How Can Cystic Fibrosis Affect the Teeth?

It might surprise you to know that people with cystic fibrosis (CF) generally have fewer cavities and cases of gum disease than people without CF. This is especially notable because people with CF often follow a high-fat, high-carbohydrate diet, which has been found to promote tooth decay. One study found that children under 6 years old with CF had 30 percent less tooth decay than children the same age who did not have CF.^1-4

However, enamel defects have been regularly reported in people with CF. Understanding the relationship between cystic fibrosis and the effects on teeth and gums can help people with CF have a clearer path to oral health.^4-5

How does cystic fibrosis affect teeth?

Enamel problems happen more often and more severely in people with CF than in those without CF. Researchers think that changes in the cystic fibrosis transmembrane regulator (CFTR) gene plays an important role in enamel formation.⁵

Evidence shows that people with cystic fibrosis have fewer enamel defects in primary (baby) teeth than in permanent teeth. This may be due to the loss of mineralization (the body's natural enamel repair process) caused by the CFTR gene during tooth development. Mineralization is the body’s natural enamel repair process.^4-6

Enamel is considered the hardest tissue in the body, but it is also vulnerable. Sugar from food connects with plaque bacteria and produces acid. Over time, this causes a breakdown in the enamel. Many researchers believe that people with CF have altered saliva that protects enamel from breaking down because it has more minerals. This makes the mouth less acidic, resulting in fewer cavities.^4,7

Studies also show that people with CF have more plaque and tartar than people without CF, but still have little to no signs of gum disease. Some researchers have suggested that the bacteria living in plaque may show up later in the lungs. This could affect the health of people living with CF.^1,3,4,8

Frequent antibiotic or pancreatic enzyme use

Antibiotics and pancreatic enzymes are an essential part of every CF treatment plan. Research shows that the low reports of cavities and gum disease in people with CF are likely due to the long-term use of these drugs. Antibiotics taken by people with CF enter plaque and gum tissue, which reduces bacteria. Pancreatic enzymes that are used to treat cystic fibrosis also lessen plaque and tartar buildup on teeth.^4-10

However, the antibiotic tetracycline should be used with caution. It can cause unwanted yellow, gray, or brown discoloration on teeth. For this reason, children under 8 years old should not use tetracycline due to the risk of permanent staining. Adults often avoid tetracycline as well, since alternatives are usually available.⁷

Are children and adults affected in the same way?

For over 40 years, research has shown that children with CF have fewer cavities. Recent studies say that teens and adults with CF may have less protection from cavities and gum disease.^3,4,6

There are several possible reasons for these changes. As children age, poor dental habits might increase their risk of cavities. Younger children often brush their teeth, go to the dentist, and use fluoride treatments more frequently. Evidence shows that up to 90 percent of children with cystic fibrosis brush their teeth at least twice a day, which may help with reducing cavities. However, this evidence also shows that more than 65 percent of adults with CF have poor oral hygiene.^4,5,8,11,12

Plus, antibiotics that are commonly prescribed to children with CF target bacteria found in the lungs and mouth. However, this antibiotic use often changes in adolescence. Most teens and young adults with CF often switch to inhaled antibiotics that generally do not reduce bacteria found in the mouth.¹⁰

How people with cystic fibrosis can keep teeth and gums healthy

It is important to remember that dental health is necessary for everyone, including people who live with CF. Visiting the dentist at least 2 times a year and flossing regularly are key factors of a healthy dental care routine for both children and adults.^5,11,12

Has cystic fibrosis adversely affected your or your loved one's teeth? Share in the comments below!