Dental Problems with Inhaled Steroids

anotherlostie

My 6yr old niece uses a Becotide 50mcg inhaler morning and night. Her mother is scrupulous about her washing out her mouth afterwards to prevent risk of infection like thrush in the mouth.

But in the last year, one of her second teeth shows signs of demineralisation, presenting as a depression in the centre of the tooth, and it is now noticeable. More second teeth are starting to come through now, so the problem may present itself again.

Obviously being able to breathe is more important than the dental problem, and hopefully she will grow out of using the steroids as she gets older, and there is always cosmetic work later to sort out the problems, but...

I wondered has anyone else heard of or experienced this problem? Their dentist, GP or pharmacist had never heard of it.

btkm8unsl0w5r4

Inhaled steroid's can cause fungal infections on the soft tissue of the mouth. As for dental decay or demineralisation the steroids do not directly cause decay however a "sick" child may have a history of illness and antibiotic use when the teeth were forming and this much like a tree ring can cause areas of white or brown on the teeth.

I would suggest a dental check up woth your family dentist or local health board clinic to see if the area needs a restoration and to initiate a regime of prevention for the future.

anotherlostie

Carl Magnificent Menswear wrote:

Inhaled steroid's can cause fungal infections on the soft tissue of the mouth. As for dental decay or demineralisation the steroids do not directly cause decay however a "sick" child may have a history of illness and antibiotic use when the teeth were forming and this much like a tree ring can cause areas of white or brown on the teeth.

I would suggest a dental check up woth your family dentist or local health board clinic to see if the area needs a restoration and to initiate a regime of prevention for the future.

Thanks for the reply; I'm actually a pharmacist, and she has never received any tetracyclines, and the tooth defect is not the one you describe above. It is like the tooth has a pit where the enamel has been removed. Her parents have been to the dentist and GP, neither of home are aware of such an issue. I was 'hoping' that someone else might have heard of such an issue. My own theory is that the pH of the carrier of the new CFC free inhalers may be more acidic, but I haven't explored this with the manufacturers yet.

Big_G

This is unlikely to be due to the inhaler, even with the suggested aetiology of decreased pH of the carrier because it affects only a single tooth. If the suggested aetiology was in fact the correct hypothesis, would not all of the teeth in the delivery pathway be affected - that would be the palatal and occlusal surfaces of the upper teeth and lingual and occlusal surfaces of the lower teeth (just a guess)?

Also, the lower teeth would be less likely to be affected due to pooling of saliva in the floor of the mouth and the buffering action of saliva. What does mum wash the mouth out with after using the inhaler?

However, a dishlike depression of the chewing surface of the tooth, with the enamel worn away suggests an acidic aetiology (without seeing the defect and establishing any sources of acid in the diet or from the stomach it is impossible to be sure).

Further exploration is required to ensure that this problem is, in fact, limited to a single tooth and if not, to establish a cause. If it is limited to a single tooth and is not progressive, a simple filling may be required. If it is progressive, the cause must be established and removed and then a filling to restore the tooth.

As fitzgeme has suggested, examination by a gdp or dental specialist is required.