Dental Side Effects of Stimulants for Treatment of Hypersomnias

May 9, 2017 in Ask the doctor, Side effects

Caring for Your Dental Health

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Did you know? Stimulants such as Adderall, Vyvanse, and Ritalin used for the treatment of hypersomnia, can have dental side effects.

by Sheri Katz, DDS, Diplomate, American Board of Dental Sleep Medicine

Stimulants are often prescribed for the treatment of hypersomnias because they act to target the nervous system to increase wakefulness. This includes medications such as Adderall, Vyvanse and Ritalin.

Most people are aware that stimulants can have various side effects but may not be familiar with dental side effects.

People taking stimulants may notice bruxism (teeth grinding and clenching) and a decrease in saliva, resulting in dry mouth (called xerostomia). These side effects do not affect everyone, but for those who find them bothersome, there are ways to manage these problems.

First, an explanation of how saliva is produced and why it’s important to dental health: saliva is a fluid secreted by four pairs of glands located between the ear and jaw, under the tongue and under the jaw. It serves several vital functions:

1. Saliva contains enzymes that function in the initial stages of digestion.

2. Saliva contains minerals that neutralize the acids produced by bacteria in dental plaque. These minerals also help to repair early tooth damage.

3. Saliva keeps your mouth moist and comfortable. It also aids in the process of tasting and swallowing and washes food off the teeth after eating.

A person with dry mouth produces less saliva and may notice an increase in temperature and sweet sensitivity. Dry mouth may also cause an increased accumulation of plaque, white spots on tooth enamel (demineralization) and an increase in tooth decay. People with dry mouth may also experience dry lips, inflammation and crusting at the corners of the mouth, unspecific gum irritations, and a painful or burning mouth. Additionally, there may be complaints of halitosis (bad breath) and an altered sense of taste.

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Dry mouth (xerostomia) may be managed in the following ways:

1. Using artificial saliva products (such as sprays) which can help moisten the tissues and lessen the discomfort of dry mouth (these do not require a prescription and may be found on drugstore shelves)

2. Chewing sugar free gum or sucking on sugar free hard candy, which can increase salivary flow

3. Applying fluoride regularly through your dentist or by prescription which will protect the teeth by:

● strengthening the enamel and making teeth more impervious to acid

● keeping bacteria from multiplying

● decreasing the ability of the bacteria to adhere to teeth

4. Stopping smoking and all tobacco use

5. Limiting caffeine

6. Avoiding use of mouthwashes that contain alcohol

7. Adding humidification at night

8. Making sure you are breathing through your nose and not your mouth, if at all possible

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9. Speaking with your prescribing physician about changing dosages or exploring other medications that do not have dry mouth as a side-effect

Clenching and/or grinding the teeth, usually at night (Bruxism)

The causes of this disorder vary and are often unknown, but there are links between bruxism and smoking, alcohol, caffeine, illicit drug use and many prescribed medications, including stimulants.

Mild bruxism may require no treatment, but if severe, can cause headaches, jaw pain (pain in the temporomandibular joint, a condition also known as TMJ) and damage to the teeth and dental restorations.

Treatment for clenching and grinding may include:

1. Getting counseling on relaxation

2. Making lifestyle changes (quitting smoking, alcohol)

3. Using mouthguards (occlusal splints), made by the dentist and worn at night to protect the teeth and remove pressure from the joint

4. Asking your dentist about orthodontia and bite adjustments — these have been used to treat bruxism; however they are irreversible, and there is no high quality evidence to support these techniques

5. Again, speaking about the dosage and type of medication with your doctor; together you can decide if the effects of the medication outweigh the discomfort of the side effects

Sources:

1. Plemons JM, Al-Hashimi I, Marek CL; Managing dry mouth and salivary gland hypofunction. Executive summary of a report American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2014 Aug;145(8):867-73. doi: 10.14219/jada.2014.44.

2. Sessle, Lavigne, et.al, Orofacial Pain: 2nd ed., 214-215.

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