Educational Articles

Medications and oral health

Connection between systemic and oral health has been extensively studied over the past decade. Medications that improve the health of one part of the body may have a detrimental effect on the mouth. For instance, over 400 medications produce dry mouth or xerostomia, which affects both periodontal tissues and teeth by promoting recurrent caries. Other drugs may cause gum tissue enlargement (gingival overgrowth). Medications with sugar as a main ingredient, such as over-the-counter cough drops and syrups, may increase plaque as well as enhance the ability of plaque to adhere to the teeth. In addition, medications with a depressant effect may make people less willing to attend to their oral hygiene habits.

Let's characterize each group of medications according to their effects on oral health.

1. Drugs that induce xerostomia (dry mouth)
   

   This group of medications includes those for:

   • high blood pressure (diuretics such as Hydrochlorothiazide and Furosemide)
   • spastic bladder syndrome (antispasmodics or anticholinergics such as Oxybutynin, Imipramine or Propantheline)
   • pain relief (narcotic analgesics such as Darvocet, Vicodin and Lortab)
   • anxiety and depression (MAO inhibitors, tricyclic antidepressants, benzodiazepines such as Ativan, Valium and other anti-psychotic medications)
   • allergy relief (Benadryl, Allegra, Sudafed)
   • chemotherapy for cancer treatment (anti-neoplastics)

   People with dry mouth accumulate more plaque and have higher gingivitis scores that make them more susceptible to periodontal disease and tooth decay.

2. Drugs that produce gingival enlargement or overgrowth
   

   These medications include the following:

   • calcium channel blockers such as Nifedipine, Procardia, Cardizem
   • seizure preventing agents such as Phenytoin or Dilantin
   • immunosuppressants widely used following organ transplantation such as Cyclosporine

   Gingivitis and poor oral hygiene act as predisposing factors to this condition, so meticulous oral care and routine periodontal maintenance visits are very important for people who use these medications. A study recently released in the Journal of Periodontology suggests that frequent dental visits following initial periodontal treatment may significantly reduce gingival overgrowth in patients taking Nifedipine, a commonly prescribed medication for high blood pressure. This is good news for the 20 to 40 percent of patients taking Nifedipine who experience discomfort from recurring gingival overgrowth and rely on nifedipine to control their high blood pressure," said Robert Genco, D.D.S., Ph.D., Editor-in-Chief of the Journal of Periodontology. "Swollen gums can be painful, unsightly and interfere with speech, eating, and everyday brushing and flossing."

   The study found that gingival overgrowth recurrence was eliminated in more than half of patients with a combination of initial periodontal therapy, including surgical and non-surgical treatments, followed by more frequent dental visits (every three months). This regimen appeared to affect recurrence more than previously known risk factors, such as gender, drug type, and duration of drug therapy.

   "Overgrown gums make it easier for bacteria to accumulate and attack supporting structures of the teeth, which can lead to severe periodontal infection," explained Jack Caton, D.D.S., M.S., president of the American Academy of Periodontology. "And we know that periodontal infection may be a risk factor for more serious conditions, such as cardiovascular disease, respiratory disease and pre-term, low birth weight babies, so it's more important now than ever for patients to take care of their periodontal health."

   These findings significantly advance the earlier research which concluded that the development and recurrence of gingival overgrowth could be minimized, but not prevented, with periodontal therapy and frequent dental visits.

   For patients who do not have the option of switching medications to control their high blood pressure minimizing drug effects is not sufficient. Today's health- and esthetic-conscious consumers are looking for treatments and medications to proactively protect their bodies and appearance with few or no side effects. Patients can help accomplish this goal by always informing their health care providers of any changes in overall health or medications.

3. High sugar containing medications
   

   Many liquid or chewable medications (cough drops and syrups), especially children's medications, are made palatable by adding sucrose, glucose or fructose as sweeteners. These may significantly alter plaque composition and increase the risk of cavities and possibly periodontal disease. Just as patients have to tell their physicians about the drugs they are taking, be sure to ask them about all the medications they are on, including herbal remedies, vitamins and over-the-counter medications. Dental professionals can work close together with patients and their physicians to minimize and treat negative drug effects and maintain overall health.