Despite improvements in dental care, especially in developed nations, dental caries, more commonly known as tooth decay, are still one of the most common health problems in the world. Disparities in oral health between and within countries are due to differences in dental care provision, sugar consumption, fluoride usage, and social determinants of health.
Teeth have a hard protective coating called enamel, mainly composed of a calcium phosphate mineral known as hydroxyapatite. Dental enamel is porous and is vulnerable to acid dissolution during demineralization. Re-mineralization repairs the damage done by demineralization. The balance between these two processes determines whether dental caries occurs.
Common Causes Of Tooth Decay
Tooth decay is caused by sticky deposits known as plaque which form on the teeth. Especially on the edges of fillings, on the grooved surfaces of the teeth, and around the gum line. Plaque consists of saliva, food residues, and bacteria. The bacteria that generally occur in the mouth act on food (especially carbohydrates) to convert them into acids.
When plaque is not removed, it gets hard and becomes what is known as tartar. Acids in plaque can and will, over time, erode the hard protective enamel surface of the teeth, and it is this that forms cavities. Cavities take months or years to create. And in some cases, they may spontaneously disappear. But if they become large, they will damage the softer inner structures of the tooth, such as the pulp and dentin.
Eating a diet rich in starchy foods and sugar increases the risk of tooth decay, and sticky foods pose a particular problem because they tend to remain on the surface of the teeth for longer.
In addition, frequent snacking increases the length of time the acids contact the teeth. Poor oral hygiene also contributes as acids can begin attacking the tooth enamel just 20 minutes after a meal.
Tooth Decay Caused By Illegal Drugs
It is known that the regular use of illegal drugs can cause tooth decay. Cocaine, crack cocaine, ecstasy, heroin, and methamphetamine cause significant tooth damage. Cocaine mixes with saliva to produce a very acidic solution that erodes the tooth enamel and gives decay-causing bacteria access to the tooth’s interior. It also causes dry mouth.
Crack cocaine, if smoked, damages the enamel, nerves, and gums. Ecstasy causes teeth grinding and dry mouth. Heroin users crave sweet foods, which increases the risk of dental caries if oral hygiene is neglected. Perhaps the best-known example of dental damage due to an illegal drug is methamphetamine, which quickly causes severe tooth decay. Dentists have coined the phrase ‘meth mouth’ to describe the extensive damage that the use of the drug causes.
Tooth Decay Caused by Prescription or Over-the-Counter Medications
What is probably less well known is that prescription drugs such as Prozac, blood pressure medications, and cholesterol medication can also contribute to tooth decay.
Over 400 commonly prescribed drugs are known to cause xerostomia, otherwise known as dry mouth, and thus contribute to the production of dental caries. It is estimated that around 40 percent of the population will be taking at least one form of medication that could contribute to tooth decay.
Dentists have found that tooth decay is increasing, particularly in individuals of middle age or older. This is the increased use of medication for depression, treating high cholesterol, and heart disease. The problem stems from the fact that these drugs reduce saliva production. Saliva plays a vital role in maintaining a healthy mouth.
Drugs such as antihistamines, oral contraceptives, immunosuppressant drugs, and antihypertensives can also cause gum problems such as bleeding, tooth sensitivity, inflammation, and ulceration. In addition, diseased gums can cause other dental issues such as tooth loss.
It is not just prescription drugs that may cause tooth decay; many over-the-counter medicines can also damage the teeth. For example, aspirin should always be taken with plenty of water and never chewed as the acids damage the enamel. In addition, cough preparations often contain syrups with high sugar levels. So therefore teeth should be brushed after dosing, or one should be chosen that does not contain sugar.
How Can Saliva Help In Preventing Tooth Decay?
Saliva flow kills the bacteria that act on food to create acids. So a decrease in saliva means that more bacteria survive in the mouth leading to an increased risk of tooth decay. In addition, the release of saliva neutralizes acids produced from food, and it consists of several substances that act to strengthen tooth enamel and thus protect the teeth. The minerals found in saliva can also help repair the damage caused by early tooth decay.
Studies completed at Tufts University in Boston indicate that drug-induced dry mouth can triple an individual’s risk of tooth decay and double their chances of developing surface cavities.
Elderly and Children at Greater Risk
The problem is particularly acute amongst elderly patients in care homes who may not receive the complete care and attention required.
For example, many elderly residents of care homes have difficulty doing regular dental visits. In addition, they often miss primary oral care because they cannot look after themselves due to memory loss or paralysis. This can lead to gum disease, tooth decay, tooth erosion, and loss of teeth, impacting their ability to eat correctly, leading to malnutrition and poor health.
Children are also particularly vulnerable as their teeth are developing.
Antibiotics such as tetracycline may cause a child’s teeth to create a brown or yellow tinge which cannot be reversed. Tooth whitening may help in adulthood. Fluoride helps to strengthen teeth, but excessive amounts can also lead to discolouration of the teeth. And for this reason, it is recommended that children use low-fluoride toothpaste.
Ways To Ameliorate Prescription Drug-Induced Tooth Decay
These problems can be treated; the treatment will depend upon the type of drug and its effect on the gums and teeth. It may be possible to either adjust the drug’s dose or change the delivery method.
In some cases, it may be possible to switch to alternative medicine that does not pose the same risk to dental health. If it is not possible to switch to another drug, then the dentist may be able to suggest professional and at-home treatments to protect the teeth.
For example, topical fluoride solutions can be applied to the teeth to strengthen them and reduce the risk of decay. Fluoride mouth rinse or tablets can be used at home.
Dental fillings, dental cleanings, root canal and restorative work will be required if the decay has progressed too far. In addition, badly decayed teeth must be removed and the patient supplied with dentures or dental implants. Veneers can also improve the appearance of teeth damaged by decay.
Always discuss with your healthcare provider about which medications can have negative impacts on your teeth. Also, know what precautions you can take to keep your teeth healthy. It is always advisable to drink plenty of water when taking medication to lessen the risk of dental disease and tooth decay.