Use of inhalers and their effects on oral health

Oral health can be altered in asthmatic patients treated with inhalers. We tell you about the most common oral conditions and how to avoid them.

Last update: 17 March, 2022

Asthmatic attacks and breathing problems are uncomfortable and even serious situations that nobody wants to suffer. Congratulations, There are treatments that reduce symptoms. But did you know that inhalers can affect oral health?

It is very common for asthmatic patients to receive inhalation treatments. This effective and easy-to-administer medication dramatically improves breathing. However, its use can have consequences for oral health. Which? In this opportunity we detail its main side effects.

Inhalers for the treatment of asthma

Asthma is a chronic disease that affects the respiratory system. It is characterized by increased airway inflammatory response to different environmental triggers.

Difficulty breathing, wheezing, coughing, and chest pain are the main manifestations of this disorder. It can affect people of any age, although it is more common during childhood.

Often, its treatment includes the use of inhalers. These are devices filled with a drug that reduces inflammation of the airways and promotes bronchodilation.

In this way, it improves symptoms, facilitates breathing and prevents the progression of the disease. Even during asthmatic crises they can save the life of the affected person.

The choice of medication It depends on the severity of the disease and the particularities of each case. Some options are as follows:

  • Short-acting bronchodilators.
  • Steroidal anti-inflammatory agents.
  • Long-acting bronchodilators.
  • Leukotriene modifiers.

The most common route of administration is inhalation. Thus, remains of these drugs are deposited in the oropharyngeal areawhich can cause unwanted local effects.

Depending on the medication used, the doses administered and the susceptibility of the patient, side effects may appear in different parts of the body. In this article we will focus on the impact of inhalers on oral health.

The inhaler can contain different types of medicine. Its purpose is to improve the symptoms suffered by patients with asthma or other respiratory conditions.

Effects of inhalers on oral health

The use of inhalers to treat non-infectious respiratory diseases such as asthma and to prevent acute attacks has an indirect influence on oral health. The medication causes changes in the oral environment. Consequently, adverse reactions appear in dental tissues and mucous membranes.

The increased risk of certain oral pathologies is mainly related to the reduction of salivary flow. Also with the use of drugs that lower the pH. However, you should know that lifestyle and the presence of other health conditions also affect risk.

Below, we mention the most frequent oral health problems in patients treated with inhalers.

Xerostomia or dry mouth

It is very common for patients suffering from asthma to also be mouth breathers. This usually happens as response to shortness of breath and to get all the air they need.

Prolonged and usual oral breathing leads to a dry mouth. In addition, certain medications contained in inhalers decrease salivary production, which exacerbates oral dryness.

A mouth without adequate lubrication is not only uncomfortable for the patient, but also It hinders oral functions and unprotects the oral structures. In particular, it leads to the following:

  • Decreased mechanical cleaning action.
  • Difficulty in maintaining the neutral pH.
  • Inhibition of the defense mechanisms of this fluid.
  • Bacterial plaque formation.
  • Oral diseases, such as cavities, gingivitis and halitosis (bad breath).

Alterations in the oral mucosa

Another effect of inhalers on oral health is lesions that can be caused in the oral mucous membranes. The continued use of corticosteroids added to dry mouth —which we already talked about— favor the appearance of these alterations:

  • Canker sores and mouth ulcers, especially on the cheeks.
  • Sore throat.
  • Dysphonia.
  • Macroglossia (increased size of the tongue), although less frequently.

Halitosis or bad breath

The bad smell in the mouth is another of the effects on oral health associated with the use of inhalers. In the absence of adequate lubrication and cleaning through saliva, Volatile sulfur compounds are produced that cause halitosis in these patients.

A dry mouth favors the development of bacteria and the accumulation of food debris on the oral surfaces. These germs and debris trapped on the tongue, gums and teeth, if not removed, cause an unpleasant mouth odor.

gum disease

Periodontal disease is another consequence that must be considered for the use of these medications. The condition of supporting tissues It occurs as a result of the interaction of several situations that come together in the asthmatic patient.

In fact, there is a strong association between asthma and periodontal disease. This is due to the imbalance in the inflammatory and immune processes and the side effects of the drugs contained in the inhalers.

Mouth breathing, the decrease in saliva, the alteration in its composition and in the defensive capacity, as well as the accumulation of bacterial plaque sWith situations that coincide and favor periodontal diseases to take place.

Some studies suggest that the accumulation of bacterial plaque is greater in asthmatic children. The inflammation of the gums would arise as a response to this excess of germs on the oral surfaces.

Gingivitis associated with the use of inhalers it is most frequently observed in the anterosuperior area of ​​the maxilla. It manifests itself with swollen, red, shiny and bleeding gums. There may also be gingival recession and tooth sensitivity.

And in the most advanced and untreated cases, the process can evolve into periodontitis. There is a greater risk of suffering from this pathology the more severe the asthma condition. Here the deep tissues that support the teeth are compromised, which can lead to the loss of the elements.

However, the use of inhaled corticosteroids It is associated with reduced bone mineral density. This alteration in the jaws could impact the onset and progression of periodontal disease in asthmatic patients.

Dental caries

Dental caries is one of the most common chronic pathologies in the entire world population. It not only affects the teeth, but also influences the general health, nutrition and quality of life of those who suffer from it.

This disorder is of multifactorial origin. The confluence of bacterial, dietary, behavioral, anatomical, and genetic factors lead to mineral loss of the hard tissues of the teeth.

There is a strong association between asthma and dental caries, especially in pediatric ages. And this relationship increases in the most severe cases and with longer treatments.

However, there are other studies that failed to find a correlation between asthma and the appearance of cavities. It is true that, as it is a pathology caused by several factors, the appearance or not of the disease varies from person to person.

The decrease in salivary flow, the increase in bacterial plaque and the added sugar in some medications are factors that favor the development of the pathology in patients with asthma.

Caries is one of the frequent diseases among patients who use inhaler regularly.

tooth erosion

Dental erosion is loss of enamel and dentin as a consequence of the action of acids present in the mouth. An oral pH lower than 5.5 is capable of demineralizing dental tissues.

People who use inhalers can suffer from this type of oral health problem, since the changes that the medication causes in the saliva favor the appearance of the disorder.

In fact, asthmatic patients not only have less saliva; the composition of the fluid is also altered. Most inhaled drugs create a pH less than 5.5.

Therefore, their saliva tends to be more acidic and they have more difficulty neutralizing the action of intrinsic acids, such as gastric acid that can reach the mouth due to gastroesophageal reflux. The extrinsic acids of soft drinks, juices and fruits suffer the same fate.

The close relationship between asthma and gastroesophageal reflux also favors this oral acidity that demineralizes the teeth. In this sense, it is advisable to look for external measures that help neutralize the pH to reduce dental erosion. For example, the following:

  • Make oral rinses with baking soda.
  • Use mouthwashes with neutral sodium fluoride after using the inhalers.


The inhalation of steroidal anti-inflammatory drugs has a great influence on the development of this mycosis in the mouth. Infection with the fungus called Candida albicans it is frequent in the areas where the aerosol is deposited.

There is a correlation between the degree of candidiasis and the frequency of corticosteroid use. It has been observed that the changes that this medicine causes in the saliva decreases the protection against this infection. Thus, patients experience symptoms such as throat discomfort and swallowing difficulties.

How to prevent the effects of inhalers on oral health?

There are some measures that can help prevent the side effects that occur in oral health due to the use of inhalers. The most important are discussed below.

  • Drink enough water: To counteract dry mouth and its consequences in the mouth, it is necessary to hydrate properly.
  • Rinses after inhalation: rinsing the mouth with water, a solution of sodium bicarbonate or mouthwashes with neutral fluoride helps to eliminate the remains of medication. It also reduces the sensation of dry mouth and the acidity of the oral environment.
  • Chewing sugar-free gum: chewing favors the production of saliva. Using sugar-free gum can lessen dry mouth.
  • Use spacers: When applying the medication, the use of spacers reduces the contact of the drug with the oral cavity. These are devices that allow the dose to be directed more directly to the respiratory tract.
  • Maintain proper oral hygiene: brushing your teeth, gums, and tongue helps remove plaque bacteria. It is also important to floss and use fluoride toothpastes.
  • Take care of the diet: Avoid acidic foods and beverages rich in simple sugars that favor the proliferation of bacteria and acidify the oral environment.
  • To visit the dentist: Regular visits to the dentist and information about your health history will help control oral health problems associated with inhaler use. Timely treatments and the application of preventive measures will avoid complications.

Avoid negative effects of inhalers on oral health

Asthma treatment reduces respiratory symptoms and prevents acute crises. But drugs that remain in the mouth when using inhalers also cause unwanted effects on oral health.

Be aware of these possible consequences of asthma treatment allows you to anticipate its appearance. With the necessary care, many of the oral pathologies can be avoided. Thus, you will not only be able to breathe better, but also smile calmly.

You might be interested…