Acero

Australian Dental Journal

The official journal of the Australian Dental Association

Australian Dental Journal 2010; 55: 128–133

REVIEW

doi: 10.1111/j.1834-7819.2010.01226.x

Asthma and oral health: a review
MS Thomas,*A Parolia,* M Kundabala,* M Vikram*
*Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, India.

ABSTRACT
Asthmais a chronic inflammatory condition that causes the airways to constrict and produce excess mucus, making
breathing difficult. It is characterized by the obstruction of airflow which is variable over a short period of time. This
condition is reversible, either spontaneously or can be controlled with the help of drugs. Asthma medication comprises
bronchodilators, corticosteroids and anticholinergicdrugs. Most of these drugs are inhaled using various forms of inhalers
or nebulizers. The effect of these drugs on oral health is the subject of debate among dental practitioners. Patients taking
asthma medication may be at risk of dental caries, dental erosion, periodontal diseases and oral candidiasis. Hence, patients
with bronchial asthma on medication should receive special prophylacticattention. This article reviews the correlation
between asthma and oral health, and suggests various measures to counter possible oral health problems related to asthma.
Keywords: Asthma, beta-2 agonist, dental caries, dental erosion, inhaled corticosteroids, oral candidiasis, periodontal disease, salivary flow.
Abbreviations and acronyms: GOR = gastro-oesophageal reflux; ICS = inhaledcorticosteroids.
(Accepted for publication 27 September 2009.)

INTRODUCTION
Asthma is a growing public health problem affecting
over 300 million people worldwide. It is estimated that
an additional 100 million may be diagnosed with
asthma by 2025.1 Asthma is characterized by chronic
airway inflammation and increased airway hyperresponsiveness, leading to symptoms such as wheezing,
coughing, chesttightness and dyspnoea. It is characterized by the obstruction of airflow which varies over a
short period of time and is reversible, either spontaneously or with treatment.
Asthma treatment has two main objectives: to
control, as well as to reduce the airway inflammation,
and reopen the airways. Drugs that achieve the first
objective are called anti-inflammatory agents and those
that achieve thesecond are called bronchodilators.
Asthma medication falls into two categories: quick
relief medication and long-term control medication.
Quick relief medication comprises of short-acting
bronchodilators, systemic corticosteroids and anticholinergic drugs. Long-term control medication includes
anti-inflammatory agents, long-acting bronchodilators
and leukotriene modifiers.1 Most asthma drugsare
inhaled using various forms of inhalers or nebulizers.
Patients should be carefully trained in the use of
inhalers for these to be effective. Patients should also
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be instructed to use inhalers regularly as prescribed.
Inhalers which deliver these medicaments may be used
up to four times a day over a long period. As the
prevalence of asthma is on the rise, the problems caused
byasthma medication could result in a significant
worldwide dental health problem. Therefore, it is
necessary to scrutinize the effects of asthma and its
medication on oral health.
Studies show that prolonged use of beta-2 agonist
can reduce salivary flow.2,3 Ryberg et al.3 observed that
the secretion rates of whole and parotid saliva
decreased by 26% and 36%, respectively, in asthmatics
onmedication when compared to the non-asthmatic
control group. Asthmatic subjects also showed a
decrease in output per minute of total protein, amylase,
hexosamine, salivary peroxidase, lysozyme and secretory IgA in stimulated parotid saliva.4 Any factor which
reduces the quality and quantity of saliva can negatively
affect oral health because saliva plays an important role
in its preservation...