Dental Cavities on Prednisone

@jfannarbor i was an internist for many years. Xerostomia from prednisone was not taught at my medical school. After practicing for some while I noticed a percentage of my patients on long term prednisone did complain of it. I usually tied it to another medication they were taking. I did, one day look it up in goodman and gillman ( did u relay on this book in dental school, just curious) and found it was a side effect, listed as less common. The following is from AI:

Prednisone, a synthetic glucocorticoid, impairs salivary gland function primarily through long-term use, leading to reduced saliva production. It diminishes store-operated calcium entry (SOCE) in salivary acinar cells, which is essential for fluid secretion triggered by intracellular calcium signaling.

From a different AI source:

Long-term use inhibits store-operated calcium entry (SOCE) in salivary acinar cells, reducing intracellular calcium levels essential for saliva secretion. This occurs when prolonged corticosteroid exposure diminishes calcium influx after endoplasmic reticulum depletion, without altering key membrane proteins like TMEM16A, AQP5, or NKCC1.[pharmacytimes +1]
Supporting Factors
Corticosteroids may thicken saliva or affect the sympathetic nervous system, limiting flow, though this is less specific to prednisone. Short-term use typically spares salivary function, with effects prominent after weeks.

Sorry I didn’t look up specific studies.

@laura1970 As I may have mentioned I went to PubMed and crossed prednisone with dental caries and the only related study was in rats and it did show reduced saliva when rats were given dexamethasone. I went to Drugs.com and searched prednisone side effects. Of the 2000 words written about side effects it did mention "dry mouth" under incidence unknown. It is shocking all the side effects of prednisone including heart attack. I am estimating that there were 100 to 200 side effects mentioned. After being on and off prednisone for 35 years, mostly on, I feel very lucky that the only side effect I had was thin skin.

@jfannarbor that is lucky. The majority of my patients experienced weight gain which I attributed to a combination of prednisone and decreased activity due to their underlying disease. Depending on the dose, a significant , but less than the majority of, developed moon facies.

It is nice to see contributions by medical professionals to this forum. I was fortunate as a nurse to take care of patients on prednisone and also to be a patient on prednisone. I saw all the side effects of prednisone on patients almost daily.

I was grateful to my nursing coworkers who saw my side effects from prednisone. They seemed concerned and were always asking me how much prednisone I was taking. Most of my coworkers never heard of PMR but they knew all about prednisone.

@laura1970 I don't know if this is the reason I don't have so many problems, but I am a championship tennis player and exercise excessively.

@jfannarbor

As a Dentist you obviously have no experience with steroids.

Prednisone and other corticosteroids can contribute to an environment in the mouth that promotes the growth of Streptococcus mutans. You literally proved yourself wrong.

Using steroids disrupts your body’s hormone balance, which might impact your gums. One common issue among steroid users is gingival overgrowth, where the gum tissue swells and grows excessively. This can cause spaces to form between your teeth and gums, creating perfect hiding spots for bacteria. If not addressed, this condition can progress to periodontitis, a serious gum infection that harms the soft tissue and even the bone that holds your teeth in place, possibly resulting in tooth loss.

In my case my gums shrunk (prednesone decreases swelling, forming pockets for food and plaque to get stuck. I have two teeth that need to be pulled due to deep gum problems that were not visible. All within a year after high prednesone use for 3 years. I also chipped a tooth on a nut as you eat vigorously on steroids. Your mouthy is always dry - prednesone changes the whole biome of your body and mouth - FACT. It also does cause stomach problems and can/does cause acid reflux. Why wouldn't you think any of thie lead to cavities? (you said acid causes cavitioes you don't just get it from sugars).
Listen to the patients - Steroids cause toothy problems.

I am a dentist and have had PMR for 35 years. I have taken prednisone off and on for 35 years, mainly on. I am still taking prednisone as an 80 yo. I have not had any dental decay for the last about 25 years. I looked at PubMed and found 14 scientific articles that addressed both prednisone and dental caries. All the articles were associated with other conditions that could affect dental caries (xerostomia, Sjogron Syndrome, asthma, and others). If you have any scientific articles or clinical studies that show a link between PMR, prednisone and dental caries I will be happy learn from it. I have not experienced it as a person with PMR on prednisone or as a dentist treating patients taking prednisone. If a patient has a dry mouth due to xerostomia, Sjogron Syndrome or is a mouth breather which leads to a dry mouth it should be treated with saliva substitutes. Here is a listing of the 14 scientific articles I found on PubMed. I am willing to learn and am aware of animal studies that show steroids reduce saliva, but in that study a very strong steroid (Dexamethasone) was used.
What follows are the 14 articles I found on PubMed:
Association between dental caries and pneumonia in patients with systemic lupus erythematosus.
Pascual-Ramos V, Hernández-Hernández C, Soto-Rojas AE, Celis-Aguilar E, Sánchez-Guerrero J. J Rheumatol. 2006 Oct;33(10):1996-2002. Epub 2006 Sep 1. PMID: 16960926
Oral health was worse among the cases, including more periapical lesions, cervical and third-grade caries, and a higher mean number of caries/patient than controls (p < or= 0.05). In the multivariate analysis, third-grade caries (odds ratio 7.5, 95% CI 2.05 …
2
Xerostomia: an immunotherapy-related adverse effect in cancer patients.
Bustillos H, Indorf A, Alwan L, Thompson J, Jung L. Support Care Cancer. 2022 Feb;30(2):1681-1687. doi: 10.1007/s00520-021-06535-9. Epub 2021 Sep 25. PMID: 34562169
PURPOSE: Xerostomia is an underrecognized adverse effect of immunotherapy (IO) that can significantly impact patients' quality of life by leading to poor nutritional status, dental caries, and oral candidiasis. The purpose of this case series was to describe the ons …
3
A Case-Control Comparison of Salivary pH, Dental and Periodontal Health, and Bacterial Counts of Porphyromonas gingivalis and Streptococcus mutans in Patients With Systemic Lupus Erythematosus.
Bashiri H, Maybodi FR, Heidari H, Haris FS, Dehkordi NR. Spec Care Dentist. 2026 Jan-Feb;46(1):e70146. doi: 10.1111/scd.70146. PMID: 41663879
CONCLUSION: Tooth loss in SLE may be related to caries rather than periodontal disease, potentially influenced by lower salivary pH and elevated S. mutans levels. Altered salivary composition may contribute to increased caries risk even in the absence of xerostomia. …
4
Oral health and the masticatory system in juvenile systemic lupus erythematosus.
Fernandes EG, Savioli C, Siqueira JT, Silva CA. Lupus. 2007;16(9):713-9. doi: 10.1177/0961203307081124. PMID: 17728364
The two groups were homogeneous regarding age, gender, Brazilian social-economic class and dental decay index (P > 0.05). Of note, the medians of the PI and the GI were higher in JSLE patients than in controls (61.5 versus 38.10, P = 0.003 and 26.0 versus 15.95, …
5
[Sjögren disease complicated by primary breast lymphoma: A case report].
Ning Y, Zhang X, Li X, Li Y, He J, Jin Y. Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):808-811. doi: 10.19723/j.issn.1671-167X.2025.04.029. PMID: 40754924 Free PMC article. Chinese.
Her clinical presentation included recurrent parotid gland enlargement accompanied by sicca symptoms, notably persistent xerostomia and xerophthalmia, followed by progressive dental caries. Serological studies demonstrated positivity for antinuclear antibodies, anti …
6
Acute lymphoblastic leukemia: dental health of children in maintenance therapy.
Sepet E, Aytepe Z, Ozerkan AG, Yalman N, Guven Y, Anak S, Devecioglu O, Agaoglu L, Gedikoglu G. J Clin Pediatr Dent. 1998 Spring;22(3):257-60. PMID: 9641104
The dental health of 41 children aged 4-16 years who were in maintenance therapy from acute lymphoblastic leukemia (ALL) was examined in relation to the period of time in maintenance. There was no significant difference in dental experience and salivary flow rate be …
7
A cross-sectional study of medication-related factors and caries experience in asthmatic children.
Milano M, Lee JY, Donovan K, Chen JW. Pediatr Dent. 2006 Sep-Oct;28(5):415-9. PMID: 17036706
PURPOSE: The purpose of this study was to examine the relationship between the specific types of medication, length of use, frequency of use, and dosing time of day on the dental caries of children diagnosed with asthma. METHODS: Using a patient list from a previous …
8
Chest Pain, Cough, and Hemoptysis.
Demetriou E. Adolesc Med. 1996 Oct;7(3):335-342. PMID: 10359979
Associated symptoms were cough with sputum, night sweats, fever, decreased appetite, and 4.5-kg weight loss; cavitary lesions were seen on chest radiograph. The patient also had significant dental caries. Nasal biopsy revealed findings consistent with Wegener's gran …
9
Increased risk for dental caries in asthmatic children.
Milano M. Tex Dent J. 1999 Sep;116(9):35-42. PMID: 10860081 No abstract available.
10
Dental management of patients after liver transplantation.
Svirsky JA, Saravia ME. Oral Surg Oral Med Oral Pathol. 1989 May;67(5):541-6. doi: 10.1016/0030-4220(89)90270-3. PMID: 2524018
As more patients undergo liver transplantation and survival rates continue to improve, the dental profession must adopt a protocol for dealing with these patients. With this in mind, a protocol for dental management of the patient who has had a liver transplant is p …
Page 2
11
[Therapy of early tuberculous cavities with tuberculostatics and prednisone (prednisolone)].
SABLJICA B, MRAKOVCIC M. Tuberkulosearzt. 1961 May;15:325-30. PMID: 13745174 German. No abstract available.
12
Sjögren syndrome in a child: favorable response of the arthritis to TNFalpha blockade.
Pessler F, Monash B, Rettig P, Forbes B, Kreiger PA, Cron RQ. Clin Rheumatol. 2006 Sep;25(5):746-8. doi: 10.1007/s10067-005-0042-z. Epub 2006 Jan 4. PMID: 16391885
We report a girl who developed purpura, polyarthritis, uveitis, and severe dental caries in the first year of life and optic neuritis by age three. SS was diagnosed at 11 years of age, when severe hypokalemic renal tubular acidosis developed during infliximab treatm …
13
Odontogenic osteomyelitis or bisphosphonate-related osteonecrosis of mandible of patient with autoimmune disease: clinical dilemma.
Tolstunov L, Cox D, Javid B. Compend Contin Educ Dent. 2012 Nov-Dec;33(10):E116-22. PMID: 23631533
14
Thrombocytopenia: first symptom in a patient with dyskeratosis congenita.
De Boeck K, Degreef H, Verwilghen R, Corbeel L, Casteels-Van Daele M. Pediatrics. 1981 Jun;67(6):898-903. PMID: 6894487

I’m a retired Administrator for a Dental group Practice. What I’ve noticed since going on prednisone (about 6 months in) is dry mouth and I feel like I’m having gum recession. My teeth are more sensitive to temperature and I’ve used Sendodyne for decades. Ugh. Thank you for all the information!

@mmavl sorry but could you clarify please? Do the steroids cause gum tissue to swell or reduce in size? Both are mentioned your comment. Gum tissue does recede with age. Is that the issue?

@gmdb I’m aware of the normal issue of some gummies due to age, however, my observation is that in the 5+ months I’ve been on prednisone, the recession is actually noticeable to me. Also, the increased sensitivity is another side effect of gum recession, right? I asked my dentist at my cleaning appointment if there was anything I could do to prevent this and he just said that medication induced recession was difficult and encouraged extra time flossing, brushing, etc. I’d already been doing that, so not really anything to be done, I guess.