Dental Dilemmas

In this episode, Don and Steve separate fact from fiction about meds and oral health.

💊 Could your favorite mouthwash be more “spirited” than you think?
😬 Can a key medication for opioid use disorder quietly sabotage your smile?
🦷 What really happens when you put aspirin on a toothache—relief, or regret? 

Ready to brush up on the facts and drill down to the truth? No need to sugarcoat it, our myth-busting pharmacist duo (and a special dentist guest expert) are here to rinse away the rumors and polish up the evidence!

Claims:

• Fluoride toothpastes and mouthwashes are harmful. 
• Alcohol-based mouthwashes should be avoided with metronidazole. 
• Patients need prophylactic antibiotics before most dental visits. 
• Putting aspirin directly on a tooth can help cure a toothache. 
• Sublingual or buccal buprenorphine is linked to tooth decay and cavities. 

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TRC Healthcare Editor Hosts:  

• Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC  
• Don Weinberger, PharmD, PMSP 

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Guest:  

• Jayson Chalmers, DDS 

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CE Information: 

None of the speakers have anything to disclose. 

TRC Healthcare offers CE credit for this podcast for subscribers at our platinum level or higher. Log in to your Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.

Claim Credit 

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Clinical Resources:  

• Chart: Alcohol and Drug Interactions 
• FAQ: Management of Opioid Use Disorder 
• Chart: Analgesics for Acute Pain in Adults 
• Toolbox: Antibiotic Stewardship 

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10% off a new or upgraded subscription with code rvt1025 at checkout.

🎓 Student free version of Pharmacist’s Letter. 

Email us: rumorvstruth@trchealthcare.com

The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Find the show on YouTube by searching for ‘TRC Healthcare’ or clicking here.

Learn more about our product offerings at trchealthcare.com.

Chapters

• 0:00 Introduction
• 0:21 Welcome
• 1:04 CE Information
• 1:46 Overview
• 2:35 Claim: Fluoride toothpastes and mouthwashes are harmful.
• 9:33 Claim: Alcohol-based mouthwashes should be avoided with metronidazole.
• 12:42 Claim: Patients need prophylactic antibiotics before most dental visits.
• 20:24 Claim: Putting aspirin directly on a tooth can help cure a toothache.
• 23:13 Claim: Sublingual or buccal buprenorphine is linked to tooth decay and cavities.
• 26:00 Summary
• 26:32 Rumor vs Truth Mailbag: Testosterone
• 29:06 A few more things...
• 30:29 Find us on YouTube!

Transcript

This transcript is automatically generated. 

00:00:05 Narrator

Welcome to Rumor vs Truth, your trusted source for facts… where we dissect the evidence behind risky rumors and reveal clinical truths. 

00:00:12 Narrator

Today we’ll take a bite out of dental-related myths.  

00:00:21 Don Weinberger

Hey, Steve, did you know that October is dental hygiene month? 

00:00:24 Steve Small

I did not.

00:00:26 Don Weinberger

And I was looking at and how are you expected to celebrate that? Am I supposed to give my dentist a gift?

00:00:32 Steve Small

Well, frankly, Don, don't they have the tooth fairy for that?

00:00:35 Steve Small

But I am curious, now that you asked this, what would your gift be to your dentist?

00:00:40 Don Weinberger

I don't know. Like a plaque, maybe.

00:00:43 Steve Small

Mine would probably be my insurance premiums. It's the gift that keeps on giving…

00:00:48 Steve Small

As our dentists in the audience are filling out their wish list. I'm Steve, the pharmacist.

00:00:53 Don Weinberger

And I'm Don the pharmacist.

00:00:55 Steve Small

And in this episode, we're celebrating dental hygiene month by sinking our teeth into claims involving medications and other products that affect oral health.

00:01:04 Don Weinberger

And new for this month, this podcast offers continuing education credit for pharmacists, pharmacy technicians, physicians, and nurses subscribed at our platinum level or higher. 

00:01:14 Don Weinberger

Just log in to your pharmacist letter Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.

00:01:22 Steve Small

Yeah, I'm very excited to be offering CE now, but that also means we need to add a little more info here and in the show notes. 

00:01:29 Steve Small

So for the purposes of disclosure, none of the speakers have anything to disclose.

00:01:35 Don Weinberger

And don't worry, folks, even though we're adding CE, we are still keeping our tongue in cheek puns you love, especially for this episode.

00:01:43 Steve Small

Very true. And what's also true is that over 4 in 10 US adults over 30 had some form of gum disease, which surprised me. 

00:01:51 Steve Small

And pharmacies of whole aisles dedicated to dental health supplies, to help with this, things from toothpaste, toothbrushes, mouthwash, you name it.

00:02:00 Don Weinberger

And dental disease doesn't just mean cavities and tooth loss. Periodontal disease is linked to things like heart disease and even cancer.

00:02:08 Don Weinberger

And I saw a study that showed almost half of the community pharmacists feel they lack enough knowledge on oral health to provide advice to patients.

00:02:16 Don Weinberger

Looking at some of these claims out there can help pharmacists and other professionals fight tooth and nail against dental disease.

00:02:23 Steve Small

Good one, Don. While we unpack these claims with our fine tooth combs, stick around, we'll also answer a listeners’ question about testosterone from our last episode.

00:02:33 Don Weinberger

Okay. So, let's go and jump into that first claim, right? I think this is on many people's minds, doing recent headlines.

00:02:42 Don Weinberger

And the claim is: “Fluoride toothpastes and mouthwashes are harmful.”

00:02:47 Don Weinberger

There's been a lot of headlines on fluoride lately. For example, FDA is revisiting ingestible fluoride products on the market, leading to similar questions about fluoride, toothpaste and mouthwashes. 

00:02:57 Don Weinberger

And to help us with this claim, reach out to the dentist expert Dr. Jayson Chalmers, DDS. He also happens to be the dentist for Matt, our podcast producer.

00:03:08 Don Weinberger

Don't worry Matt. We didn't ask how well you've been flossing, at least on camera.

00:03:12 Don Weinberger

But we did ask about concerns with fluoride products. Let's see what doctor Chalmers had to say.

00:03:22 Don Weinberger

So, Doctor Chalmers, the first one I have for you is.

00:03:26 Don Weinberger

“Fluoride toothpastes and mouthwashes are harmful.” What's your take on that?

00:03:32 Jayson Chalmers

Yeah, fluoride has been used for many years and very important in the dental, right? Yeah. I think anybody's been to the dentist, even if you haven't been to the dentist, you know, fluoride exists and and kind of what it’s for.

00:03:44 Jayson Chalmers

So, harmful or beneficial?

00:03:46 Jayson Chalmers

The answer is yes on both. It can be harmful, it can be beneficial.

00:03:50 Jayson Chalmers

I think as long as it's used appropriately, like any medication in the right dosage, the right application it, it should be absolutely 100% safe. Really it's a, it's a well-tested medication that we use every day in our practice.

00:04:09 Jayson Chalmers

Most toothpaste, over the counter that you're going to see have about 900 parts per million this is your Colgate your Crest. You're going to be using those on a daily basis.

00:04:22 Jayson Chalmers

And you're brushing with that a couple times a day, applying it to the teeth then you know that's usually enough for most people to help strand teeth remineralize the teeth protect them from from cavities forming right?

00:04:34 Jayson Chalmers

Occasionally, people might need a little bit more.

00:04:37 Jayson Chalmers

Maybe their teeth are a little softer. Maybe they're they're got food traps in there. Recession. Their roots are much softer than the crown of the tooth. So the roots get cavities much easier.

00:04:46 Jayson Chalmers

So for those people we’ll prescribe a prescription toothpaste sometimes and those will come out like a we talked earlier about this about the number 5000. What does that mean in toothpaste?

00:04:56 Jayson Chalmers

Prevident 5000 or this five, that's 5000 parts per million, about five times stronger than your over the counter two phase. So that's what it's for.

00:05:05 Jayson Chalmers

Real quickly, when you're brushing with these things, you're going to apply it at least once a day on the prescription toothpaste twice a day for your over the counter toothpaste. 

00:05:14 Jayson Chalmers

You're going to brush for two minutes, you're going to spit it out and you're going to not rinse or do anything for about... I like about 1/2 an hour afterwards, so no water, no rinsing, no food, for about 1/2 an hour after you brush with these, especially these prescriptions strength toothpaste.

00:05:30 Jayson Chalmers

Let them do their work. Let them. I often tell people it's a lot like applying sunscreen on your skin. You wouldn't apply it. Wash it off immediately. 

00:05:37 Jayson Chalmers

You're allowed to sit for a little bit. And I believe you guys had a a podcast about sunscreens recently I think, right?

00:05:43 Jayson Chalmers

Apply it every 20 minutes or 20 minutes before you get in the water, and then if you swim every couple hours, right? Right. So a little thing of that and it kind of the same thing. 

00:05:51 Jayson Chalmers

Treat treat the the high fluoride toothpaste like that. Put it on. Let it sit for a while before you do anything.

00:05:56 Don Weinberger

I do like the consultation point because I think a lot of when we get those prescription toothpaste in the pharmacy.

00:06:04 Don Weinberger

It will say use as directed where it may be, so the patient may this OK, I brush my teeth with the fluoride. I'm gonna wash my mouth out immediately with water to get it off and it's it. 

00:06:12 Don Weinberger

It's good to go. But you're saying Nope. Leave it on there for…

00:06:16 Jayson Chalmers

Leave it on for a little bit. Yeah. 

00:06:18 Jayson Chalmers

Even your over-the-counter toothpaste. It's better to leave it on. Don't rinse it off. And I I I I have to look, I haven't looked at one of the labels in many years. It's like, you know, you kind of just get the tube, you use it and forget about it. But I believe it doesn't say rinse on most of them.

00:06:32 Jayson Chalmers

I think it says to expectorate and that's it. So spit it out. Leave it. So even with my over-the-counter toothpaste and what I do is I actually switch back and forth, I'll do an over the counter usually in the morning I'll do a prescription at night.

00:06:44 Jayson Chalmers

That's kind of how I do my levels of fluoride. But yeah, don't don't rinse with either one of them. Yeah, it's better not to just leave it.

00:06:52 Jayson Chalmers

It's a little awkward and beginning but people get used to it.

00:06:56 Don Weinberger

I also know that they were planning to remove some of those prescription ingestible fluoride products that we have like the tablets.

00:07:03 Jayson Chalmers

Yeah.

00:07:04 Don Weinberger

I'm sure you probably…

00:07:06 Jayson Chalmers

Yeah, end of this month, HHS is saying that we're going to get rid of those ingestible fluorides that maybe you and I would have taken when we were kids. We would have taken the little tablets kind of sweet, you know, it's basically just a fluoride tablet.

00:07:18 Jayson Chalmers

Most dentists haven't prescribed those for a decade or two. It's been a little while, and you're probably not seeing it much on your side either. 

00:07:26 Jayson Chalmers

And and I think for the most part, that's probably in our industry. OK, people are getting fluoride from other sources. They're getting it from the toothpaste. They're getting it from their water, their community water. So having it in your community water, having in your toothpaste.

00:07:41 Jayson Chalmers

You know you don't need as much on a prescription strength as you used to. Yeah. So but it's still a big benefit to some people.

00:07:48 Don Weinberger

OK, got it. Alright. Well, thank you very much for that fluoride overview and all that great information.

00:07:54 Don Weinberger

I'll take it back to Steve and see what he has to say. Thank you.

00:08:01 Steve Small

That was great. I liked Doctor Chalmers’ point about how these products are safe when used according to their directions. That's really key. 

00:08:08 Steve Small

After all, fluid toothpaste shouldn't be ingested, and you could say the same about fluoride mouthwashes, right? If you swallow these products consistently, fluid levels can build up and cause fluorosis.

00:08:18 Steve Small

Including dental fluorosis, which I looked up and says that this is where enamel can develop discolored flex spots or lines even in the teeth, so pretty serious stuff.

00:08:27 Don Weinberger

Right. Yeah. Sounds like it. And that's why kids should use small amounts of toothpaste when brushing, since they're more likely to swallow toothpaste by accident.

00:08:37 Don Weinberger

For example, talk to a dentist before using fluoride toothpaste in kids younger than two and use the size of a grain of rice when kids are two to three years old and the size of a pea from three to six years old.

00:08:49 Steve Small

Nice.

00:08:51 Don Weinberger

So let's go and go back to that claim. And it is “Fluoride toothpastes and mouthwashes are harmful.”

00:08:57 Don Weinberger

And the verdict is…

00:09:02 Don Weinberger

Rumor with conditions.

00:09:05 Steve Small

Right. So before we bad mouth fluoride toothpastes and mouthwashes here it is important to really put that into perspective. Right. 

00:09:12 Don Weinberger

It is. Yeah. Right. So dose is everything when it comes to meds, these products are safe when used according to the directions we can provide these helpful tips on correct toothpaste and mouthwash use.

00:09:23 Don Weinberger

Especially to help patients limit fluoride risks for kids and advise adults to read product directions carefully for safe use.

00:09:31 Steve Small

Great tips there Don, and speaking of mouthwashes, you may have heard this next claim that “alcohol-based mouth losses should be avoided with metronidazole.”

00:09:40 Steve Small

And I remember being taught mixing alcohol even in mouthwashes with metronidazole, a common antibiotic, can cause a disulfiram reaction, and that's where a patient can get flushed, sweaty, nauseous and may even throw up from that combination.

00:09:55 Steve Small

And we know mouthwashes can contain high amounts of alcohol, sometimes almost to a 30% concentration, which is about the same alcoholic content as some vodka brands believe it or not.

00:10:07 Don Weinberger

Yep, good old 60 proof mouthwash, right?

00:10:10 Steve Small

Let it rip!

00:10:12 Don Weinberger

Yep. And in fact, there's thought that this reaction could occur with alcohol up to three days after stopping metronidazole.

00:10:19 Steve Small

Yeah. So it's not just immediately gone once you stop it and it's been questioned, though, whether this alcohol metronidazole interaction is really that big of a to do.

00:10:29 Steve Small

The incidence isn't frankly very clear. It appears very rare. Plus reactions vary amongst patients. They don't all have the same effects.

00:10:38 Steve Small

And even in the Center for Disease Control's 2021 antibiotic guidelines for sexually transmitted diseases.

00:10:44 Steve Small

They mentioned that avoiding alcohol while taking metronidazole or a related drug tinidazole is unnecessary due to lacking evidence, which I found surprising.

00:10:54 Don Weinberger

Yeah, yeah, me too. Especially since, as we've learned, ingrained in pharmacy school and beyond. Right. And it's important to point out mouthwashes generally shouldn't be ingested.

00:11:03 Don Weinberger

Absorption through the mouth from a quick swish and spit isn't expected to cause significant systemic levels though.

00:11:10 Steve Small

Yeah. And I couldn't find any clear cut published cases of these disulfiram reactions from metronidazole and alcohol laden mouthwash. It's mostly with cases using recreational alcohol that you're supposed to consume.

00:11:23 Steve Small

So keep in mind, it's possible that nausea and vomiting here in these patients taking metronidazole is due to the med itself, possibly not the interaction. 

00:11:32 Steve Small

So with all that in mind, this claim that “alcohol-based mouthwashes should be avoided with metronidazole,” the verdict is…

00:11:45 Steve Small

Rumor. Ethanol exposure from mouthwashes is low, like Don said, when used appropriately, and metronidazole's interaction risk seems dubious in this scenario. 

00:11:54 Steve Small

And if you're always concerned about that risk, you can steer patients to alcohol free mouthwashes, which might be a good idea to help decrease mouthwash side effects even.

00:12:02 Steve Small

Such as dry mouth and oral pain. So think about that.

00:12:04 Don Weinberger

Yeah, that fun sting, that alcohol, you can bring my mouthwash, right? Yeah.

00:12:09 Steve Small

Exactly.

00:12:10 Don Weinberger

But we should specify that alcohol drug interactions should still be considered if ethanol is actually ingested, since blood levels will be higher in those cases, check out our alcohol and drug interactions chart online for handy list of possible combinations to avoid.

00:12:26 Steve Small

Yeah, I'll toast to that reference, Don. 

00:12:28 Steve Small

So take a look at the show notes or description, we've linked directly to that chart and a few others related to this episode for easy access.

00:12:34 Don Weinberger

And if you already aren’t a subscriber, don't miss out on these resources. Sign up today to stay ahead with trusted insights and tools.

00:12:43 Don Weinberger

And if that wasn't a pain, brace yourself for this next claim.

00:12:49 Don Weinberger

Patients need prophylactic antibiotics before most dental visits. 

00:12:54 Don Weinberger

I think we may be used to seeing rounds of antibiotics like 2 grams of amoxicillin before dental procedures. But a study of nearly 170,000 dental visits determined 80% of antibiotics prescribed before dental visits to prevent infection are unnecessary.

00:13:11 Don Weinberger

And we know that antibiotic overuse can lead to bacterial resistance. And we know that even a single dose of clindamycin can increase the risk of diarrhea from C difficile infection. 

00:13:20 Steve Small

Yeah, really good point there. So when are antibiotics actually needed during a dental visit then?

00:13:25 Don Weinberger

Well, you know what? I brought our dentist back. 

00:13:29 Steve Small

Great. 

00:13:30 Don Weinberger

Doctor Chalmers. About this claim, to see what's happening in practice, here's what he had to say.

00:13:40 Don Weinberger

My pharmacist colleagues are still saying we're seeing a lot of prophylactic antibiotic dental prescriptions come through for a lot of patients and this is kind of an important claim to address. So what are your thoughts on this?

00:13:50 Jayson Chalmers

Oh, great. Well, thanks for having me. Yeah, we are not seeing in the dental field as many prophylactic antibiotic cases as we used to.

00:13:59 Jayson Chalmers

They’ve really kind of scaled them down over the last decade or two. Now it's just it's very few cases really. 

00:14:06 Jayson Chalmers

And the two things we're mostly worried about are artificial joints and infective endocarditis. That's kind of the reasons we do the prophylactic antibiotic in the first place.

00:14:14 Jayson Chalmers

It’s typically given between 30 and 60 minutes before a dental appointment and then again this with somebody who's really just a high risk for either losing a joint or a new joint, or they've had endocarditis before. 

00:14:28 Jayson Chalmers

They're at risk of getting it again for whatever reason. Sometimes it's an artificial valve.

00:14:34 Jayson Chalmers

Sometimes it's the regurgitation, like the the blood flow isn't the laminar and smooth through the the heart and it eddies and pools. And for people who have had an artificial valve.

00:14:46 Jayson Chalmers

Or a stent or something placed like that, or they've had heart transplant. These are patients. That's for some time until they get that laminar blood flow back again or some in some cases they never get it back, will be on prophylactic antibiotics before dental appointments. 

00:15:01 Jayson Chalmers

So. So we're basically doing for those two reasons for at risk joints like somebody let's say had an artificial hip placed, it became infected immediately after…

00:15:12 Jayson Chalmers

And the doctor is, the orthopedic surgeon is, really nervous about this joint. So, I'm really scared that it's going to fail for some reason. So that's a person.

00:15:20 Jayson Chalmers

And the way this works is usually it's the orthopedic surgeon who's going to tell us in what case it needs to be done or the cardiovascular, doctor, surgeon, will tell us when it needs to be done. 

00:15:32 Jayson Chalmers

So we're not making that determination on our own here at the dental office. We're kind of being told by somebody else this is a good candidate, a patient who needs this.

00:15:41 Jayson Chalmers

That kind of makes sense.

00:15:42 Don Weinberger

Right. That's good to know. And I I like the cardiovascular lesson and the dental lesson all in once in that particular claim. 

00:15:49 Don Weinberger

So when you do need to prescribe antibiotic for that patient subsets, what do you tend to lean towards? What type?

00:15:55 Jayson Chalmers

Yeah, amoxicillin has been our go to for many years. Traditionally, it had been clindamycin if they were allergic to amoxicillin or penicillin or something in that family, right? 

00:16:05 Jayson Chalmers

But recently they've gotten away from the the clindamycin because of c. diff issue in the intestines, right. So they've steered away from that now.

00:16:15 Jayson Chalmers

And we're we're kind of going towards. If you're allergic to penicillin, maybe something like a cephalexin or you're going to be at azithromycin maybe, let's say so that's pretty traditional now. As we're going for amoxicillin, if you're allergic to that, to cephalexin or to azithromycin.

00:16:30 Jayson Chalmers

So that's where we're at.

00:16:33 Jayson Chalmers

So that's the medications we use. They're typically given 30 minutes to 60 minutes before you know the visit. 

00:16:39 Jayson Chalmers

Oh, here's a good point. If they're already on an antibiotic for another reason, let's say somebody was on amoxicillin, they had some other respiratory issue or something their MD places them on amoxicillin. 

00:16:50 Jayson Chalmers

We still want them on a different antibiotic, even though they're on that one, we just want to choose a different class. 

00:16:57 Jayson Chalmers

So we would use then like azithromycin. That's a really… for me, azithromycin an easy go to… you know it's a pretty easy drug on the gut. So I'll usually pick something like that.

00:17:07 Jayson Chalmers

And say, OK, take this azithromycin and 60 minutes before you come to the office, even though you're already on amoxicillin. But, but that's how they're kind of working that these days. So I don't.

00:17:17 Don Weinberger

Oh yeah, I I like that point you made about them being on an antibiotic and no need… they need a different antibiotic for this. So that's a point I didn’t even think of. But definitely key information to give. So I do appreciate that, yeah.

00:17:29 Jayson Chalmers

It is, yeah, it's important. It is important. Yeah, because these are really at risk people. These aren't people who are usually super healthy, you know, they're coming in. They had an infective endocarditis. They've had a heart transplant. They've had a valve or stent placed.

00:17:42 Jayson Chalmers

You know, we got to be really careful with these patients. The bacteria from our mouth gets into our bloodstream very rapidly. 

00:17:49 Jayson Chalmers

Years ago, there was a study about some. They took people with periodontal disease, bad gum disease. They tested their blood anti cubital, right. They took it from the… the arm.

00:18:00 Jayson Chalmers

They had them eat, 10 minutes later they tested them again.

00:18:05 Jayson Chalmers

After eating all of that bacteria from the mouth is found in the bloodstream within 10 minutes after eating. So if you have gum disease, you're getting bacteria that doesn't belong in your bloodstream in your bloodstream, causing who knows what all kinds of inflammatory processes, probably.

00:18:20 Jayson Chalmers

So it is very important to to be careful with these people. Yeah

00:18:23 Don Weinberger

Appreciate it. Well. Thank you. Thank you, doctor. For information, I'll kick it back to Steve and see what he thinks.

00:18:29 Jayson Chalmers

Great, thanks Don for having me.

00:18:34 Steve Small

Nice. Now Don, my first thought was all this talk about mouth bacteria in the blood makes me want to go brush my teeth.

00:18:41 Steve Small

But seriously, those points were great and really aligns with guidance from the American Dental Association, which only recommends antibiotics in certain cases before dental work specifically for patients at the highest risk.

00:18:53 Steve Small

Things like prosthetic joint infection, or endocarditis, that they're really at high risk of that.

00:18:59 Don Weinberger

And those with prosthetic joints who have multiple risk factors as well. So immunocompromised, you know, A1C over 8 percent, things like that. 

00:19:08 Don Weinberger

And those with prosthetic heart valves or some types of congenital heart disease.

00:19:15 Steve Small

Right. And even then, it's not every single dental procedure, dental visit, right. It's really to save antibiotics or dental procedures that involve the gums or soft tissue like teeth cleaning or extractions, things like that.

00:19:26 Don Weinberger

Yeah. So let's go and take it back to the claim, which is “Patients need prophylactic antibiotics before most dental visits” and the verdict is…

00:19:41 Don Weinberger

Rumor.

00:19:43 Don Weinberger

So this is quite the mouth myth now, but don't run off to brush your teeth just yet. Steve. 

00:19:49 Steve Small

Darn. 

00:19:50 Don Weinberger

Yeah. We still have two more claims here.

00:19:53 Steve Small

And you could say I'm chomping at the bit, Don, but seriously, dental prophylaxis, this is a great opportunity for antibiotic stewardship to help limit that resistance Don was talking about. 

00:20:01 Steve Small

So use our resource, antibiotic stewardship toolbox, for more tips on when to save antibiotics for when they are really needed.

00:20:08 Don Weinberger

And that resource is also directly linked in the show notes.

00:20:12 Don Weinberger

And don't forget you can now get CE credit for this episode and, you guessed it, all that info is in the show notes as well.

00:20:20 Steve Small

Yeah, those show notes are super helpful and you should definitely take a look at them. 

00:20:23 Steve Small

And listeners may also be aching to know the facts behind this next claim that “Putting aspirin directly on a tooth can help cure a toothache.”

00:20:32 Steve Small

Now we know that aspirin can help relieve pain when taken orally, and people may think putting it directly on the tooth can locally relieve pain without causing any systemic side effects like bleeding that we sometimes associate with aspirin.

00:20:45 Steve Small

But there's little to no clinical evidence supporting this that that this actually helps with tooth pain. 

00:20:51 Steve Small

I only found one related study all the way back from 1983. Looking at an experimental aspirin solution to decrease oral pain, and it was only in like 11 patients. 

00:21:02 Steve Small

And even then, the authors in that study said don't put Aspirin on a tooth directly.

00:21:07 Don Weinberger

Ok, well. Why not? Yeah, certainly bad. Why not, Steve?

00:21:13 Steve Small

There's some cool chemistry here. Aspirin is acidic, and if you keep putting it on a tooth, it can actually wear down enamel and also even lead to chemical burns on the gums. 

00:21:23 Steve Small

And I was able to find multiple case reports of patients trying this home remedy and it was actually causing more gum damage.

00:21:29 Steve Small

So you're actually likely to cause more pain by doing this, so with this claim that “putting aspirin directly on a tooth can help cure a toothache,” the verdict is...

00:21:45 Steve Small

Rumor. This claim sounds like a home remedy that is long in the tooth. Have you ever seen a patient actually do this, Don? 

00:21:54 Don Weinberger

No, not at all, thank goodness. And we should steer patients to evidence-based approaches for dental pain. 

00:21:59 Steve Small

Right. 

00:22:00 Don Weinberger

First, obviously is getting the issue looked at ASAP by a dentist to see if there needs to be surgery.

00:22:07 Don Weinberger

But you may be asked about pain control until then.

00:22:11 Steve Small

Right. For example, you recommend teens and adults take a non-steroidal anti-inflammatory drug or an NSAID, things like ibuprofen, with or without acetaminophen first line. 

00:22:21 Steve Small

And folks, you do need to take these orally, not topically please. I saw someone make a good point on this.

00:22:29 Steve Small

You wouldn't put aspirin in your forehead for a headache, right? So we need to make sure we take these meds by mouth.

00:22:34 Steve Small

And patients can also temporarily use topical benzocaine products. But these really should not be used in kids under 2 due to increased risk of blood disorders.

00:22:44 Don Weinberger

Yeah, good point there, Steve, thank you for that.

00:22:47 Don Weinberger

And use our handy chart analgesics for acute pain in adults to review tips on safety, using NSAIDs, acetaminophen, and more.

00:22:54 Steve Small

Right. And before we get into our next claim, a quick reminder if you're enjoying this episode and want access to even more clinical insights, check out Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights. 

00:23:05 Steve Small

As a listener you can get 10% off a new subscription with the code rvt1025 at checkout.

00:23:13 Don Weinberger

OK, let's talk about something that actually puts bad taste in people's mouths, so buckle up here and the claim is “sublingual or buccal buprenorphine is linked to tooth decay and cavities.”

00:23:26 Don Weinberger

So we do know sublingual and buccal, buccal means you just you park it inside the cheek where it's absorbed through that area.

00:23:36 Don Weinberger

Those versions of buprenorphine and buprenorphine with naloxone are commonly used to treat opioid use disorder or OUD.

00:23:43 Steve Small

Right. And I remember FDA released a statement in 2022 when they noticed an uptick in dental issues such as tooth decay, cavities, infections and tooth loss even in patients taking these meds, even those who didn't have any previous dental issues.

00:23:57 Don Weinberger

That's true. And even more recent evidence suggests that this can indeed be a risk with these types of buprenorphine. It's possibly because of buprenorphine’s acidity causing tooth erosion, but it's still hard to say. 

00:24:11 Steve Small

Yeah, it kind of reminds you of aspirin we we're talking about but we should put it in perspective, right? These medications can save lives by treating opioid use disorder and these dental issues were reported in only about 300 cases out of 2 million patients taking buprenorphine in 2022.

00:24:27 Steve Small

So this dental issue is not a reason to withhold treatment or suddenly stop taking buprenorphine for opioid use disorder.

00:24:35 Don Weinberger

Yeah. Good, good. Follow up there, Steve. Thank you. And going back to that claim, it's “sublingual or buccal buprenorphine is linked to tooth decay and cavities.” And the verdict is...

00:24:54 Don Weinberger

True.

00:24:55 Steve Small

Yeah. So the side effect is not as rare as hen's teeth, but the risk is still pretty small compared to the benefits we were talking about with buprenorphine.

00:25:02 Don Weinberger

OK. Before we get to more science, I need to go back to what you just said, Steve.

00:25:09 Steve Small

What?

00:25:11 Don Weinberger

Rare as hens teeth? Gonna need you to explain that one.

00:25:16 Steve Small

Ohh well, I think we'll have to get doctor Chalmers on the line because I'm not a veterinary dentist.

00:25:20 Steve Small

But I am from Iowa, so keep that in mind.

00:25:22 Don Weinberger

OK. OK, Enough said you're good, alright.

00:25:26 Don Weinberger

And pharmacists can consult patients taking sublingual or buccal buprenorphine on good oral hygiene to prevent disease. 

00:25:34 Don Weinberger

After the medicine has completely dissolved patients should gently rinse their teeth and gums with water, then swallow and patients should wait at least one hour before brushing their teeth.

00:25:45 Don Weinberger

Getting regular dental checkups is also key to monitor for issues. 

00:25:48 Steve Small

Yeah, and good for just general dental health, and you could read more about using buprenorphine and other meds for opioid use disorder and pain. Using our management of opioid use disorder resource online.

00:26:00 Don Weinberger

Cool. All right, let's go ahead and drill down to that bottom line truth, right?

00:26:05 Don Weinberger

So, medications can have a large impact on oral health. Healthcare professionals can help patients sort through treatment options and ditch those risky home remedies.

00:26:14 Steve Small

Yeah, quite a mouthful of myths with this episode Don, and now I want to schedule my own dental appointment as a result of that.

00:26:20 Don Weinberger

Yeah, me too. Yeah. Yeah. I think I'm gonna call him after this. 

00:26:24 Don Weinberger

But you took the words right out of my mouth, Steve. And our dental colleagues can be an excellent resource on oral health questions to keep our pearly white shining bright.

00:26:31 Steve Small

Yeah. And speaking of questions, you reminding me it's time for the Rumor vs Truth mail bag. We have an audience question from the last episode about testosterone claims.

00:26:40 Steve Small

And one viewer sent us a text from the link in the show notes and asked.

00:26:44 Steve Small

“I saw a news article saying studies show drinking carbonated beverages like cola will increase testosterone levels. What's your take?”

00:26:53 Don Weinberger

Well, we found the study that the news article referenced, get this drinking certain cola drinks may increase testicle size. And testosterone production, study says.

00:27:03 Don Weinberger

And was spat out my pop actually reading that.

00:27:06 Steve Small

Pop. OK, so you can't judge me for saying hens teeth. If you're gonna start pulling out pop like that, that's so Midwest.

00:27:10 Don Weinberger

Will you rub on me? So that's fine. Yeah, we're becoming one mind.

00:27:16 Steve Small

Personally, I think that there's little chance that this claim is clinically true. 

00:27:22 Don Weinberger

Yeah, well, the study that you're mentioning is from 2022. And, dived in a little more than mice. They gave mice water or varying amounts of Coca-Cola for 15 days. And they harvested the testes from the mice and ran tests on the testosterone levels and receptor production.

00:27:40 Don Weinberger

They found increases in all of these in the Coca-Cola Group.

00:27:43 Steve Small

Yikes. I'm glad we didn't run this kind of experiment in humans, Don, but that is the kicker. This wasn't performed in humans at all. It didn't look at outcomes we want from testosterone therapy, like increased libido, muscle strength. So a very preliminary study.

00:27:58 Steve Small

And we know drinking too many sugary soft drinks can actually have downsides that we know about, such as obesity, type 2 diabetes and things like that. 

00:28:07 Don Weinberger

Yeah, so don't bank on soft drinks boosting your testosterone levels. We don't have the data in humans, and they have, as we do, have a soft drinks, suggest it's not worth that nutritional risk.

00:28:18 Don Weinberger

Well, that was a unique question, Steve. And remember folks, we also use your suggestions to plan our episode. So please, please, please keep them coming.

00:28:29 Steve Small

Yeah. And if you've got a dental dilemma or a rumor that's been gnawing at you, send it in, maybe we'll take a bite out of it for our future episode.

00:28:38 Steve Small

Email us at rumorvstruth@trchealthcare.com, or “send us a text” right from the podcast show notes.

00:28:44 Don Weinberger

And we know you've got some great ideas for us to demystify.

00:28:48 Steve Small

Yeah, I bet someone’s going to ask what Matt's dentist will want as a present for dental hygiene month.

00:28:54 Don Weinberger

I think he told us actually…at the end, he said… he just wants more people to floss. 

00:29:00 Steve Small

OK, that's definitely a dentist answer. Oh boy… I'm so glad you could join us. 

00:29:06 Steve Small

And if this episode gave you something good to chew on, be sure to follow rate and review Rumor vs Truth wherever you get your podcasts. And of course, check us out at TRChealthcare.com.

00:29:16 Don Weinberger

You can also help grow our show by telling a friend about the awesome things you've learned about and where you found us, and a quick reminder for our special 10% discount we mentioned earlier. Just use the code rvt1025 when you checkout.

00:29:30 Steve Small

Yeah. And if you're a student, even better. Students can access a free version of Pharmacist’s Letter.

00:29:36 Steve Small

We've got links in the show notes that take you directly to the right places to take advantage of these awesome deals, so go check them out.

00:29:42 Don Weinberger

Also… don’t forget… you can also get CE credit for listening to Rumor vs Truth, if you are a platinum or diamond subscriber.

00:29:50 Don Weinberger

Click the “Claim Credit” link in the show notes and search for it in your CE organizer. 

00:29:55 Don Weinberger

And join us next time where we'll take a look at cold and flu claims with natural meds.

00:30:00 Steve Small

A timely topic that is nothing to sneeze at. So thanks for joining us…

00:30:03 Don Weinberger

Get those puns ready.

00:30:05 Steve Small

You betcha. And thanks for joining us on Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths. We'll see you next time.