The Association Between Long-Term Corticosteroids Use and Dental Caries: A Systematic Review

Abstract

Corticosteroids (CSs) are a group of medications prescribed regularly to treat a wide range of inflammatory and immune-related conditions with great benefit. The impact of long-term use of CSs on the oral cavity has been reported before, including increased risk of periodontal disease and dental caries. Thus, the aim of this study is to evaluate the prevalence of dental caries in patients using CSs. A literature review was completed using PubMed and Cochrane search engines. The search was based on questions related to adults and children (P); corticosteroids (I); no corticosteroids (C); and dental caries (O) (PICO questions) using the keywords “steroids” and “caries” with all relevant variations and MeSH terms. Decay missing filling tooth/decay missing filling surface (DMFT/DMFS) scores were selected as parameters to assess the effects of CSs on caries prevalence. Data was extracted and analyzed for comparisons. The search yielded 1,206 articles from January 2001 to January 2023, of which 21 papers were eligible for analysis. Overall, 14 studies reported an increase in caries with CSs use. However, seven studies failed to report an association of caries prevalence with CSs use. Current evidence supports the correlation between increased risk of caries with chronic CSs use, specifically for inhaler formulation. Future studies with randomized controlled clinical studies are warranted to confirm these findings.

An Update on Drug–Nutrient Interactions and Dental Decay in Older Adults

“…The impact of the long-term use of CSs on the oral cavity has been reported, including an increased risk of periodontal disease and dental caries in addition to changes in the properties and function of saliva [209]. However, the impacts of CS use on oral health are unclear and may include a decrease in salivary flow, lower pH, and higher bacterial levels of Streptococcus mutans and Lactobacilli as well as an increased risk of dental caries [210].…”

“…Patients should also be educated to perform mouth rinses after using inhalers. Chewing sugarless gum for at least one minute after drug administration will also help to neutralise salivary pH, stimulate salivary flow, and buffer oral acids, reducing the risk of caries formation [209,216].…”