Dental Cavities on Prednisone

As a dentist, I do not know of any relationship between prednisone and tooth decay. Tooth decay has been well researched. The three absolute requirements are: 1 refined carbohydrate, 2 streptococcus mutans and, 3 tooth structure. Without any one of the 3 above items there cannot be tooth decay. I do not know of any relationship between the above three and prednisone. Without knowing your personal situation my first guess is you are going to a new dentist. My experience is if you go to a new dentist that does not know your caries rate and they will try to fix every minor defect. Caries in most people can be completely controlled with good oral hygiene. Does your dentist or hygienist review you oral hygiene at each visit? If you do not know the quality of your oral hygiene you can not correct any defects. My daughter is 42 and has no cavities or fillings due to her diet and oral hygiene. She obviously has a low caries rate. I have told her if a dentist ever tells her she needs a filling, get a second opinion. Caries free individuals at 42 are not going to get any cavities unless their diet or oral hygiene changes

@jfannarbor

I would be the first to admit that I don't know anything about it. My dentist didn't know what changed but I had an increase in cavities when I was on Prednisone. My dentist was conservative when it came to fillings so she would commonly put a "watch" on potential problems.

Those things she put a watch on turned into cavities rather quickly. The solution was more frequent visits and cleanings---every 3 months. My dentist got my dental insurance to approve frequent visits because of medical reasons.

I don't think I had "new cavities" very often but frequent revisions of old fillings that "leaked." I got the impression it was the tooth structure around the fillings that was the problem.

In any case, my dentist wondered if Prednisone was causing my problems. My dentist thought prednisone could affect the oral environment, which likely contributed to changes in my mouth's biome and a dry mouth.

What is your take on the following research? I don't know if it is credible or not.
https://juniperpublishers.com/adoh/ADOH.MS.ID.555801.php
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I suspect more research is needed.

He has been going to the same dentist for two decades. He usually has to have one or two fillings after his six month’s checkups, but since he’s been on prednisone, he’s had five or six cavities at each visit. Thank you for your reply.

@crs1950

I didn't have that many cavities... maybe 1 or 2 every six months. More frequent dentist visits didn't seem to reduce that rate. I was on Prednisone daily for 12 years so the cavities added up.

I'm off Prednisone now and I don't have so many dental problems anymore. Some of my dental problems were abscesses and cracked teeth. I needed a couple of root canals but those teeth are now dental implants.

@dadcue This research article related to alveolar bone (the bone that holes the teeth in place) and periodontal disease (gum disease or lost of bone around teeth that is a leading cause of tooth loss in older individuals). I can understand how prednisone can influence these oral problems. My response related to tooth decay. I am now trying to figure out how prednisone used to treat PMR could influence tooth decay. My only thought now relates to generalized pain, and the pain in the shoulder girdle area could possible affect the ability or desire to maintain good oral hygiene. I am now going to use PubMed to see if there are any articles relating to prednisone and tooth decay. More later.

@crs1950 Any comment by the dentist or staff on the level or quality of oral hygiene? If prednisone is directly affecting tooth decay this is a major problem since many older adults are taking prednisone for PMR or arthritis or other auto immune diseases. Until I know more my guess is a reduced level of oral hygiene due to pain or increase time needed to accomplished the activities of daily living, leaving less time or motivation to practice good oral hygiene.

@jfannarbor

Pain was a factor for me but not PMR pain. I forgot about trigeminal neuralgia and how it used to affect my oral hygiene. Brushing my teeth would trigger electric shocks to my face that I called "zaps." I practiced the "10 zap rule" for brushing my teeth. Some days 10 facial zaps while I brushed my teeth equated to less than 10 seconds. On days when I experienced episodes of full on facial electricity, I wouldn't even attempt to brush my teeth.
https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344

@dadcue - how did your dentist make that request for your dental insurance to approve frequent visits because of medical reasons? What should we tell our dentist to accomplish this?

@jfannarbor I agree completely with your statement.
Additionally I always told my patients that as far as your teeth are concerned it’s not the amount of sugar or carbs that affects your teeth but the frequency that you’re repeating. Once you take the first bite of cake you can eat the entire thing and it won’t be worse than the first bite as far as your decay rate. The patients that get the worst decay are those that take small amounts of sugar repeatedly throughout their day ie, Tic Tacs, or jelly beans, etc.
Once you put any sugar in your mouth it takes about 45 minutes for your saliva to neutralize the acid formed by the bacteria. If you then repeat that every hour because the gum has lost its flavor or your “ snacking” etc. because you think your breath is bad that’s where we saw patients with rampant decay.
Same principle of not putting a baby to bed with a juice bottle or anything sweet as it ruins their primary teeth.
Prednisone does cause dry mouth in some patients and that will/ can cause an increase in their decay rate as it’s your saliva that works to neutralize any acid formation from the carbs etc. If you’re using breath mints or anything with sugar to combat your dry mouth it will exacerbate the problem.

@crs1950

I don't know exactly. I had a Delta Dental plan that covered cleanings and "preventative care" every 6 months. Apparently my plan had a provision for cleanings every 3 months for certain medical conditions. My dentist asked me about my medical conditions but we never discussed the details. I wouldn't have said I had PMR but she knew I was on Prednisone.