Side Effects: Dealing With Cavities

I had no idea asthma medicine may cause cavities. That is, until a couple years ago when I read Dia’s post, “Dental Care And Asthma.”  It’s that post that got me to thinking: “Have inhalers contributed to my cavities? Let’s investigate.

I used to be a bronchodilatoraholic.

That’s slang for “Rescue inhaler abuser.” I do not get credit for the term. It comes from another fellow asthma blogger.

So, I used lots of puffs of albuterol (Ventolin) as a kid. Before that it was metapreterenol (Alupent). I estimated once that I have taken over 300,000 puffs of rescue medicine in my life. This made me one of the initial members of “The Club.”

Rescue medicine is fast acting. But, it’s also short acting. It’s often referred to as Short-Acting Beta 2 Adrenergic (SABA) medicine.  You inhale the medicine. Medicine particles attach to b2 receptors on airway cells. When this happens the smooth muscles wrapped around airways are told to relax. This is how beta 2 adrenergics open airways and make breathing easier.

Today I don’t use rescue medicine so much. The better option is Long-Acting Beta 2 Adrenergic (LABA) medicine. These medicines open airways and keep them open for 12-24 hours. LABAs are an ingredient contained in combination inhalers like Symbicort. They work nicely for preventing and controlling asthma.

So, today I take Symbicort every day. I still have albuterol on standby in case I have symptoms between puffs of Symbicort. But, I rarely use my albuterol. Still, beta 2 adrenergic medicine enters my airways when I puff on my Symbicort or Albuterol. And it’s beta 2 adrenergics that are linked to cavities.

So, did beta 2 adrenergics cause my cavities?

There’s no possible way to know for sure. But, I used lots of beta 2 adrenergics in my day. This was especially true when I was a kid. I was using lots and lots and lots of albuterol. Before that it was Alupent.  And it was when I was a kid that I got most of my cavities.

Mom used to lecture me about poor teeth brushing even though I felt that I was a good tooth brusher. Thinking maybe twice a day wasn’t enough, I started brushing after every meal. And that’s something I continue to this day. And yet I still get occasional cavities.

So, does new evidence vindicate me?

When you inhale any medicine, most of the medicine doesn’t make it to your lungs where it’s needed. In fact, up to 50% of the medicine impacts in your upper airway. This includes your mouth.1

Keep in mind that how much medicine ends up in your upper airway depends on the medicine used. It also depends on the device used. It also depends on your technique. And, also, as a side note here, the dose of medicine is adjusted to account for this.

Either way, some inhaled medicine will impact into your upper airway. Some of it will stay in your mouth. Inhaled corticosteroids (ICS) may also have an impact there. They may cause a condition called thrush. I discussed thrush in my post, “What Is Thrush?” Here we will focus on B2 Adrenergic medicine, which has been linked with cavities.

How are b2 adrenergics linked to cavities?

B2 Agonists cause less saliva to be made and secreted. They also diminish components in your mouth that control bacteria. These include amalyse, calcium ions, secretory IgA, peroxidase, and lysozyme. So, the combination of these effects may lead to plaque buildup and an increased risk for cavities.2

Apparently, B2 Agonists contain “fermentable carbohydrates and sugar.” So, this is what experts think links b2 agonists with cavities.

B2 agonists also cause other effects in your mouth. For instance, they may also lower the pH. This is the acidity in your mouth. This decrease may last up to 30 minutes after each inhalation. This is another factor that may contribute to less saliva.2

What to make of this?

Experts recommend you rinse and spit after using inhaled corticosteroids. This is because some of that medication may impact in your mouth and cause thrush. So, this new evidence may indicate that you should rinse and spit after using any inhaled medication, including your rescue medicine.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Gardenhire, Douglas S., Dave Burnett, Shawna Strickland, Timothy R. Myers, "A Guide To Aerosol Delivery Devices for Respiratory Therapists," 4th Edition, 2017, pages 2-3
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213714/

Comments

View Comments (6)
  • TracyLee
    2 weeks ago

    Yes, I always take the time to swish and gargle. Shortly after I developed adult onset asthma and started using a corticosteroid inhaler, someone told me of their extremely painful case of thrush. Now I know that thrush is not necessarily always a horrible extensive struggle to get rid of it, but their warning did get me in the habit of swishing and gargling right away.

  • Leon Lebowitz, RRT moderator
    2 weeks ago

    Hi again, TracyLee, and thanks for this most recent post. Glad you have a better understanding of oral thrush and how to prevent it. Keep up the good work! Leon (site moderator)

  • TracyLee
    2 weeks ago

    I’ve had several different dental hygienists clean my teeth who were aware that I have asthma. One (and only one ) mentioned that they maybe I should brush my teeth before instead of after using a corticsteroid inhaler because the medicine temporarily softened the enamel. This advice was something they were trying to remember mentioned by one of their teachers, but they weren’t positive they were remembering correctly. Can you shed any light on this?

  • Leon Lebowitz, RRT moderator
    2 weeks ago

    Hi TracyLee and thanks for this post. While we cannot provide medical advice or diagnostics over the internet (for your own safety), your concern certainly warrants a reply. The conventional wisdom is to gargle and rinse after using inhaled corticosteroids (ICS), to prevent oral thrush (Candida) from developing. I cannot imagine why you would be advised to brush before administration for prevention. You may want to take that up with the (one and only) hygienist who made the recommendation. How does that sound? Leon (site moderator)

  • Leon Lebowitz, RRT moderator
    2 weeks ago

    It’s my pleasure, TracyLee.
    Just remember, that it is medically recommended to rinse and gargle after using the ICS inhaler. By rinsing and gargling after using it, you are actually cleaning the residual medication that may be in your mouth and oral cavity area. If the residue is allowed to remain, that is what can lead to oral thrush.
    If you feel you want to brush your teeth, you may want to consider (as you said) brushing after rinsing and gargling.
    Leon (site moderator)

  • TracyLee
    2 weeks ago

    Leon, thank you for the fast reply. The dental hygienist offered to contact me if she could get details from her former teacher. I didn’t hear from her and she left my dentist.

    I always swish and gargle after the inhaler but doing it immediately after I brushed my teeth meant I was swishing away the fluoride in the toothpaste. I think I will go back to doing the inhaler and swishing before the toothbrushing.

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