Drug-related caries and dental erosion *

*This article is based on the article ‘Caries dentaires: des médicaments favorisent leur apparition’ from our French sister publication La Revue Prescrire 2014; 34: 750-755.

Caries and dental erosions usually arise due to poor dietary habits and inadequate oral hygiene, such as insufficiently brushing the teeth. In rare cases, the use of certain drugs can contribute to caries and dental erosion. This may be caused by excipients, such as sugar in oral solutions or chewable tablets, or eroding powder particles used in powder inhalers. In addition, medicines can contribute to caries indirectly by reducing saliva secretion, as saliva protects the teeth by its antibacterial and buffering effects, and it also cleanses the oral cavity. Pharmacologically, this could include a large number of agents.
The relation between medication use and caries and erosions has received little attention in the scientific literature. What is known about it derives from studies producing low levels of evidence, such as a few cohort studies, cross-sectional studies and, mostly, reports to adverse effects reporting centres or anecdotal reports. These concern oral solutions containing sugar and chewable tablets in general, asthma medications, antidepressives and antipsychotics. Such studies cannot prove causal relationships, so there is a need for further research into the relation between drugs and the development of caries and dental erosion.
Doctors and dentists need to be aware of the role of drugs when a patient presents with caries or dental erosions, especially if there is no other satisfactory explanation and the patient has been using a drug frequently and over a long period of time. Patients using a drug that can cause caries or erosions should be advised to visit a dentist regularly. In addition they should be given advice on diet, oral hygiene and measures relating to the use of the medication, such as rinsing the oral cavity with water after having taken a sugary oral solution. Dentists should also report suspected side-effects (to adverse effects reporting centres) as fully as possible, that is, providing information on possible temporal relations, co-medication and other possible causes.


  1. Baat C de (red.). Compendium mondzorg. Houten: Prelum, 2011.
  2. Schuurs AHB (red.). Gebitspathologie: afwijkingen van de harde tandweefsels. Houten: Bohn Stafleu Van Loghum, 1999.
  3. Durso SC. Oral manifestations of disease. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. (red.). Harrison’s principles of internal medicine. New York: McGraw-Hill, 2008: 214-221.
  4. Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010: CD007868.
  5. Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database Syst Rev 2011: CD007592.
  6. Li H, Zou Y, Ding G. Dietary factors associated with dental erosion: a meta-analysis. PLoS One 2012; 7: e42626.
  7. Tredwin CJ, Scully C, Bagan-Sebastian JV. Drug-induced disorders of teeth. J Dent Res 2005; 84: 596-602.
  8. O’Sullivan EA, Curzon ME. Drug treatments for asthma may cause erosive tooth damage. BMJ 1998; 317: 820.
  9. Roberts IF, Roberts GJ. Relation between medicines sweetened with sucrose and dental disease. Br Med J 1979; 2 (6181): 14-16.
  10. Compte-rendu de la séance n°2 du 25 avril 2013 [document op het internet]. Agence de sécurité du medicament et des produits de santé. Via: http://ansm.sante.fr/var/ansm_site/storage/original/application/6d973fd489c248605008096abef628d8.pdf.
  11. Productinformatie fentanyl (Actiq®), via: www.cbg-meb.nl, Geneesmiddeleninformatiebank.
  12. Mandel L, Carunchio MJ. Rampant caries from oral transmucosal fentanyl citrate lozenge abuse. J Am Dent Assoc 2011; 142: 406-409.
  13. Sharma V, Miah M, Cameron M. Lozenge risks. Br Dent J 2012; 213: 199.
  14. Wogelius P, Poulsen S, Sørensen HT. Use of asthma-drugs and risk of dental caries among 5 to 7 year old Danish children: a cohort study. Community Dent Health 2004; 21: 207-211.
  15. Santos NC, Jamelli S, Costa L, Baracho Filho C, Medeiros D, Rizzo JA, et al. Assessing caries, dental plaque and salivary flow in asthmatic adolescents using inhaled corticosteroids. Allergol Immunopathol 2012; 40: 220-224.
  16. Vries TW de, Langen-Wouterse JJ de, Puijenbroek E van, Duiverman EJ, Jong-Van den Berg LT de. Reported adverse drug reactions during the use of inhaled steroids in children with asthma in the Netherlands. Eur J Clin Pharmacol 2006; 62: 343-346.
  17. Zweers P, Hunsel F van. Alertheid moet gebitsschade door geneesmiddel voorkomen. Pharm Weekbl 2014; 149: 30-31.
  18. Salbutamol inhalation and dental caries [document op het internet]. Nederlands Bijwerkingen Centrum Lareb. Via: http://www.lareb.nl/larebcorporatewebsite/media/publicaties/kwb_2007_4_salbut.pdf.
  19. Bijwerkingendatabank, via: www.lareb.nl, bijwerkingen.
  20. Peeters FPML, Vries MW de, Vissink A. Remming van de speekselsecretie door antidepressiva; risico’s voor de mondgezondheid. Ned Tijdsch Geneeskd 1996; 140: 533-536.
  21. Rindal DB, Rush WA, Peters D, Maupomé G. Antidepressant xerogenic medications and restoration rates. Community Dent Oral Epidemiol 2005; 33: 74-80.
  22. Zorginstituut Nederland. GIPdatabank, via: www.gipdatabank.nl.
  23. Boyd LD, Wyer JT, Papas A. Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: a case study. Nutr Rev 1997; 55: 362-368.
  24. Knorring AL von, Wahlin YB. Tricyclic antidepressants and dental caries in children. Neuropsychobiology 1986; 15: 143-145.
  25. Boomsma LJ, Dijk PA van, Dijkstra RH, Laan JR van der, Meulen P van der, Ubbink JTh, et al. NHG-Standaard Enuresis nocturna (eerste herziening). Huisarts Wet 2006; 49: 663-671.
  26. Stevens JB, Wilkinson EG. Drugs, dry mouth, and dental disease. A case report. Psychosomatics 1971; 12: 310-312.
  27. Vries MW de, Peeters F. Dental caries with long term use of antidepressants. Lancet 1995; 346: 1640.
  28. Peeters FP, Vries MW de, Vissink A. Risks for oral health with the use of antidepressants. Gen Hosp Psychiatry 1998; 20: 150-154.
  29. Winer JA, Bahn S. Loss of teeth with antidepressant drug therapy. Arch Gen Psychiatry 1967; 16: 239-240.
  30. Harrison-Woolrych M, Garcia-Quiroga J, Ashton J, Herbison P. Safety and usage of atypical antipsychotic medicines in children: a nationwide prospective cohort study. Drug Saf 2007; 30: 569-579.
  31. Chu KY, Yang NP, Chou P, Chi LY, Chiu HJ. The relationship between body mass index, the use of second-generation antipsychotics, and dental caries among hospitalized patients with schizophrenia. Int J Psychiatry Med 2011; 41: 343-353.
  32. Informatorium Medicamentorum. Den Haag: KNMP, 2015.
  33. Gillis A. Lithium carbonate and dental caries. Br Med J 1978; 2 (6153): 1717.
  34. Eduardo C de P, Simões A, de Freitas PM, Arana-Chavez VE, Nicolau J, Gentil V. Dentin decalcification during lithium treatment: case report. Spec Care Dentist 2013; 33: 91-95.
  35. Lupi-Pégurier L, Muller-Bolla M, Fontas E, Ortonne JP. Reduced salivary flow induced by systemic isotretinoin may lead to dental decay. A prospective clinical study. Dermatology 2007; 214: 221-226.
  36. McCracken M, O’Neal SJ. Dental erosion and aspirin headache powders: a clinical report. J Prosthodont 2000; 9: 95-98.
  37. Sheedy JJ. Methadone and caries. Case reports. Aust Dent J 1996; 41: 367-369.
  38. Bigwood CS, Coelho AJ. Methadone and caries. Br Dent J 1990; 168: 231.
  39. Lewis DA. ’Methadone and caries’.Br Dent J 1990; 168: 349.
  40. Hutchinson S. ’Methadone and caries’. Br Dent J 1990; 168: 430.
  41. Suzuki J, Park EM. Buprenorphine/naloxone and dental caries: a case report. Am J Addict 2012; 21: 494-495.

*The literature refers to the Dutch text