Orthodontics and Asthma UK — What Asthma Patients Need to Know

How steroid inhalers affect oral health

Inhaled corticosteroids (ICS) — including beclomethasone (Clenil, QVAR), budesonide (Pulmicort), and fluticasone (Flixotide, Seretide, Relvar) — are the cornerstone of preventive asthma management in the UK and are prescribed to hundreds of thousands of patients. Their local side effects on the mouth and throat are well recognised and directly relevant to anyone undergoing orthodontic treatment. The most common oral side effect is dry mouth (xerostomia), caused by the inhaled particles depositing in the oropharynx and reducing saliva flow in some patients. Saliva is critical for oral health — it buffers acids, remineralises enamel, and washes away food debris and bacteria. Reduced salivary flow raises the risk of tooth decay, gum disease, and discomfort during orthodontic treatment. Oral candidiasis (thrush) — a fungal infection caused by Candida albicans — is a recognised side effect of inhaled steroids, presenting as white patches on the palate, tongue, or throat, and is more likely in patients who do not rinse their mouth after inhaler use. Enamel erosion risk is also modestly elevated in patients with dry mouth who sip acidic drinks frequently to alleviate the discomfort of dryness.

What to tell your orthodontist about asthma

Always disclose your asthma diagnosis and all current medications — including both preventer and reliever inhalers — at your orthodontic consultation. This information affects clinical decisions including the frequency of monitoring appointments, the choice of appliance, and the emphasis placed on oral hygiene instruction. Some orthodontists will recommend additional fluoride supplementation for high-caries-risk patients using ICS, such as prescription-strength fluoride toothpaste (2800ppm or 5000ppm fluoride) used in place of standard toothpaste. The orthodontist may also liaise with your GP or respiratory consultant if there are concerns about how treatment will interact with your management plan — for example, if stress or anxiety triggers your asthma, and orthodontic appointments cause anxiety. Disclosing any latex allergy is also important, as some older elastics, gloves, and dam materials contain latex, though latex-free alternatives are now standard in most practices.

Oral hygiene precautions for asthmatic patients in braces

Patients using ICS should rinse their mouth thoroughly with water immediately after every inhaler use — before and during orthodontic treatment. This simple step significantly reduces both the risk of oral thrush and the deposition of steroid particles on the teeth and gingival tissues. If possible, use a spacer device with the inhaler, which reduces oropharyngeal deposition and improves lung delivery. With fixed braces in place, meticulous cleaning around brackets and wires is essential. A fluoride mouthwash used after brushing — separate from the brushing step so as not to rinse away toothpaste fluoride — provides additional protection against white spot lesions. Patients with clinically significant dry mouth should discuss saliva substitutes or stimulants with their dentist, as these can reduce the discomfort of dryness and lower decay risk. Regular orthodontic hygiene appointments throughout treatment are particularly important for asthmatic patients.

Can inhalers affect how quickly teeth move?

There is limited clinical evidence that routine use of standard-dose inhaled corticosteroids significantly affects the rate of orthodontic tooth movement. Some experimental studies have suggested that systemic steroids may influence bone remodelling — the process by which teeth move through the alveolar bone — but the doses used in these studies are far higher than those in standard inhaled asthma treatment. For the overwhelming majority of asthmatic patients using standard ICS doses, tooth movement rates are not clinically affected. If you are taking high-dose ICS or concurrent oral steroids for severe asthma, it is worth discussing this with your orthodontist, but it should not be a barrier to treatment. The far more clinically relevant concern for asthmatic patients is the oral health impact of dry mouth and thrush rather than any effect on tooth movement rate.

Clear aligners vs fixed braces for asthma patients

Neither clear aligners nor fixed braces is absolutely contraindicated in asthma. The choice is made on clinical grounds in the same way as for any patient. However, there are some practical considerations specific to asthmatic patients. Clear aligners must be removed for inhaler use — using an inhaler with aligners in place traps steroid particles against the teeth and gingival tissues. This reinforces the habit of removing aligners before each inhaler dose. Fixed braces require more intensive cleaning to protect against white spot lesions in the context of dry-mouth-related reduced salivary buffering, so oral hygiene compliance is particularly important. Patients with exercise-induced asthma who use a reliever inhaler before sport should factor aligner removal into their pre-exercise routine. Overall, the decision between aligner and brace treatment should be made on clinical suitability, with asthma representing a consideration for hygiene and aftercare rather than a reason to prefer one appliance type over another.

Using a spacer and rinsing after inhalers — the dental recommendations

The two most impactful recommendations for protecting oral health in inhaled steroid users are using a spacer device and rinsing the mouth after every use. A spacer (also called a volumatic or AeroChamber, depending on the device) attaches to the inhaler and allows the propellant to slow down before inhalation, significantly reducing the amount of drug deposited in the mouth and throat and improving the proportion that reaches the lungs. Spacers are available on NHS prescription and should be used routinely if a pressurised metered-dose inhaler (pMDI) is prescribed. After each inhaler use — with or without a spacer — rinsing the mouth with water and spitting out removes residual steroid from the mucosa. Some dental professionals recommend also gargling. These steps are particularly important during orthodontic treatment when the presence of brackets or aligners creates additional surfaces and spaces where residual medication or biofilm can accumulate.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.