Side Effects of Aspirin and How to Minimize Them

Introduction

Ciancio (2004) mentioned in his studies, Many adults and particularly people who are over 65 years of age use over-the-counter and prescription drugs. But these medications-prescription, over-the-counter, vitamins and minerals, herbal preparations can affect oral health. Over the years with the increase in population's aging, more drugs become available and dentists are expecting to encounter medication-related oral side effects among their patients.

Generally medicines are designed to make us feel better but sometimes their side effects have negative impacts on an individual's teeth and oral health. All medicines, whether they are taken orally or injected, come with a risk of side effects, and many medicines are known to cause oral problems. Medicines used to treat cancer, high blood pressure, painkillers, depression, allergies, and even the common cold, can have a negative impact on patient’s oral health. That is the reason it is so important for a dentist to know about all the medications taken by the patient, including over-the-counter products, vitamins, and supplements.

Aspirin, or acetylsalicylic acid (ASA), is the most widely used medicine in the world. It is commonly used for headaches, period pains, colds and flu, sprains and strains, and for long-term conditions, such as arthritis. It is an anti-inflammatory drug and can be used as a blood thinner. People suffering with a high risk of blood clots, stroke, and heart attack can use aspirin long term in low doses.

Herres J et al (2009) mention in their research, Aspirin and other salicylates are among the oldest medications remaining in clinical practice. The use of aspirin has declined due to its association with Reye's syndrome in children, and the development of other nonsteroidal antiinflammatory drugs (NSAIDs). However, aspirin remains a common analgesic and a widely prescribed antiplatelet therapy for patients with cardiovascular and cerebrovascular disease, and thus aspirin toxicity remains an important clinical problem

Campos et al (2007) mentioned that Acetylsalicylic acid interrupts the production of prostaglandins into the body by targeting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) . When injected into human body, prostaglandins substances known to cause headaches and pain. Prostaglandins increases the sensitivity of pain receptors and substances such as histamine and bradykinin. Due to the disruption in the production and prevention of release of prostaglandins, this drug may prevent pain receptors to generate pain in the human body. Acetylsalicylic acid is considered an antipyretic agent because of its ability to interfere with the production of brain prostaglandin E1. Prostaglandin E1, which is known to be an extremely powerful fever-inducing agent.

O'Malley GF (2007) states that, The universal nature of salicylates makes them easily available for overdose whether intentionally or not. Salicylate poisoning cases can become very complex because of the erratic absorption, distribution, metabolism, and elimination of the drug. Because of these drug characteristics, any medical practitioner who cares for a salicylate-toxic patient should appreciate how quickly their clinical status can deteriorate.

All efforts have been aiming in treating and removal of salicylate from the bloodstream. The recent concept is to keeping the salicylate away from the brain. An understanding of the fate and distribution of salicylic acid is necessary to assess possible advantages and disadvantages of any given therapeutic maneuver in relation to this concept. Salicylates are usually administered as sodium salicylate or acetylsalicylic acid (aspirin), which is rapidly hydrolyzed to salicylic acid in blood and distributes rapidly throughout all the tissues. Salicylic acid is metabolized to salicyluric acid, a phenolic glucuronide, an acyl glucuronide, and gentisic acid, which is further conjugated. These metabolites are continuously excreted that for practical purposes, only salicylic acid is in the body. Generally, in man, a single 3-g oral dose of sodium salicylate is recoverable in the urine within 48 to 72 hours.

There are some most common oral side effects of Aspirin are:

Aspirin is a non-steroidal anti-inflammatory drug (NSAID), which means it is not steroids. Steroids often have unwanted side effects. Aspirin can cause gastric irritation and contribute to GI bleeding and peptic ulcers. Moderately high therapeutic doses can cause tinnitus, which is described as an abnormal auditory sensation or buzzing noise and is considered an early sign of salicylate toxicity.

Excessive doses of aspirin produce the toxic effects. Hyperventilation is caused by direct and indirect stimulation of the respiratory center in the medulla, which leads to increase in exhalation of carbon dioxide and respiratory alkalosis. Increase in number of plasma salicylate concentrations can cause fever, dehydration, and severe metabolic acidosis. In the absence of proper treatment, these events can culminate in shock, coma, organ failure, and death. Excessive doses of aspirin can also cause hypoprothrombinemia, which is an impairment of hemostasis and causes bleeding.

Zero (1996). stated in his studies that the use of aspirin, if chewed, can contribute to the cause of tooth erosion. These studies analyzed both laboratory studies, where extracted teeth were placed in a water with aspirin mixture, and clinical case studies, where people took six doses of aspirin powder per day for a two-to-three year period of time. In the laboratory study, scientists observed changes in the surface of both the enamel, outer covering of the teeth, and dentin, the layer of tooth structure under the enamel, of the extracted teeth tested. In the clinical case study, the top surface of the teeth has severe erosion of the teeth. McCraken (2000) concludes in his research that the aspirin powder is the reason behind the tooth erosion.

Sullivan (1983). studies examined 42 children with rheumatoid arthritis. All the participants were split into two groups, group 1 consists of those who chewed aspirin, and group 2, who swallowed it. Study shows that children who chewed aspirin tablets experienced severe erosion of the upper and lower primary molars, and their first permanent molars. And the children who swallowed the aspirin tablets experienced no erosion of their teeth. The scientists concluded that the tooth erosion these children developed was due to chewing the aspirin tablets. These studies proves that aspirin can affect the structure of the tooth surface depending how the analgesic is taken and can cause irritation to the soft tissue in the mouth.

Some medicines can cause a dry mouth because it reduces the amount of saliva in the mouth. In the absence of enough saliva, the tissues in the mouth can become irritated and inflamed, Saliva plays an important role in protecting our teeth from bacteria. So when our mouth is dry, risk for infection and tooth decay is increased.

Those who take regular pain medication, should follow Oral care regimen:

• Increase daily water intake by drinking at least 8-10 glasses of water a day.
• Brushing twice a day.
• Regular dental check-ups and cleanings.
• Use a moisturizing mouth spray.
• Eating hydrating snacks like celery sticks.
• Don’t use tobacco products.
• Cut back on caffeinated and dehydrating drinks like coffee, tea and alcohol.

For the bad breath which often accompanies dry mouth, one should try chewing on any of the following herbs: parsley, aniseed, fennel or rosemary. When you do reach for the antacids to treat heartburn or acid reflux, find a sugar-free option. Be sure to brush your teeth after taking an antacid to help reduce any damaging effects.

To minimize the damage of acid reflux on teeth, try to avoid foods that trigger heartburn and acid reflux, such as the following:

• Spicy foods
• Alcohol (particularly red wine)
• Black pepper
• Garlic
• Raw onions
• Chocolate
• Citrus fruits and juices
• Coffee and caffeinated drinks
• Peppermint
• Tomatoes

Add the following foods to your diet to help reduce the occurrence of heartburn and acid reflux:

• Vegetables (green beans, broccoli, asparagus, cauliflower, leafy greens, potatoes and cucumbers)
• Ginger
• Oatmeal
• Whole-grain bread and whole-grain rice
• Non-citrus fruits (melons, bananas, apples and pears)
• Lean meats (chicken, turkey, fish and seafood grilled, broiled baked or poached — avoid fried meat)
• Egg whites
• Healthy fats (avocados, walnuts, flaxseed, olive oil, sesame oil and sunflower oil)

Conclusions

To minimise damage, brushing every 4 hours and at bedtime helps mouth to get moisturized and prevent any infections. One should be careful, as It is important to brush and floss very gently. Rinsing mouth frequently with antiseptic mouth cleanser, prevents periodontal (gum) infections and inflammation. Good oral hygiene and frequent visits to the dentist can help in reducing the chances of tooth erosions. Since many patients regularly take medications, both prescribed and non prescribed, dentists always must take a thorough medical history so that they can be aware of medication-related problems and the impact of medications on diagnosis and treatment planning.