SPECIALISTS SAY MEDICINES TAINT PEOPLE'S TEETH, GUMS.

Byline: Lauran Neergaard Associated Press

The elderly man had tooth decay like Dr. Sebastian Ciancio had never seen before: a large black hole on the outside of one of his two front teeth.

It turns out the man gagged on his heart medicine when he stuck the nitroglycerin tablets under his tongue - where they're supposed to go - so instead he stuck them under his top lip. And they ate the hole in his tooth.

Hundreds of medicines that Americans take every day, from the country's most popular blood pressure pills to chewable vitamin C tablets, can cause serious tooth decay and gum disease, oral medicine specialists told the American Dental Association.

Many doctors either don't know about these dental side effects or don't warn patients, the specialists said. They urged dentists to question patients about their general health and medications.

``We have to look very carefully at the medicines our patients take and think very carefully about the side effects,'' said Ciancio, a dentist and pharmacologist at the University of Buffalo.

Added Dr. Michael Siegel of the University of Maryland: ``If you know ahead of time what they're taking, you know what their mouth looks like before you get in there.''

Oral medicine specialists, who taught classes at this week's ADA meeting on recognizing drug side effects, said the top problems include:

Up to 20 percent of patients taking calcium channel blockers for high blood pressure and heart disease suffer gum swelling. The inflammation opens pockets in the gums for bacteria to infiltrate, leading to massive swelling and serious gum disease. These medicines include some of the nation's biggest-selling drugs, including Procardia, Cardizem and Adalat.

Similar swelling is caused by anti-epilepsy drugs, particularly Dilantin, and some amphetamines used to treat hyperactivity in children.

Cyclosporin, used by organ transplant recipients to prevent organ rejection, can cause an even more massive gum overgrowth. Its appearance also can resemble the gum inflammation caused by leukemia, Ciancio warned.

More than 400 drugs cause dry mouth, as can radiation treatment for cancer. Saliva is vital to a healthy mouth, and people who don't have enough are prone to cavities, excess plaque and fungal infections, and may need topical fluoride treatment.

The problems are serious enough that Ciancio will ask doctors to switch patients with swollen gums from calcium channel blockers to another heart medicine if possible.

``If not, they need very strict plaque control and to see the dentist every two months,'' he said.

Indeed, gum side effects could be prevented by a clean mouth, said Siegel, who showed a photograph of a Procardia patient whose teeth and gums were so damaged the patient needed surgery.

``If there's no plaque, there's no problem,'' he said. But ``the physician will say, `I didn't know about that.' ''

Ciancio also showed a photograph of a Dilantin patient whose gums were so swollen only the tips of the front teeth were visible.

``If you have patients going on Dilantin, getting them to the dentist in 10 days can minimize that condition,'' by treating gum pockets where bacteria lurks, he advised.

But prescription drugs aren't the only problem. Over-the-counter lozenges, cough drops and antacids are full of sugar, Ciancio warned.

He cited a woman who repeatedly had new cavities throughout her mouth. She said she brushed regularly and avoided sweets, leaving Ciancio perplexed. Then his receptionist spotted the woman popping a Tums, and she acknowledged she sucked on three packs of the antacid a day.

``Besides calcium, the biggest ingredient is sugar,'' Ciancio said.

Even chewable vitamin C can pose a problem, both because of the sugar that makes the pills palatable and because people who chew many tablets a day have a much higher than normal acid content in their mouths, he said.