This resource intends to help you understand some of the oral health implications of various classes of medications. It is not a complete list of all medications with oral side effects, and it does not outline all oral side effects that any given medication may cause. Most importantly, this resource does not provide guidance on how these medications can impact your overall health. It only intends to provide insight into the oral effects of some common medication classes.
This resource is not a substitute for professional guidance from your physician, dentist, or pharmacist.
Many medications and therapies can negatively impact your oral health. It is important to understand these risks and take the proper precautions.
Be open with your dentist when you provide details about your
health history and current health status. When sharing this information, be sure to provide your dentist with a complete list of medications you take, including over-the-counter products, vitamins, and supplements. Your dentist can inform you of possible oral health effects from these medications and the steps you should take to address these risks. They can also work with your physician to ensure you get safe and appropriate care.
Other specific considerations related to medications include:
- The effects of oral disease: Poor oral health can complicate the management of a wide variety of health conditions. These conditions may lead to the need for additional medications that can have oral side effects. It's important to follow a strict at-home oral health routine and visit the dentist as recommended to help ensure these issues do not continue to impact one another.
Older adults: Seniors often take multiple medications. Drug interactions can worsen oral health issues and should be monitored by a dentist and physician on the schedule they recommend. In addition, many long-term medications routinely taken by seniors can cause
dry mouth (xerostomia), which can lead to
tooth decay and
periodontal disease (periodontitis) that may require extensive dental treatment to correct.
- Opioids: Opioids for
pain management following dental treatments are prescribed far more frequently than you may realize. When not properly prescribed or used as directed, opioids can present a significant risk of dependence or addiction. This is of particular concern for adolescents, who are often inappropriately or over-prescribed these drugs following procedures such as wisdom tooth removal. Seniors who undergo dental treatment should also be supervised to ensure that they follow the directed usage for opioids if they are prescribed for pain. The American Dental Association (ADA) supports limiting opioid dosages and limiting opioid duration to no more than three days.
- Acne medications: Prescription acne medications such as tetracycline are antibiotics. Some of these medications may cause dry mouth,
tooth discoloration, and
gum discoloration. Gum discoloration typically goes away when these drugs are no longer taken. Acne medications have been known to permanently darken developing
permanent teeth. This is important to consider for younger children who take prescribed acne medication before their permanent teeth have erupted. It is also important to consider for women that are
pregnant or nursing, as these effects can impact their child. Tooth discoloration from the use of these medications is typically not an issue once permanent teeth have fully developed and erupted.
- Analgesics (NSAIDs and Anti-inflammatories): Analgesics (pain relievers) include acetaminophen and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. They also include narcotic analgesics, which combine these drugs with opioids. NSAIDs and aspirin are among the most commonly recommended medications for pain management. They are often recommended following dental treatments. Prolonged use for any reason has been associated with dry mouth and
excessive bleeding. You should take special precautions when taking these drugs if you are taking other medications such as blood thinners, given that the combination can increase your risk of abnormal bleeding.
- Anesthesia: Local or
general anesthesia may temporarily affect the
sense of taste.
- Antacids: Antacids neutralize stomach acid to relieve heartburn, acid indigestion, or upset stomach. Many antacids contain sugar, which can remain on your teeth and lead to tooth decay.
- Antianemia drugs: Antianemics increase red blood cell or hemoglobin production. These include prescription medications and over-the-counter supplements such as folic acid, iron, and vitamin B12. Some of these may affect the sense of taste.
- Anti-anxiety drugs: Anti-anxiety medications help relieve fear, anxiety, and worry by enhancing the effect of certain neurotransmitter chemicals in your brain. The most common sub-class is known as benzodiazepines. These medications may also be useful to reduce oral effects of anxiety, such as tooth
grinding or clenching (bruxism). Some anti-anxiety medications may cause dry mouth.
- Antibiotics/antibacterials: Antibiotics include a wide range of medicines that help stop or slow bacterial infections. These drugs may cause dry mouth,
thrush (oral candidiasis),
mouth sores and affect the sense of taste.
- Anticoagulants: Anticoagulants slow the process of blood clotting. These medications are commonly referred to as blood thinners. They include such medications as aspirin, heparin, coumadin, and others. Medications in this class of drugs may cause excessive bleeding, which can be problematic if you need invasive dental treatment. If this is the case, your dentist may collaborate with your physician to temporarily suspend anticoagulant medication long enough for you to safely receive treatment without the risk of abnormal bleeding. Some anticoagulant medications have also been associated with dry mouth and the development of mouth sores.
- Antidepressants: Antidepressants are used to calm or correct chemical imbalances that may contribute to
anxiety and depression. Some may cause dry mouth and affect the sense of taste.
- Antidiabetics: Antidiabetics help to stabilize blood glucose levels in people with
diabetes. These medications may cause dry mouth and affect the sense of taste.
- Antidiarrheals and Irritable Bowel Syndrome (IBS) drugs: Antidiarrheals and IBS drugs help reduce diarrhea and discomfort (bloating, cramping, and
swelling) associated with some gastrointestinal conditions. Some drugs in this class may cause dry mouth and affect the sense of taste.
- Antifungals: Antifungals treat bacterial infections, usually of the skin, hair, or nails. They may also be prescribed for thrush, a common dental condition. Some antifungals may cause dry mouth or affect the sense of taste. If your dentist or physician prescribes an antifungal, make sure they are aware you have
kidney disease or reduced kidney function as certain antifungals can worsen these conditions.
- Antihistamines: Antihistamines stop or reduce the symptoms of allergies, motion sickness, and some cold and flu symptoms. Some may cause dry mouth and affect the sense of taste.
- Anti-hypertensives: These drugs reduce and maintain blood pressure. Anti-hypertensives include beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics, and others. Common side-effects may include dry mouth, mouth sores, and inflammation of the
gums (gingiva). These medications may also affect the sense of taste. Patients who take diuretics may need to make frequent trips to the bathroom, and the dentist should be aware of this as it can impact the time allotted for appointments.
- Antipsychotics: Antipsychotic medications alter brain chemistry to reduce and prevent symptoms such as hallucinations, delusions, and disordered thinking. They may cause dry mouth or affect the sense of taste. They may also cause lethargy or impair memory, which may undermine good oral hygiene.
- Anti-seizure and anticonvulsant medications: These medications may be prescribed for conditions that cause seizures, such as epilepsy, as well as for bipolar disorders. They reduce abnormal electrical activity in the brain. Oral side-effects may include dry mouth,
enlarged gums, and jaw pain. These medications may also affect the sense of taste.
- Antivirals: Antivirals treat viral infections throughout the body. Some may cause dry mouth and affect the sense of taste. Others may cause nausea and vomiting, which can increase stomach acid on your teeth and lead to
- Asthma and respiratory disorder drugs:
Chronic lung diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD) are most often treated with bronchodilators. These medications open inflamed or narrowed airways. The most commonly prescribed of these drugs are corticosteroids, but there are others. Most are taken through inhalers or nebulizers. Common ingredients in these medications (known as beta-adrenergic agonists) are acidic. This can erode tooth enamel, which can leave teeth more susceptible to tooth decay. Other medications in this class may cause dry mouth and thrush. They may also affect the sense of taste.
Cancer Drugs: Cancer treatment such as radiation therapy or chemotherapy can cause a wide variety of oral side effects. If possible, you should get any necessary dental treatment completed before starting on these treatments and talk to your dentist and physician about possible implications. Side effects may include dry mouth, excessive bleeding, gum discoloration, mouth sores, thrush, enlarged gums, an increased chance of infection, and tooth decay. These drugs may also affect the sense of taste. Your dentist may be able to prescribe appliances and medications to help alleviate the discomfort caused by certain cancer drugs and therapies.
Cardiovascular disease (CVD) drugs: CVD medications include blood thinners, arrhythmia and angina drugs, and thyroid hormones. Cholesterol-lowering drugs, anticoagulants, and blood pressure medications (anti-hypertensives) can also be included in this classification. Some of these medications can cause excessive bleeding, so care should be taken if you require invasive dental treatment. These medications may also affect the sense of taste and cause enlarged gums.
- Central Nervous System (CNS) stimulants: CNS stimulants increase certain brain chemicals to improve alertness, attention, and energy. Prescribed CNS stimulants are often used to treat ADD, ADHD, narcolepsy, and weight loss. Prescribed CNS stimulants may cause dry mouth and affect the sense of taste. Caffeine,
tobacco products, and some illicit drugs are also considered part of this class. These substances have potential oral side-effects that include tooth discoloration and periodontal disease.
- Cholesterol-lowering drugs: Cholesterol-lowering drugs include statins or fibrates and over-the-counter supplements such as omega-3 fatty acids. Some of these medications may cause dry mouth or affect the sense of taste.
- Cough drops or syrup: While the active ingredients in cough drops or cough syrup do not have any oral side effects, many contain sugar. This can increase the risk of tooth decay if used regularly.
- Decongestants: Decongestants shrink blood vessels in your nose to help relieve colds and allergy symptoms. They can be over-the-counter or prescription strength. Since they work to shrink blood vessels in and around the sinus cavity, they can also reduce saliva production and circulation to the gums. If used regularly, this may cause dry mouth, which can lead to tooth decay and periodontal disease.
- Dementia and Alzheimer's medications: Dementia and Alzheimer's disease medications may cause dry mouth, tooth decay, periodontal disease, and affect the sense of taste. In addition, people with these conditions may have a diminished ability to maintain good oral hygiene.
- Diuretics: Diuretics cause the body to excrete water. They help your kidneys remove salt (sodium), which is a strong contributor to high blood pressure. They may also be used for people with diabetes or
osteoporosis. These drugs may cause dry mouth and affect the sense of taste. Patients who take diuretics may need to make frequent trips to the bathroom, and the dentist should be aware of this as it can impact the time allotted for appointments.
- Eye drops, gels, and ointments (ophthalmics): Ophthalmics are anti-infection drugs specifically for the eyes. They are associated with causing dry mouth, which increases the risk of tooth decay.
Fluoride: Fluoride from water, supplements, and professional application are typically harmless. However, excessive amounts of fluoride can cause white or discolored spots to form on developing permanent teeth (fluorosis). Young children who routinely swallow fluoridated toothpaste are at an increased risk of this discoloration and may require professional treatment to correct it. Extreme intake of fluoride can cause an overdose, but this is very rare.
- Immunosuppressants: Immunosuppressants are prescribed to suppress your body's normal immune response. They have many applications, including the control of dermatitis and rheumatoid
arthritis, acceptance of organ transplants, and more. Because these medications alter your immune system, they can increase the risk of inflammation and infection in the soft tissues of your mouth. They may also cause mouth sores.
- Migraine medications: These medications help address recurring, severe headaches called migraines, which can affect people of any age. Common oral side-effects of some prescription migraine medications include dry mouth and affect the sense of taste. Since migraines can also cause nausea and vomiting, stomach acid can remain on your teeth leading to enamel erosion and tooth decay.
- Mouth rinses: Mouth rinses can be prescription-strength or over-the-counter. They are used to slow or treat tooth decay,
gingivitis, and periodontal disease. These medications may cause tooth discoloration that may require whitening products or professional procedures to return the teeth to their normal color.
- Muscle relaxants: Muscle relaxants are drugs that act as central nervous system depressants. In addition to muscle pain, they may sometimes be used for other conditions such as fibromyalgia, multiple sclerosis, Parkinson's disease, seizure disorders, and others. Some of these drugs may cause dry mouth and affect the sense of taste.
- Nerve Impulse Reducers: Nerve impulse-reducing drugs (anticholinergics) block certain brain neurotransmitters to help inhibit specific nerve impulses. They are used for a wide variety of conditions. A common side-effect is dry mouth, which increases the risk of tooth decay.
- Opioids: Opioids may be used to treat severe pain. Dry mouth is a common side-effect of opioid medications. There is a high risk of dependence and addiction, so it is important to consider opioid alternatives. When taken, it is important to understand these risks and strictly follow the recommended directions and dosage. It is also important to note that the FDA recently warned that buprenorphine, an opioid painkiller that may also be used to ease opioid withdrawal symptoms, has been associated with oral problems. These problems may include infections, tooth decay and
tooth loss (edentulism), and have been known to occur when buprenorphine is administered as a tablet that dissolves under the tongue or a film that is applied to the inside of the mouth.
- Oral Contraceptives: Oral contraceptives may cause gum discoloration, soft tissue inflammation, and mouth sores. They have also been associated with nausea and vomiting, which can increase the amount of stomach acid on your teeth. This can increase the risk of enamel erosion and tooth decay. Be sure to alert your dentist if you take an oral contraceptive. This is important because some dentist-prescribed antibiotics may interfere with the effectiveness of oral contraceptives.
- Osteoporosis drugs (bisphosphonates): Bisphosphonates are often prescribed to treat osteoporosis. Bisphosphonates may reduce blood circulation to bones, particularly in the head and neck. Reduced circulation slows the ability for healing and immune cells to reach dental procedure sites such as extractions,
bone grafts, or implants. This can result in poor wound healing and increase the risk of infection. A rare but severe side effect of bisphosphonate treatment called "
osteonecrosis of the jaw" (ONJ) can lead to increasing pain, loss of bone function, and progressive jaw bone destruction.
- Sedatives and sleeping drugs: Sedatives and sleeping drugs aid in relaxation and improve your ability to fall and stay asleep. These medications increase your risk of dry mouth due to deep mouth breathing, which dries out soft tissues. Some drugs in this class may affect the sense of taste or cause jaw pain.
- Skin disorder drugs (systemic retinoids): Systemic retinoids taken in pill form or injected to help treat autoimmune skin disorders such as psoriasis, skin lupus, certain cancers, and other conditions may cause dry mouth and affect the sense of taste.
- Smoking cessation drugs: Smoking cessation drugs, whether taken orally or through a patch, have been associated with dry mouth and temporary gum discoloration.
- Vitamins: Vitamin deficiencies can have significant and widely varying effects on your oral health. Vitamin deficiencies have been associated with poor tooth and gum development, periodontal disease, dry mouth, soft tissue inflammation, and
bad breath (halitosis). Vitamin K deficiency may increase the risk of excessive bleeding, which may be of concern when undergoing invasive dental treatment. Some vitamin supplements contain sugar, which can increase the risk of tooth decay.
- Weight loss drugs (anorexiants): Anorexiants are appetite suppression drugs typically used for weight loss. They may cause dry mouth and affect the sense of taste. They have also been known to cause acid reflux which can increase the amount of stomach acid on your teeth. This can lead to an increased risk of enamel erosion and tooth decay.
Author: go2dental staff
Medical review: Thomas J. Greany DDS
Last medical review: September 20, 2021
Last updated January 18, 2022
© go2dental. All rights reserved.