Asthma and Oral Health

As dental professionals, we know asthma affects the lower respiratory tract characterized by increased sensitivity to certain stimuli. These stimuli induce inflammation and constriction of the airways. On exposure to the irritants or stimuli, there is an aggravated response comprised of various symptoms such as coughing, difficulty in breathing, hyperventilation, chest tightness, excessive mucus production, and increased rate and intensity of breathing. Although a crippling condition, asthma is a chronic but reversible condition, resolving either spontaneously or using medication or an inhaler.

Treatment of Asthma: The treatment of asthma involves physical therapy to improve air circulation through the lungs. In addition, certain medications are suggested to the patient. Two major classes of drugs used for this purpose are:

  1. Bronchodilators
  2. Anti-inflammatory agents

The various drugs used in treating asthma are most commonly given in an inhaler, which can be used as needed. However, bronchodilators are used in routine medication for quick relief, while anti-inflammatory medications are generally used for long-term treatment. The anti-inflammatory agents’ function aid in reducing the inflammation while the bronchodilators mediate the reopening of the airway.

Prevalence of Asthma: The poor air quality, accompanied by a weakened immune system due to poor diet and nutritional status, has led to an increasing number of asthma cases. It has been predicted that the number of people affected by asthma would rise to 100 million by 20252. This is an alarming situation as breathing is essential for a quality life.

Effect of Asthma on Oral Health: Asthma, in addition to impairing breathing, also has various effects on oral and dental health.

  1. Reduced Salivation: The use of inhalers containing beta-2 agonists, a standard component of inhalers, can reduce salivary outflow by suppressing the glandular secretions of the parotid and submandibular salivary glands. Saliva is an essential component in maintaining oral health by its many functions, including maintaining mucosal integrity, cleansing the crevices and diluting excess sugars, buffering the pH of the oral cavity, and antimicrobial action. Loss of salivation leads to many adverse effects that can gravely damage the integrity of the oral mucosa and produce dental complications.
  2. Reduced Enzymes and Proteins: In addition, asthmatic patients show a decrease in the production of several enzymes, mediators of initiators of digestion in the oral cavity, including lysozyme and salivary peroxidase.
  3. Disruption of Oral pH: The most common disease usually accompanied by asthma are dental caries, dental erosion, and oral mucosal changes, all due to disruption of the pH to acidic conditions. Beta-2 agonists have an inhibitory action on the smooth muscles around the lower esophageal sphincter. The inhibition of the sphincter allows acidic gastric contents of the stomach to enter the mouth quickly. This acid also damages the enamel of the teeth and may result in erosive lesions. Inhalers also contain lactose which also reduces the pH and contributes to caries formation (4).
  4. Increased Glucose Concentration: Inhalers containing corticosteroids also increase the glucose concentration promoting the formation of oral candidiasis5.
  5. Calcium in Saliva: Due to unknown causes, inhaler use also increases calcium concentration in the saliva leading to increased risk of calcification of plaque and deposition of calculus, further compromising oral hygiene. Prolonged use of inhalers can lead to diminished bone density, as well as progressing periodontal disease. Thus, oral and dental health is impaired by the use of various medications necessary to treat asthma. Therefore, there is a need to correct and maintain oral and dental hygiene while correcting asthma.

Conclusion: Dental professionals must educate patients and parents/caregivers of children with asthma on any potential oral complications. Oral health professionals must take many precautions to protect patients’ systemic health, including managing possible oral consequences from asthma medications and biological changes associated with asthma.

 

References:

  1. Innes JA, Reid PT. Respiratory diseases. In: NA Boon, NR Colledge, BR Walker, JA Hunter, eds. Davidson’s Principles and Practice of Medicine. 20th edn. Churchill Livingstone: Elsevier, 2006: 670– 678.
  2. Thomas, M., Parolia, A., Kundabala, M. and Vikram, M. (2010), Asthma and oral health: a review. Australian Dental Journal, 55: 128-133. https://doi.org/10.1111/j.1834-7819.2010.01226.x
  3. Ryberg, M., Möller, C., & Ericson, T. (1987). Effect of beta 2-adrenoceptor agonists on saliva proteins and dental caries in asthmatic children. Journal of dental research, 66(8), 1404–1406. https://doi.org/10.1177/00220345870660082401
  4. Kargul B, Tanboga I, Ergeneli S, Karakoc F, Dagli E. Inhaler medicament effects on saliva and plaque pH in asthmatic children. J Clin Pediatr Dent. 1998;22:137–40.
  5. Fukushima, C., Matsuse, H., Tomari, S., Obase, Y., Miyazaki, Y., Shimoda, T., & Kohno, S. (2003). Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone. Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology, 90(6), 646–651. https://doi.org/10.1016/S1081-1206(10)61870-4
  6. Boot, A. M., de Jongste, J. C., Verberne, A. A., Pols, H. A., & de Muinck Keizer-Schrama, S. M. (1997). Bone mineral density and bone metabolism of prepubertal children with asthma after long-term treatment with inhaled corticosteroids. Pediatric pulmonology, 24(6), 379–384. https://doi.org/10.1002/(sici)1099-0496(199712)24:6<379::aid-ppul1>3.0.co;2-c
  7. Moraschini, V., Calasans-Maia, J. A., & Calasans-Maia, M. D. (2018). Association between asthma and periodontal disease: A systematic review and meta-analysis. Journal of Periodontology, 89(4), 440–455. https://doi.org/10.1902/jop.2017.170363

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