Methotrexate is a medication prescribed for various conditions, including autoimmune disorders like rheumatoid arthritis and psoriasis, and some types of cancer. It functions by interfering with cell growth and suppressing the immune system, which helps manage inflammation and disease progression. While effective, methotrexate can have various effects on the body, including specific impacts on oral health. Understanding these potential dental side effects is helpful for individuals undergoing this treatment.
Common Oral Side Effects of Methotrexate
Methotrexate affects rapidly dividing cells, leading to oral issues. Oral mucositis, painful mouth sores or ulcers, is a frequent side effect. These lesions can appear on the gums, under the tongue, or on the roof of the mouth, causing discomfort and making eating or speaking challenging.
Stomatitis, a general inflammation of the mouth lining, can make the entire oral cavity feel sore and irritated. Gingivitis, or gum inflammation, can also occur, presenting with redness, swelling, and tenderness. These conditions can lead to increased gum bleeding, especially during brushing or flossing.
Impact on Saliva and Infection Risk
Methotrexate can contribute to xerostomia, or dry mouth, by reducing saliva production. Saliva plays a significant role in maintaining oral health by neutralizing acids and washing away food particles and bacteria. A decrease in saliva flow can lead to increased acid levels in the mouth, elevating the risk of dental caries, or cavities, as tooth enamel becomes more vulnerable to decay.
The immunosuppressive nature of methotrexate increases susceptibility to opportunistic infections. Oral candidiasis, or thrush, is a fungal infection that can occur. Symptoms of thrush include white patches on the tongue or inner cheeks that can often be rubbed off, revealing sore, red areas underneath. This infection can also cause a burning sensation, an unpleasant taste, or difficulty swallowing.
Managing and Preventing Dental Issues
Maintaining diligent oral hygiene is important for individuals taking methotrexate. Using a soft-bristled toothbrush and brushing gently helps prevent irritation to the sensitive oral tissues while still effectively removing plaque. Avoiding oral products that contain alcohol, such as certain mouthwashes, can also reduce irritation. Staying well-hydrated by drinking plenty of water throughout the day helps alleviate dry mouth symptoms and supports saliva production.
Over-the-counter saliva substitutes, gels, or lozenges can provide temporary relief from xerostomia, especially at night. These products help moisten the mouth and protect oral tissues. Physicians often prescribe folic acid supplementation alongside methotrexate to mitigate some common side effects, including mouth sores and gastrointestinal issues. Folic acid helps counteract the medication’s effect on folate levels, which can reduce the incidence of oral discomfort. Patients should always follow their doctor’s specific instructions regarding folic acid dosage and timing.
Considerations for Dental Procedures
It is important for individuals taking methotrexate to inform their dentist or oral surgeon about their medication before any dental procedure. This information allows the dental team to take appropriate precautions. Methotrexate can affect the body’s healing processes and immune response, which can lead to complications following dental interventions.
Risks associated with dental procedures while on methotrexate include delayed wound healing and a higher chance of infection. Slower recovery can occur due to the medication’s interference with tissue repair. Therefore, close communication between the patient’s dentist and their prescribing physician is advised. The physician may recommend adjustments to the methotrexate regimen, such as a temporary pause in medication, but this should only be done under medical guidance.