouth. Dry mouth significantly increases the risk of tooth decay. This is because saliva:

• reduces the population of bacteria in the mouth
• neutralises mouth acids that cause tooth decay
• consistently repairs tooth enamel (the hard surface layer that protects the tooth) that has been damaged by acids. This repair is called remineralisation
• has a washing effect that clears food particles away from tooth surfaces.

There are many medications that can cause reduction in saliva. Some examples include: antidepressants, diuretics (water pills), antihistamines, decongestants, medications for Parkinson’s disease, blood pressure tablets (betablockers) and inhalers.

Talk to your doctor, pharmacist or dentist for more information about whether your medications could be causing dry mouth.

Effect of medications on teeth and gums

Many medications, including prescription, over-the-counter and herbal products, can affect your teeth and gums in different ways. The effects depend on the type of medication and how long it is taken for.

Medications that increase the risk of tooth decay

Some medicines reduce saliva flow (dry mouth) or contain sugar. These increase the risk of tooth decay because saliva helps protect teeth from acids and bacteria.

Examples include:

• Antidepressants – can cause dry mouth and increase the risk of tooth decay.
• Antihistamines and decongestants - may reduce saliva and cause dry mouth.
• Antihypertensives (taken to reduce blood pressure) – can lead to an increased risk of gum swelling and overgrowth.
• Medicated syrups - may contain added sugars, which can lead to tooth decay if teeth are not brushed afterwards.
• High dose and long term antibiotics – can cause oral thrush, particularily in people with dry mouth.

Medications linked with gum changes

Some medicines can affect the gums, causing swelling, inflammation or overgrowth (called gingival hyperplasia). Inflamed or swollen gums are harder to clean and can increase the risk of gum disease.
Examples include:

• Antihypertensives (blood pressure medications) – can lead to gum swelling or overgrowth.
• Epilepsy medicines – some are known to cause gum overgrowth.
• Immunosuppressive medicines (such as cyclosporin) – can increase the risk of gum inflammation and mouth infections.
• Oral contraceptives – may increase gum inflammation in some people.

Medications requiring special dental precautions

Some medications affect how the mouth heals or responds to dental treatment. It is important to tell your dentist about all medications you take, including new or temporary ones.

Examples include:

• Bisphosphonates and denosumab – used to treat osteoporosis and some bone conditions. These medicines can, in rare cases, cause serious jawbone problems known as medication-related osteonecrosis of the jaw (MRONJ). Always tell your dentist if you take these medications, particularly if you require any teeth to be removed or dental surgery.
• Aspirin and blood-thinning medications – may increase the risk of bleeding during dental treatment. Do not change or stop these medications without medical advice.

Changes in taste

Some medications can alter the way foods and drinks taste. This effect is usually temporary, but speak with your dentist or doctor if it persists.

When to seek advice

If you notice dry mouth, gum changes, changes in taste, thrush, or any new oral symptoms while taking medication, speak to your dentist, pharmacist or doctor.

Treating tooth and gum problems related to medications

Professional treatment depends on the type of medication or drug and its effects on your teeth and gums, but may include:

• If a medicine is causing dental health problems, the dentist may suggest that you talk to your doctor about adjusting the dose or method of taking it. In some cases, it may be possible to switch to another type of medicine that does not risk your dental health.
• If the doctor advises that changing your medication is not possible, talk to your dentist about professional and at-home treatments that can help to protect your teeth.
• Fluoride strengthens teeth and reduces the risk of decay. The dentist may apply topical fluoride to the surface of your teeth. Fluoride mouthwashes or higher-strength fluoride toothpaste may be recommended for use at home.
• Decayed teeth will need dental fillings or other restorative work such as crowns.
• Badly decayed teeth may need to be removed. Bridges, dental implants or partial or full dentures may be recommended.
• The dentist can carefully trim gum tissue affected by gingival hyperplasia.
• The dentist can recommend cosmetic treatments (such as veneers) that can improve the look of your mouth and smile if it is important to you.

Preventing tooth and gum problems

Suggestions include:

• Avoid fizzy soft drinks, which are highly acidic and can erode tooth enamel. Drink fluoridated tap water instead.
• Cut back on sweet or sticky foods such as biscuits or lollies.
• Chew sugar-free gum to encourage a steady flow of saliva.
• Pay careful attention to your tooth brushing and flossing habits. Brush your teeth thoroughly at least twice a day and floss once a day. Be gentle when cleaning your teeth to avoid damaging the gums.
• If your medication is acidic, rinse your mouth with water after taking it and avoid brushing your teeth for at least 30 minutes.
• Visit your dentist at least once or twice a year.
• Ask your doctor, dentist or pharmacist about the medicines you take and if they may affect your dental health.
• Minimise your intake of alcohol.
• Consider quitting smoking. Speak to your doctor or dentist about support available to help you quit.
• If you have a drug or alcohol dependence problem, consider talking to your doctor about support services or entering a drug treatment program.

Your doctor and dentist may offer further self-care suggestions. Follow these suggestions carefully.

Medications and dental treatment

If you are scheduled for dental treatment, tell your dentist about any medications you are taking or have recently taken, including prescription, over-the-counter and herbal medications. Some medications, such as aspirin and blood-thinning medications, can increase the risk of uncontrolled bleeding.

Also tell your dentist about your alcohol or smoking intake, as well any drugs you are taking or have recently taken.

Where to get help

• Your dentist
• Your GP (doctor)
• Pharmacist
• Australian Dental Association – ’Find a dentist’
• Oral Health Victoria – provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people.