Medication administered with an inhaler can alter the oral health of asthma patients. Preventative measures or treatment options should be considered, as indicated by your pediatric dentist.
Medical advisor María Fernanda Quintero
Pediatric dentist, practitioner at Coomeva Private Healthcare
According to WHO, asthma is a chronic respiratory disease. It consists of recurrent episodes of dyspnea (difficulty breathing), wheezing, chest tightness and coughing. Currently, it is estimated that 235 million people live with asthma, the most common chronic disease among children. In Colombia, this disease affects about 10% of children.
Asthmatic patients need medications that are administered either with an inhaler or in pill form; these medications have components such as acids (with inhalers) and sugars (in pills).
Inhalers allow for about 20% of the drug to reach the lungs, the remaining 80% stays in the oral cavity. This can cause some side effects in the mouth due to how the drug works, how it changes the saliva and how the drug’s particles affect the mouth’s tissues as it is inhaled.
Modifications to the texture, composition and flow of saliva change its function in our oral health, which include: lubricating and keeping the oral mucosa healthy, cleaning the mouth, dissolving food, neutralizing pH levels, remineralizing dental tissues and acting as an antimicrobial agent.
The side effects of using an inhaler include xerostomia (dry mouth), reduced salivary flow and lower pH levels in saliva. This can result in dental erosion, an effect of the medication’s chemical action, or in acid reflux. This medication can even change the color of the teeth.
In soft tissues, the following side effects may arise: stomatitis (inflammation of the oral mucosa), candidiasis (yeast), canker sores and ulcers. Medication also increases the risk of gum inflammation and gum disease. When plaque is not removed through proper oral hygiene, the risk of cavities grows or the progress of existing cavities accelerates. Medications that are inhaled in a powder form have lower pH levels that cause the tooth’s minerals to separate, making it easier to lose teeth. Additionally, asthmatic patients generally breathe through their mouths, which can lead to malocclusion problems.
Pediatric dentist María Fernanda Quintero Vásquez confirms, “Dentists should know how severe the case of asthma is and what medication the patient is on. If the patient does not already have a condition, preventative measures should be taken to keep the patient healthy, minimizing the risk of disease. If the patient already has a mouth condition, it must be monitored, taking treatment measures to improve the condition and reducing risk to a minimum. The patient should be encouraged to maintain a healthy lifestyle, promoting their self-care, and parents or caregivers should be involved in this process if the patient is a child.” •
Some measures for guaranteeing the oral health of asthmatic patients that use inhalers:
- Maintain good oral hygiene
- Remove and control plaque
- Drink plenty of water to fight the effects of dry mouth.
- Avoid consuming sugar. Use fluoride toothpaste, mouthwashes or varnishes to neutralize low salivary pH levels and to protect dental enamel
- Use a baking soda mouthwash or rinse your mouth with just water
- See your dentist every three months
- The use of topical fluoride is safe and has proven to significantly reduce the presence of cavities. Its application depends on the patient’s risk for cavities and is applied in gel form every three months, or as a varnish every six months. Varnishes should always be used for patients under age five.
- A sealant, provided that it is applied according to indications, acts as a physical barrier that prevents the deposit of plaque in the teeth, preventing the appearance of cavities.
Using an inhaler
- Asthmatic patients or their caretakers must be trained by their respiratory therapist in order to use an inhaler correctly.
In some cases, adding attachments to the inhaler is recommended: holding chambers protect gum tissues from the negative effects of the medication, and spacers guide the metered dose to the upper airways, reducing its contact with the oral cavity and lowering the risk of damaging the mouth’s tissues.