The Tribune

By Deandra Duncombe

Registered Dental Hygienist

ASTHMA is the most common chronic childhood disease and is a major public health issue throughout the world. Asthma is a disorder in which the airways of the lungs swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing. The severity of the airway inflammation and airflow determines the need for asthma medication. Cavities, often referred to as tooth decay or caries, are the most common childhood disease. Cavities lead to the breakdown of the layers of the teeth and can cause many other complications.

In the 1970s, the first study to examine the role of asthma as a leading determinant in the formation of dental cavities was conducted. Since then, several studies have evaluated the effect of asthma severity on cavities prevalence. Some studies have explored the possible cavity causing mechanisms related to the use of asthma medication while other studies chose to evaluate the constant ‘mouth breathing’ of the asthmatic which may lead to decreased salivary flow and lowed protection for the patient. These changes can be the result of the medication that the asthmatic is taking or the disease itself which can lead to an increase in cavities.

The human race has faced wars, famines, death and destruction, but its most dangerous offender is microscopic.

Diseases have plagued mankind for thousands of years, killing millions and altering the lives of every human being.

In the early part of the 20th century, Japanese scientist Jokici Takamine isolated adrenalin, which has since played a major role in the fields of cardiology, obstetrics, and also in the treatment of asthma.

This discovery has had an enormous impact on the treatment of asthma. Takamine’s work allowed the previously assumed psychotic cause of asthma to be re-evaluated and determined that the illness was of a physical origin. In the late 1950s, devices such as the Metered-Dose Inhaler, bronchodilator and the nebuliser delivered fast acting asthma medications, containing isoproterenol and epinephrine, directly into the patients lungs via inhalation.

The four main factors that play an essential role in the development of asthma induced cavities are the length of the disease, the medication used, the severity of the disease, and the amount of exposure to systemic fluoride.

Most asthma medications contain sugar which is also used to mask the taste and also acts as an indicator for users to recognise that the medication has been released. Some inhalers contain up to 25 mg of sugar per dose.

Studies have proven that with frequent use, asthmatic medications can decrease the flow of saliva which is used to protect the teeth against cavities. Severe asthmatics may use the inhaler more often and can also mouth breathe which can add to the dryness of the mouth. The reduced salivary flow leads the user to drink fluids which will most likely contain sugar as well. This combination of factors creates an ideal environment for bacteria to multiply and wreak havoc on the oral cavity. With tooth decay being five times more prevalent than asthma, systemic and topical fluoride (a solution used to strengthen teeth) is crucial for developing and erupting teeth. Exposure to fluoride, even in the smallest amount, greatly decreases the amount of cavities in an asthmatic child.

Beta-agonists, a type of asthma medication, are known to cause very severe dry mouth.

It is also reported that beta-agonists alone are not the most effective medication on the market.

Patients using both beta-agonists and corticosteroids have been shown to have a lowered cavity rate because the effectiveness of both drugs leads to less frequent use. Asthma-induced cavities in children can have a major impact on the oral health of those children once they’ve reached adulthood.

It is important to distinguish that asthma itself does not cause caries but the medication used in combination with poor nutritional habits are the culprits. Most children prefer sugary substances so parents should be conscious of sweet foods and liquids ingested by an asthmatic child.

The use of fluoride should be stressed with asthmatic children due to the continuous development of the teeth and also because newly erupted teeth not being completed mineralised. All measures to prevent dental caries, such as sealants, should be considered along with frequent re-mineralisation. Additionally, it is also important for dental professionals to not only be able to teach asthmatic children correct tooth brushing techniques but to also teach them the correct way to use an inhaler. Patients should be informed to rinse with water after each dose of medication and not to choose sugary liquids to treat inhaler-induced dry mouth. Information is the best defence against any disease so it is important to stay knowledgeable.

Visit your dentist or dental hygienist for more information on how to protect your child from tooth decay and other oral diseases.