7 Types of Medications That Can Hurt Your Teeth

Take your meds with a meal. That is, if they can be taken with food rather than in between meals. Since you’re more likely to brush after eating, the sugar won’t linger.

3. Some antibacterial mouth rinses

What they can cause: Discolored teeth (in the form of yellowish-brown stains) and an increase in tartar. That dullness, by the way, is usually caused by the interaction of the antiseptic with chromogens, pigmented compounds found in foods (berries and coffee have high concentrations).

Common culprits: “The one we see most often is chlorhexidine, an antiseptic mouth rinse,” Fatahzadeh says. Other potential troublemakers: antihistamines (like Benadryl) and anti-hypertension medications — including ACE inhibitors such as benazepril (Lotensin), calcium channel blockers such as amlodipine (Norvasc) and felodipine (Plendil), and beta-blockers such as metoprolol succinate (Lopressor) — all of which can reduce saliva production, making it harder to get rid of stain-causing food and debris in the mouth. Inhaled corticosteroids, such as fluticasone (Flonase), can also damage tooth enamel because of the acid content in the spray. Cholestyramine (Prevalite), a powder-formulated cholesterol med designed to be mixed in a beverage, can result in discoloration when sipped slowly.

The fixes

Clean up. “It’s important to distinguish the type of discoloration that your medications are causing,” Chi says. Extrinsic discoloration on the surface of the tooth — from mouth rinses containing chlorhexidine, for example — can be cleaned off at your next dental hygiene visit or with a whitening treatment.

Go deep. For more stubborn stains, your dentist may recommend microabrasion (a procedure that involves using abrasive agents to remove a small amount of enamel from your teeth to make stains less noticeable), bonding or porcelain veneers.

4. Calcium channel blockers used to lower blood pressure in patients with hypertension

What they can cause: Gingival overgrowth, a buildup of swollen gum tissue that begins to grow over teeth, creating a friendly environment for bacteria. Unsightly, for sure, but it can also lead to discomfort and pain, especially if that overgrowth gets in the way of chewing.

Common culprits: Calcium channel blockers such as amlodipine (Norvasc) and felodipine (Plendil) can be frequent offenders. This condition is also associated with anti-seizure medications, such as phenytoin (Phenytek), and with immunosuppressive agents, such as cyclosporine (Neoral and Gengraf) and methotrexate (Otrexup and Trexall), which prevent the immune system from damaging healthy cells and are usually taken by people with organ transplants or by those with autoimmune diseases such as severe rheumatoid or psoriatic arthritis. “Gingival overgrowth doesn’t usually happen from the drugs alone,” Shuman points out. “It’s usually the drug in combination with tissue irritation from things like plaque. When they take these medications and maintain good hygiene, we don’t seem to see problems.”

The fixes

Swap in a new drug. Work with your physician to see if there is an alternative medication that might work.

Up your dental visits. More frequent cleanings (every four months) can also help lower your chances of developing this condition. Patients who already have overgrowth, in particular, should increase their oral hygiene regimen. It won’t reverse the problem, but plaque control can prevent it from getting worse.

Get it trimmed. If the problem persists, there are periodontal procedures that can remove overgrown gum tissue. One is a gingivectomy, which involves surgically cutting away diseased gum tissue around the teeth. “However, this is a temporary fix,” Chi says. “The medication the patient is taking will often lead to continued overgrowth, and over time the gum tissue will come back again.”   

5. Oral bisphosphonates, commonly prescribed for osteoporosis to strengthen bones

What it can cause: Osteonecrosis of the jaw (ONJ) is a rare but potentially serious complication of oral surgery that causes death of the jawbone tissue.

Common culprits: Antiresorptive drugs such as oral bisphosphonates — alendronate (Fosamax), risedronate (Actonel and Atelvia) and ibandronate (Boniva) — are commonly prescribed for osteoporosis to strengthen bones. They are also used in cancer patients to limit or prevent the spread of cancer to the bones, such as bone metastasis in breast cancer or multiple myeloma. “These drugs can be livesaving and quality-of-life-preserving,” says dentist Thomas Schlieve, M.D., associate professor in the Department of Surgery at UT Southwestern Medical Center in Dallas. “But they can have one side effect: osteonecrosis of the jaw.”

ONJ is a potential side effect of dental surgery while taking these medications. The condition typically occurs after a tooth extraction or some other invasive dental work, which may leave a bit of your jawbone exposed. If the gum tissue is slow to heal or fails to heal entirely, that area of jawbone is left exposed, doesn’t get blood flow and dies. In the early stages, “Osteonecrosis can be asymptomatic, to the point where you don’t even know you have it. Maybe they just feel a rough spot with their tongue,” Schlieve says. If it progresses, the dead bone becomes infected and painful and, in later stages, can spread beyond the bone that supports your teeth to the nerves.

The fixes

Be proactive. Talk to your doctor about potential alternatives to bisphosphonate drugs that may pose less risk. Before scheduling dental work, discuss your osteoporosis drug history with your oral surgeon and doctor. Typically, the longer a patient is on this medication, the higher the risk is for ONJ. Proactive dental care before and during antiresorptive drug therapy can reduce the risk of developing ONJ by as much as 50 percent.

Keep it clean. Treatment depends on the stage of ONJ at diagnosis. Once all of the bone tissue dies, it can’t be revived. But if caught early, doctors can help reduce bone loss. In the early stages, approximately half of patients will heal through nonsurgical debridement. This involves gently scrubbing the exposed bone twice a day with a prescription-strength antiseptic mouth rinse and a soft baby toothbrush or Q-tip. This helps removes bacteria off of the surface of the bone to prevent it from getting infected and to aid in tissue healing. It also helps loosen things up: Over time, the gums regrow underneath the dead bone and it pops right out.

Consider surgery. Those who don’t heal experience increased pain and recurrent infections, requiring surgery. An oral surgeon who has experience with ONJ removes the dead bone, along with any teeth that may be touching it and a bit of tissue, to make sure no diseased cells remain.

6. Some antidepressants and anxiety meds

What it can cause: Dry mouth that can increase risk for cavities, gum disease and canker sores. Saliva not only lubricates the mouth, but it also neutralizes the acid produced in the mouth. But as we age, our salivary glands become less active, making us more susceptible to tooth decay. Add to the mix the medications that further reduce our salivary flow, and this can lead to trouble. Without good salivary flow, food can accumulate, putting you at risk for cavities, gum disease, bad breath and fungal infections. And since the mouth’s mucosal lining is protected by that coating of saliva, you can get canker sores more frequently.

Not having enough saliva can affect taste perception, notes Fatahzadeh, because food particles have to be dissolved in the saliva to stimulate the receptors in the mouth. “A patient may have a tendency to put more [seasoning] in their food,” she says. “Imagine someone who is hypertensive putting more salt in their diet, or a diabetic putting more sugar in their drink.”

Common culprits: Dry mouth is a potential side effect of literally hundreds of medications that interrupt the secretion of saliva. In particular, drugs that alter our central nervous system, including anxiety meds such as escitalopram (Lexapro) and sertraline (Zoloft), and antidepressants such as fluoxetine (Prozac) and alprazolam (Xanax). “They can suppress the production of acetylcholine, a neurotransmitter that stimulates the production of saliva by the central nervous system,” Sanders says.

Also on the list: meds to treat urinary incontinence or an overactive bladder, such as oxybutynin chloride (Ditropan XL) and oxybutynin (Oxytrol); Parkinson’s disease medications, such as levodopa, also called L-dopa (Sinemet); blood pressure and heart medications, including ACE inhibitors such as lisinopril (Prinivil and Zestril), enalapril (Innovace) and benazepril (Lotensin); and beta-blockers such as metoprolol succinate (Lopressor and Toprol XL). Plus, not surprisingly, diuretics which help rid your body of water and salt to bring down blood pressure, such as furosemide (Lasix). Radiation therapy and chemotherapy may also damage the salivary glands.

The fixes

If this is a serious problem, perhaps the medication can be changed. If that isn’t possible, the patient needs a strategy to minimize symptoms.

Chew on it. Stimulate the salivary glands and keep your mouth moisturized by chomping on sugar-free gum or sucking on sugar-free candy periodically throughout the day.

Moisturize your mouth. Keep a water bottle nearby and take sips throughout the day, Fatahzadeh says. “Fill a spray bottle with water and spritz your mouth to create a coating on the mucosa.” Limit your caffeine intake: Consuming a lot of coffee, tea or soda can make dry mouth worse. Rinsing your mouth in the morning and at night with an alcohol-free mouthwash after brushing your teeth can help reduce dry mouth. Mouthwashes that contain xylitol (such as Act Dry Mouth Mouthwash) have been shown to promote saliva production.

Try an over-the-counter saliva substitute. Products such as Allday Dry Mouth Spray can help keep the mouth lubricated. For severe dry mouth, physicians may prescribe medications such as Salagen or Evoxac to help stimulate saliva production.

Turn on the humidifier. “If you’re a mouth breather who wakes up feeling parched,” Fatahzadeh says, “put a humidifier next to your bed to add moisture to the air and to make your mouth less dry when you wake up.”

7. Nonsteroidal anti-inflammatory drugs (NSAIDs) used to relieve pain and reduce inflammation

What they can cause: Painful soft tissue reactions, including mucositis (inflammation of the mucous membrane that lines the inside of the mouth), and ulcerated sores, which can occur inside the mouth or on the tongue.

Common culprits: NSAIDs such as ibuprofen and aspirin, for starters. Other potential irritants include hypoglycemic agents for type 2 diabetes such as metformin (Fortamet or Glucophage); beta-blockers, including metoprolol succinate (Toprol XL) and bisoprolol (Zebeta), used by those with angina, high blood pressure and abnormal heart rhythm to help the heart beat more slowly; and immunosuppressive agents, among them prednisone (Deltasone) and methotrexate (Otrexup and Trexall), which prevent the immune system from damaging healthy cells and are usually taken by people with autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease.

Chemotherapy and radiation therapy may cause changes in the lining of the mouth and the salivary glands, upsetting the healthy balance of bacteria. In addition: “Quick-dissolving tablets that dissolve under, or on top of, your tongue can cause irritation at the site,” Sanders says. Among them: nitroglycerine tablets (Nitrostat) used to prevent angina (chest pain) caused by coronary artery disease, anti-nausea medications such as ondansetron (Zofran), or benzodiazepines such as lorazepam (Ativan), which target anxiety or sleeping problems.

The fixes

Keep your mouth in good shape. Good oral care can help prevent or decrease the severity of mucositis as well as infections. See your dentist regularly to make sure your gums are healthy. “Mucositis can make dental problems, such as preexisting gingivitis, even more painful and cause more bleeding when you brush,” Fatahzadeh says. “That can interfere with oral hygiene, and you may end up getting cavities on top of everything else.” Start by brushing with a soft-bristle brush, which is easy on your gums. Still experiencing sensitivity? Swap your toothbrush for a foam swab.

Gentle, please. “Many toothpastes have additives like anti-plaque, anti-tartar and whitening ingredients, which can cause adverse reactions in some people,” says dentist Mark Wenzel, clinical assistant professor in the Division of Restorative and Prosthetic Dentistry at The Ohio State University Wexner Medical Center. Strong minty or cinnamon flavoring agents, dyes, gritty particles and foaming agents such as sodium lauryl sulfate can also irritate the mouth. Choose a mild formula — maybe one with baking soda. “Do adequate brushing with a toothpaste that has plain old fluoride, and you’re going to be fine,” Wenzel notes. While you’re at it, stick with an alcohol-free mouthwash, which is less likely to cause a burning sensation.

Eat (and drink) smart. Avoid spicy, salty or hot foods and drinks until your mouth heals. Hard, sharp munchies (think potato chips or crackers) can also hurt tissue that’s swollen. Stick with soft foods (or moisten with broth or sauces). Also, steer clear of alcohol, drinks with caffeine and acidic juices.

Ease the sting. Cryotherapy, as in sucking on ice chips, is sometimes used by cancer patients to prevent mucositis caused by chemo treatments. Try the same thing at home, allowing the chips to slowly dissolve in your mouth. Or create a soothing homemade mouth rinse by mixing a teaspoon of baking soda and a teaspoon of salt in 4 cups of warm water. Swish the solution around in your mouth, then spit it out. Keep the remaining solution in a covered container at room temperature and use throughout the day. (Bonus: It helps keep the inflamed tissue clean.)

Stop puffing. The heat and chemicals in tobacco irritate the mucous membranes.

Get an Rx. Your physician or dentist may prescribe a rinse or a topical coating agent, such as hydrocortisone buccal tablets (they stick gently to the inside of your mouth, releasing hydrocortisone as they dissolve), to coat the mucosa, forming a protective barrier to minimize any pain you might feel while eating or drinking.

Bring out the big guns. “If someone has mouth sores from chemotherapy, there’s a product your dentist or physician can prescribe, called ‘magic mouthwash,’ ” Shuman says. “It’s kind of a catchall that contains a mixture of medications, such as Benadryl and Maalox, along with other ingredients — for example, an anesthetic, antibiotic or an antifungal med to coat the tissues.”

Barbara Stepko is a longtime health and lifestyle writer and the former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.