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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Medication Effects on Teeth and Mouth

Many medications have known adverse effects on the oral cavity. Common oral medication side effects include:

Gingival Hyperplasia
Gingival hyperplasia in children can be:

  • Hereditary – Rare, onset in early childhood
  • Inflammatory – Chronic gingivitis can trigger gingival overgrowth
  • Infiltrative – Leukemia, often the monocytic type, can infiltrate the gingival tissues
  • Drug-induced. Medications that can cause hyperplasia:
    • Phenytoin
    • Calcium channel blockers (nifedipine)
    • Cyclosporin A

In addition to the cosmetic concern, gingival hyperplasia puts children at risk for:

  • Poor oral hygiene
  • Impaired tooth eruption,
  • Difficulty chewing
  • Severe gingivitis.

Treatment includes meticulous hygiene, discontinuing the offending agent, and gingivectomy if severe.

Oral Candidiasis
Increased risk in patients with diabetes, immunosuppression, and xerostomia. Characterized by adherent white plaques on mucosa and palate. Common complication of inhaled steroid use, usually for treatment of asthma. Counsel use of a spacer and always rinse the mouth after inhaled steroid use. Treat with topical antifungals (e.g. Nystatin) and sterilize bottles and nipples to prevent reinfection.

Xerostomia: Abnormal dryness of the mouth due to insufficient saliva production.

Medications that can cause dental staining:
  • Tetracycline class of antibiotics
    Cause a yellow, brown, or greyish discoloration of permanent teeth and should not be administered to pregnant women or children younger than 8. 
  • Iron
    Liquid drops can cause a reversible grey-black stain on teeth, which can generally be prevented or minimized by good oral hygiene. Staining is easily removed by a dental professional.
  • Fluoride
    Overdose can result in fluorosis of the permanent enamel and preferentially affects the incisors and molars. (See Chapter 6: Fluoride.)
    Fluorosis: An abnormal condition (as mottled enamel of human teeth) caused by fluorine or its compounds.

Fast Facts
Inhaled steroids increase the risk for oral candidiasis.
Staining from iron supplements is not permanent.
Tetracycline staining affects all teeth.
Fluorosis preferentially affects the incisors and molars.
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