Medications That Can Cause Tooth Decay and Other Oral Health Issues

When you visit the dentist for a teeth cleaning, they often remind you to brush and floss your teeth regularly. They may also remind you that your diet and how well you take care of your teeth determine how likely it is you’ll develop tooth decay, including cavities. Cavities occur when there’s damage to the surface of your tooth (enamel). The cavity, a small hole on the tooth, can cause tooth pain and infection. In serious cases, you could even lose a tooth.

But sometimes, even the most diligent person may not be able to avoid tooth decay. This is especially possible if you take a medication known to cause tooth decay. Below, we will talk about medications that are known to cause oral health side effects.

How do medications cause tooth decay?

Medications can cause tooth decay in various ways. But first, let’s talk about how tooth decay happens in general.

The outer layer of your teeth (the enamel) has minerals that protect your teeth and keep them strong. The enamel can lose minerals and become damaged when it comes into contact with acid. Acid is created when bacteria in your mouth comes into contact with sugars and starches (from the food and drinks you consume). If your teeth encounter acid often, the enamel continues to lose its minerals. Over time, your teeth get progressively weaker and become damaged enough to form cavities.

Some medications create an environment that makes your mouth more acidic. One way this can happen is by causing dry mouth. When your mouth is dry, you have less saliva. Saliva is more important than most people realize, and the average person makes three pints of it a day. It has enzymes that break down starches in your mouth, and helps return minerals to your tooth enamel. The more saliva you have, the less acidic your mouth is. Without an adequate amount of saliva, tooth decay can happen.

Other medications, especially liquid forms, have sugar as an ingredient. Excess sugar in the mouth is also known to cause tooth decay. 

How can I spot signs of tooth decay?

When tooth decay begins, you might not have any symptoms. As tooth decay worsens, you might notice the following: 

• Tooth pain 

• Tooth sensitivity  

• Stained teeth

• An infection in the mouth that can cause pain, swelling, and fever

What medications cause tooth decay?

Various medications are known to cause tooth decay. Most commonly, medications can cause tooth decay by causing dry mouth.

Most recently, the FDA warned about dental problems with dissolvable forms of buprenorphine, a medication used to treat opioid addiction. These include the sublingual (placed under the tongue) and buccal forms (placed between your gum and cheek). While buprenorphine can cause dry mouth leading to tooth decay, its benefits clearly outweigh its risks for tooth decay.

And, buprenorphine is not the only medication that causes dry mouth. Hundreds of medications can cause dry mouth, including a broad group of medications called anticholinergics. Anticholinergic medications treat a wide range of medical conditions, including irritable bowel syndrome, asthma, and nausea. These include hyoscyamine (Levsin) and scopolamine (Transderm Scop).

Below is a list of specific medication groups that can cause tooth decay due to dry mouth over time: 

• Antihistamines (e.g., Benadryl)

• Decongestants (e.g., pseudoephedrine)

• Opioid pain medications, like hydrocodone/acetaminophen (Norco)

• High blood pressure medications (e.g., propranolol)

• Antidepressants (e.g., selective serotonin reuptake inhibitors like fluoxetine)

• Muscle relaxants (e.g., cyclobenzaprine)

• Parkinson’s disease medications (e.g., benztropine)

Some medications are sweetened with sugar, which can also cause tooth decay. People who take these medications for a long time are at the greatest risk. Examples include:

• Children’s syrup-based medications (e.g., Children’s Tylenol)

• Chewable antacid tablets (e.g., Tums)

• Some antifungal medications (e.g., nystatin liquid suspension)

Which medications cause other oral health side effects?

Medications can cause oral side effects other than tooth decay. For example, some medications can stain your teeth and cause tooth discoloration. These include: 

• Tetracycline antibiotics

• Ciprofloxacin (Cipro) 

• Inhaled corticosteroids (e.g., Pulmicort)

• Chlorhexidine (Peridex)

Gingival enlargement (overgrowth of gum tissue) is also a side effect of some medications. It can lead to difficulty eating, swelling, and inflammation. Some medications that may cause gingival enlargement include phenytoin (Dilantin), cyclosporine (Sandimmune), and amlodipine (Norvasc).

Other medications can cause bleeding, which raises the risk of bleeding from the gums. These include medications that lower your blood’s ability to form clots. This includes anticoagulants like warfarin (Coumadin) or rivaroxaban (Xarelto) and NSAIDs, like aspirin.

Some medications can also cause a rare side effect called osteonecrosis of the jaw (ONJ). This occurs when part of the jaw bone breaks down. Oral bisphosphonates (commonly prescribed for osteoporosis) and cancer treatments like chemotherapy can cause ONJ. Though bisphosphonates and chemotherapy are widely used, ONJ is not common — it affects fewer than 1 in 10,000 people.

How can I take care of my mouth if I have to take these medications?

There are general steps you can take to prevent tooth decay and maintain good oral health. This includes using a fluoride toothpaste, fluoride mouth rinse, or drinking tap water with fluoride in it. If you take medications that put you at higher risk for tooth decay, you might need more fluoride. Make sure your dentist knows what medications you take.

Other general steps to maintain good oral health: 

• Have regular appointments with your dentist

• Brush your teeth twice a day and floss regularly

• Eat a balanced diet that is low in foods with excess sugars and starches

• Quit tobacco products if you smoke or use smokeless tobacco

If you take medications known to cause tooth decay, talk to your healthcare provider if you notice signs of damage. Your provider may be able to prescribe another medication that doesn’t cause these side effects.

But, stopping your medication may not be an option, so there are some steps you can take to prevent tooth decay. If your medication causes dry mouth, drink water often. And avoid drinking acidic fruit juices. Your healthcare provider may recommend an artificial saliva product to keep your mouth from becoming dry.

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Written by:

John Maneno, PharmD

John Maneno, PharmD, is a licensed pharmacist and freelance writer. He completed a 2-year fellowship program with Belmont University and Aegis Sciences Corporation where he served as an instructor for biomedical literature evaluation and intro to drug information and informatics courses.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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