Medications, Side Effects and your Oral Health

Aging seems to bring an increase in the number and type of medications we take.  Each has its purpose and provides benefits to help us enjoy healthier and happier lives.  Unfortunately, many also have bothersome side effects that impact our oral health.  Many common medications cause a range of problems that can make your mouth dry and sensitive, and can even cause rampant decay. Others may cause excessive bleeding or problems with the bone in your jaws.  Great communication with your dentist is key to minimizing the risks and severity of these oral side effects.

 Osteoporosis drugs (like Fossamax, Boniva, Actonel and others) are used to strengthen bones and decrease the risk of hip and other bone fractures. They are also used in certain cancer treatments.  Dental risks come from taking these long-term and seem to be even more prevalent with intravenous use as opposed to taking them orally.  Men and women who have taken these medications risk oral problems if teeth are removed or periodontal (gum disease) treatments are done that involve the jaw bone.  Occasionally, these areas do not heal correctly and are chronically raw, painful, inflamed and can lead to exposed jaw bone through the gums.  Never stop taking these without consulting with your physician.  The risks of developing these dental side effects are low and the benefits of taking these medications far outweigh the risks.  More studies are currently being done, so stay in touch with your health care providers and pharmacists to be informed regarding the most recent updates.

 Blood thinning drugs such as Coumadin or Warfarin slow the blood’s ability to form clots to decrease the possibility of a heart attack or stroke.  The key is to regulate the amount of this medication in your system to keep the clotting time within a specific range.  As long as the proper level is maintained, it is safe to have dental work done and even safe to remove one or two teeth.  Never stop taking this drug without strict monitoring by your physician. The risks of serious medical complications and/or death go up considerably when you stop taking blood thinners.  On the other hand, too much of this drug may thin your blood so much that you could lose too much blood during a dental procedure.  If you are taking this type of medication and need a dental procedure that might cause bleeding, have your blood level checked within a day of the dental appointment to be safe.

Dry Mouth is a side effect of over 400 drugs in use today. These include: antihistamines, decongestants, high blood pressure medications, antidepressants, sedatives, pain medications, Parkinson’s disease medications and antacids. It is hard to avoid this side affect if you take many different medications.

Saliva is critical to oral health.  It lubricates and eases chewing, swallowing and digestion. It also dilutes the acids that cause cavities.  People who wear dentures may have a difficult time keeping them in their mouth because of increased mouth sores and lack of suction. Those with natural teeth can see marked increases in decay and tooth sensitivity.  Mouth soreness and tenderness can affect anyone with decrease saliva flow. There is no real solution to these problems, but using a “saliva substitute”, sipping on water or sugarless liquids, or sucking on sugarless candy can help.

Tooth Decay is a side affect of any medication that dries out your mouth.  Many medications, both prescription and over-the-counter, contain a lot of sugar.  These include antacids, cough drops and many chewable tablets.  This increase of sugar can result in a marked increase in tooth decay even with good home brushing and flossing habits. Ask your dentist for a fluoride supplement to brush on your teeth and seek regular preventive care.

Altered taste sensation results in a metallic or bitter taste.  Some medications can change the perceived taste of all the foods you eat. These include certain cardiovascular drugs, central nervous system stimulants, Flagyl (metronidazole, an antibiotic) nicotine skin patches and some respiratory inhalants.  Ask your physician or pharmacists if you suspect that the medication you take is causing altered taste.  If this side effect is intolerable, ask your physician if your medication can be changed.

 Herbal supplements are often marketed to treat depression or help memory functions.  Many people think that it is not important to tell their health care providers that they take these supplements.  However, many “herbal remedies” can have a significant, negative impact on your other medications.  For example, Ginko may interfere with blood thinners like Coumadin, causing over thinning and bleeding disorders.  Ginseng can increase blood pressure and should not be used if you are taking a medicine for high blood pressure.  There are many others.  If you take herbal supplements, be honest and fully disclose them to your physician and pharmacist to minimize potential complications.

The bottom line is to be sure to let your dentist know about all the medications and over-the-counter products you use.  Good oral health is a team effort that needs excellent communication among you, your physician and your dentist.  Be sure to take a list of your medications and supplements to give to your dentist and update him/her of any changes in your medications or health history. 

            Keep Smiling – Dr. Steve Wegner