Steroids can affect dental health, but the specific problems depend heavily on the type of steroid and how it enters the body. Corticosteroids, most commonly prescribed to manage inflammation for conditions like asthma or autoimmune disorders, alter the body’s natural processes, and these alterations extend to the mouth and jawbone. The risks range from superficial oral infections to deep, structural changes in the bone that supports the teeth. Understanding the route of administration, whether localized through an inhaler or systemic via pills or injections, is essential for managing risk.
How Steroid Type Determines Oral Risk
The method by which a steroid is delivered dictates the resulting oral health risk profile. Corticosteroids are the primary concern for most patients, delivered either locally (like an asthma inhaler) or systemically (tablets or injections). Localized delivery concentrates the medication in the mouth and throat, leading to direct surface issues. Conversely, systemic corticosteroids circulate throughout the bloodstream, influencing deeper biological mechanisms like bone and immune function.
A distinct category is anabolic-androgenic steroids (AAS), often used illicitly for performance enhancement. AAS impact oral health through hormonal changes and can lead to significant gingival enlargement, causing the gum tissue to swell and overgrow the teeth. This enlargement creates deeper pockets around the teeth, increasing the risk for severe periodontitis.
Direct Oral Side Effects from Inhaled Use
Inhaled corticosteroids (ICS) are a common cause of localized oral complications because medication residue remains on the oral and pharyngeal tissues. The most frequent direct side effect is oral candidiasis, known as thrush, a fungal infection caused by an overgrowth of the yeast Candida albicans. The steroid suppresses the local immune response in the mouth, allowing the fungus to multiply, resulting in white, creamy patches that can be painful or cause a burning sensation.
Inhaler use is also associated with xerostomia, or chronic dry mouth, because the medications reduce the flow rate of saliva. Saliva is the mouth’s natural defense mechanism, neutralizing harmful acids and washing away food debris and bacteria. When saliva production is significantly decreased, the mouth loses this protective buffer, encouraging acid erosion and accelerating the formation of dental caries, or cavities.
Systemic Impact on Jawbone and Gums
Long-term use of systemic corticosteroids can trigger profound effects on the body’s internal structures. These medications interfere with the metabolism of calcium and vitamin D, directly inhibiting osteoblasts, the cells responsible for building new bone tissue. This mechanism can lead to corticosteroid-induced osteoporosis, a condition characterized by a loss of mineral density in the alveolar bone of the jaw that anchors the teeth.
A weakening jawbone provides less support for the teeth, potentially increasing tooth mobility and the risk of eventual tooth loss. Systemic steroids also suppress the overall immune response, which is a primary defense against periodontal disease. This suppression can allow existing gum disease to progress more aggressively, leading to deeper pocket formation and faster destruction of the ligaments and bone around the teeth. Reduced immune function also slows down the healing process following dental extractions or oral surgical procedures.
Strategies for Protecting Dental Health
Individuals using inhaled corticosteroids can significantly reduce localized side effects by adopting specific post-inhalation hygiene practices. Rinsing the mouth thoroughly with water immediately after each use helps wash away medication residue. Using a spacer device with the inhaler can also help ensure more medication reaches the lungs.
For patients experiencing dry mouth, consistent hydration is important, as is the use of sugar-free gum or lozenges to stimulate saliva production. Those on long-term systemic steroid therapy must maintain consistent communication with their dental provider about their medication history and dosage. This information is important before planning any invasive treatment, due to concerns regarding bone density and delayed wound healing. Routine dental checkups monitor for early signs of bone loss or aggressive periodontal disease.