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.
• 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 in a process known as 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

Some medications, including prescription and over-the-counter preparations, can damage your teeth. Medications can cause gum problems such as inflammation, bleeding or ulcers. Diseased gums can lead to other dental problems, including tooth loss.

Some of the medications that can damage teeth and gums include:

• Antidepressants – this range of medicines can cause dry mouth and increase the risk of tooth decay.
• Antihistamines – can cause dry mouth and an increased risk of gum problems.
• Antihypertensives (taken to reduce blood pressure) – can lead to an increased risk of gum swelling and overgrowth.
• Aspirin – chewing aspirin can directly damage the tooth enamel, as aspirin is acidic. Always take aspirin strictly as directed. The tablets should be swallowed whole with water, not placed beside a tooth or near the gums.
• Asthma medications – some asthma medications are highly acidic and can dissolve tooth enamel if used regularly over a long period of time.
• Chemotherapy medications – can cause a dry mouth and lead to an increased risk of gum problems and oral inflammation.
• Immunosuppressive medications – can lead to an increased risk of gum problems and mouth infections.
• Oral contraceptives – can lead to an increased risk of gum problems.
• Syrups – medicated syrups can contain hidden sugars which may increase the risk of tooth decay if teeth are not brushed after these syrups are taken.
• Bisphosphonates (for osteoporosis) and monoclonal antibodies such as denosumab (for bone problems) – can cause severe problems in the jaw bones, such as non-healing painful ulcers.
• Antibiotics – large or prolonged dosages of antibiotics can cause oral thrush.

Some medications can cause the gum tissue to thicken and grow over the teeth. This condition is called gingival hyperplasia. Medications linked to an increased risk of gingival hyperplasia include epilepsy medications, cyclosporin (organ transplant rejection drug), some blood pressure medications and calcium channel blockers.

Medications can also alter the taste in the mouth.

Talk to your doctor, pharmacist or dentist about whether the medications you are taking could harm your teeth. Don’t stop taking any prescribed medicine or adjust the dose without your doctor’s advice.

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’ Tel. (03) 8825 4600 in Victoria
• Dental Health Services Victoria – provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people Tel. (03) 9341 1000 or 1800 833 039 outside Melbourne metro