ORAL MANIFISTATIONS OF ASTHMA

Most asthma patients and health care practitioners are familiar with the common oral side effects of

inhaled and systemic medications to control asthma. This may be a review for some of you, but may

contain new information for others.

SOME OF THE MOST COMMON SIDE EFFECTS OF INHALED AND SYSTEMIC ASTHMA MEDICATIONS:

1.) Thrush-the dreaded yeast infection that can arise from frequent use of inhaled corticosteroids.

2.) Mucous membrane irritation

3.) Dry mouth

SOME OF THE LESS FREQUENT SIDE EFFECTS:

1.) Low ph — acidity in the mouth

2.) Gastroesophageal reflux

3.) Tongue enlargement

4.) Burning sensation in the mouth or tongue

5.) Mouth breathing

Let’s look at these:

Oral inhaled and systemic medications can alter the “normal” bacterial counts in the mouth allowing the

yeast organisms to dramatically increase. This whitish, painful infection needs to be treated with

medication and is best prevented as we will talk about later.

Mucous membrane irritation is also associated with inhaled medications and can lead to oral infections

in the mouth and even further in the throat and esophagus.

Dry mouth-many medications, not just those associated with asthma, have as a side effect “dry mouth”.

The clinical manifestation of this is a dry mouth can lead to an increase in dental cavities, bad breath,

and gum disease(periodontitis).

In the less common side effect category is the possibility of lower ph in the mouth(higher acidity), again

leading to an increase in dental cavities(caries). Gastroesophageal reflux means that stomach acid

normally contained in the stomach backs up into the esophagus, again causing irritation and burning in

the esophagus and increasing the acid content in the mouth. Tongue enlargement, although rare,

obviously leads to more difficulty in breathing, swallowing, and even speaking . Burning mouth/tongue-

this is a very difficult to diagnose and control condition that is extremely uncomfortable to those

afflicted-making eating and speaking a painful experience. Mouth breathing-once again here we have

the beginnings of dry mouth, increase in dental caries, mouth soreness and the potential of yeast

growth due to the lack of saliva “bathing” the teeth to remove plaque and bacteria.

THEREFORE: BE VERY PROACTIVE IN YOUR DENTAL HEALTH

1.) RINSE YOUR MOUTH THOROUGHLY AFTER USING AN INHALER!!!!!!!

2.) Brush, floss, and rinse after each meal

3.) See your dentist for a thorough cleaning and exam every 3-4 months

4.) Look for “white spots” on the enamel of your teeth-a sign that acids are starting to weaken the

enamel possibly causing future problems

5.) Drink lots of water frequently. We are supposed to have 8 glasses of water(8X8 ounces) every

day-people with asthma should consume at least that and more

6.) AVOID SUGARY FOODS AND SNACKS-THIS IS THE “FOOD” BACTERIA NEED TO ATTACK THE TEETH

AND CAUSE CAVITIES AND GUM PROBLEMS

7.) Try sugarless gum (Xylitol containing) to increase saliva flow and to help clean the teeth if

brushing and flossing are not possible after a meal

8.) Use a spacer for your inhaler and make sure your health care professional has observed that

you are correctly inhaling the medication. This is to insure that the meds are not just stopping in

your mouth, but are actually getting deeply in to the lungs

9.) If you have a history of dental caries, dry mouth, or periodontal disease, talk to your dentist

about using fluoride rinses and/or fluoride trays. This use of topical fluoride can decrease the

possibility of cavities, gum disease and can even decrease sensitivity to cold and sweet things

Charles A. Matlach, DDS

Clinical Director AEGD

Advance Education in General Dentistry

A.T. Still University Arizona School of Dentistry and Oral Health

5835 E Still Circle

Mesa, Az 85206

THE LINK BETWEEN VITAMIN D AND ASTHMA

The exact etiology of asthma still remains a mystery to health care practitioners.  Part of the difficulty is that there are numerous forms and types of asthma and varying degrees of severity in the categories.  It is well known that asthma cases are on the increase dramatically since the 1960s, and many theories  exist to account for this—diet changes, environmental influences, a decrease in exercise and a lack of exposure to sunlight.(1) There has been significant research showing a correlation between Vitamin D intake and reduction in asthma severity.

Vitamin D has long been recognized to reduce inflammation (2), and “boost” the immune system. It has been theorized that this reduction in inflammation could help individuals suffering from asthma since asthma is inflammation of the airways.  The immune system helps the body to fight off infections,  so, in turn, reducing the chances of inflammation and subsequent infections after attacks.(3)

There are numerous studies linking Vitamin D intake with reduction in childhood asthma attacks and frequency, however, more research needs to be done to see if proper dosing of Vitamin D to newborns and infants can decrease the likelihood of developing asthma later in life.(4)

People living in areas with less sunshine, overcast winters and lower temperatures had higher rates of asthma and also had lower blood levels of Vitamin D. The lower Vitamin D levels make sense since this vitamin is produced by the body when in contact with sunlight.  The correlation for this is that we have many studies showing people that spend more time in the sun have reduced risk of asthma and reduced number of attacks.(5)(6)

The bottom line is, there are studies that show a major correlation between Vitamin D intake and decreased asthma incidence and attacks in children, and studies that show very little correlation(especially in adolescents and adults).(7)  Should we all take Vitamin during our lifetime as a preventative for asthma and severity of attacks if you have the disease?  How does this affect me and my family?  The best recommendation from the Vitamin D Council is: children take 1,000 units of Vitamin D a day for every 25 pounds of their weight up to 5,000 units for a 125 pound child or adolescent.  The same 5,000 units a day for adults-although the federal government has stated that up to 10,000 units will probably do you no harm. Vitamin D is stored in the body fat, so it is possible to over due it. Stick to the guidelines and consult your health care professional if you have and questions.

The Vitamin D Council also recommends that pregnant women take 6,000 units a day of D.  How this affects the risk of your child developing asthma later in life is not known, but it does appear to reduce some of the complications associated with pregnancy.(8)

In summary, my best advice is to follow the guidelines of the Vitamin D council for ALL age groups. If taken appropriately, Vitamin D can’t hurt you and it most certainly can help with your immune system,  an increase in skeletal strength, cardiovascular health, etc.  Get outside, exercise and enjoy the sunshine(in Moderation), take your appropriate supplements and consult your health care professional with any questions!

Charles A. Matlach, DDS  MM

Clinical Associate Director, AEGD

A.T.Still University  Az School  of Dentistry and Oral Health

5835 E. Still Circle

Mesa, Az. 85206

480-248-8107

 

References

  1. National Institute of Health. What is Asthma? 2014
  2. Gupta, A., Bush, A., Hawrylowicz., et al., Vitamin D and Asthma in Children.

Paediatr  Respir Rev, 2012. 13(4): p. 236-43

  1. Ibid
  2. Niruban, S.J., Alagiakrishan, K., Beach,J., et al., Association Between Vitamin D

And Respiratory Outcomes in Canadian Adolescents and Adults. J Asthma, 2015: p.1-33

  1. Krstic, G., Asthma Prevalence Associated with Geographical Latitude and Regional Insolation
  2. In the United Sates of America and Australia Plos One, 2011. 6(4): p. e14892
  3. Castro, M., et al., Effect of Vitamin D3 on Asthma Treatment Failures in Adults with Severe

Bronchial Asthma and lower Vitamin D Levels. JAMA, 2014. 311(20): p. 2083-91

  1. Wagner, CL., Baggerly, C., McDonnell, S., Baggerly, KA., French, CB., et al., Post Hoc Analysis
  2. Of Vitamin D Status and Reduced Risk of Preterm Birth in Two Vitamin D Pregnancy Cohort Compared with South Carolina March of Dimes Rates. Steroid Biochem Mol Bio. 2015 Nov7