Plague on teeth

Question

Hello, my daughter (8 years, CF) has a yellowish plaque on her teeth every day, difficult and on some places impossible to remove with a teethbrush. She is now for one year on Azythromycin 250mg every second day (she is not taking any other ATB). Is it possible, that Azythromycin is causing that plaque? If yes, how to avoid it (taking vitamins etc.)? Thanks.

Answer

Hello,
Such complication is not listed in adverse effects of azithromycin, even accessible expert literature does not mention this.
Coloured plaque (green, brown-blackish, yellow-orange) is a clinical finding that is not unusual. The type, referred to in this question (yellow-orange) is something that can be typically seen in children, often -but not exclusively- during the period of changing teeth. It is a variant of plaque in which a microbial shift has occurred so that pigment forming bacteria become predominant. The plaque is yellow to orange in color, typically runs along the gingival border and in local pits and fissures. It can be removed by brushing the teeth but this is rather difficult because it is very sticky (much more than normal plaque). Very often this plaque can be seen in children with insufficient hygiene of the mouth (brushing the teeth irregularly or insufficiently i.e. not along the gingival margin. Since it is caused by a shifting microbial composition, it could theoretically be triggered by taking antibiotics but there is really no scientific evidence for that.
Other reasons for plagues might be some foodstuffs, fruit drinks and also some mucolytics esp. inhaled ones. If the plagues occurred certainly new and especially in the mornings, episodes of a reflux of gastric acid into the oesophagus at night might be a reason for the plagues. In addition, if the child breathes trough the mouth at night due to nasal obstruction/adenoids, this could play a role in having plagues, either.
As to treatment, it is not really helpful to try and culture the microbial flora because this doesn't bring any therapeutic benefit. It is usually sufficient to have a thorough professional cleaning done by the dentist and to optimize oral hygiene (frequency as well as technique). Use of an electric toothbrush is one possible option. The type of toothpaste will make little difference. It is very important to keep drinking properly and keep consequent hygiene of oral cavity. Some dentists recommend to brush teeth after every meal – so take Your tooth-brush all the time with You.
Best regards, Jitka Brazova

10.08.2009