Dental erosion in asthma: A case‐control study from south east Queensland

Abstract

Background: Asthma medication places patients at risk of dental erosion by reducing salivary protection against extrinsic or intrinsic acids. But patterns of lesions in asthmatics may differ from patterns in non-asthmatics, because gastro-oesophageal reflux (GOR) is found in 60 per cent of asthmatics. Methods: The lesions in 44 asthma cases were compared to those of age and sex match controls with no history of asthma or medications drawn from the dental records of 423 patients referred concerning excessive tooth wear. The subjects were 70 males age range 15 to 55 years and 18 females age range 18 to 45. Anamnestic clinical data were compared between the two groups. Models of all 88 subjects were examined by light microscopy, and wear patterns were recorded on permanent central incisor, canine, premolar and first molar teeth. Results: Clinical differences were a higher incidence of tooth hypersensitivity, xerostomia, salivary gland abnormalities, gastric complaints, and self induced vomiting in the cases. No differences were found between the cases and controls on citrus fruit and acid soft drink consumption. More occlusal erosion sites were found in cases, whereas more attrition sites were found in the controls. There were no significant differences in palatal erosion on maxillary anterior teeth found between cases and controls. Lingual erosion of the mandibular incisors, found only in GOR patients, was not observed. Conclusions: A higher incidence of erosion was found in asthmatics. Gastro-oesophageal reflux symptoms were not associated with the sign of lingual mandibular incisor erosion. The clinical significance is that asthmatics are at risk of dental erosion from extrinsic acid, but GOR does not appear to contribute in a site-specific manner.

Oral health in young adults with long-term, controlled asthma

“…Published studies on oral health in adults with asthma are relatively few and present large variations in ages of the participants, asthma severity, duration, medication and sample size [10,11,[22][23][24]. One explanation for this may be the difficulty involved in recruiting well-controlled, homogeneous groups with long-term disease.…”

“…A low pH in the oral cavity may also be a risk factor for the development of dental erosions. Sivasithamparam et al [23] found a higher incidence of erosions on occlusal surfaces in asthmatics compared with healthy controls. One explanation for erosion may be that dry powder inhalers have a low pH and sometimes contains lactose monohydrate as a carrier vehicle in proportions of 12-25 mg per dose.…”

A literature review of dental erosion in children

“…21 A number of studies have looked at the association between erosion and medications used to treat asthma and have provided conflicting results. [44][45][46][47] Asthmatic medications may cause erosion through the acidic nature of the aerosols on the teeth. 46 In addition, prolonged use of the beta-2 agonists in drugs such as salbutamol and terbutaline can lead to xerostomia, which indirectly contributes to erosion through reducing the modifying and protective effects of saliva.…”

Demineralization–remineralization dynamics in teeth and bone

“…93 Moreover, several medication and asthmatic inhalers were shown to induce xerostomia by reducing salivary flow, in addition to decreasing its pH; thus, weakening its overall buffering effect against intrinsic and extrinsic acids. 94,95 Saliva is considered one of the most important biological factors in dictating the intraoral neutralizing effects of acid exposure. Pathogenesis of dental erosion is directly related to the buffering capacity and rate of secretion of saliva.…”