{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:23:59Z","timestamp":1787743439780,"version":"build-2784847793"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":97,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Inhalers, which are essential for chronic airway disease treatment, differ in formulations. Dry powder inhalers (DPIs) with lactose monohydrate may increase the risk of dental caries compared with lactose-free pressurized metered-dose inhalers (pMDIs). We investigated the incidence of dental caries among users of these inhaler types for chronic airway diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this study, we analyzed inhalation technique checklists and patient records at a single center from 2010 to 2018. The study included adult patients with asthma or chronic obstructive pulmonary disease who initiated inhaler usage for the first time and continued for at least 6 months. Those with preexisting dental caries, inhaler changes, or missing lung function data were excluded. We analyzed the incidence rate of dental caries during the study period, the time to the first dental caries occurrence, and the adjusted hazard ratios among pMDI and DPI users employing Kaplan\u2013Meier survival analysis and Cox proportional hazards model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 4,092 patients, 1,381 (33.7%) and 2,711 (66.3%) used pMDIs and DPIs, respectively. The incidence rate of dental caries was 2.28 per 1,000 person-years for pMDI users and 4.53 for DPI users. DPI users exhibited a significantly shorter time to first dental caries occurrence (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.029, log-rank test) with a higher 5-year caries occurrence rate (1.9% vs. 0.8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015) and a higher risk of dental caries than pMDI users, with an adjusted hazard ratio of 2.09 (95% confidence interval: 1.04\u20134.18,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.037) in the multivariable Cox regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with chronic airway disease using DPIs have a higher risk of dental caries than those using pMDIs. Thus, vigilant dental health monitoring is necessary for DPI users.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08583-1","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:03:56Z","timestamp":1779357836000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dental caries risk in patients with chronic airway diseases using dry powder inhalers: a retrospective cohort study"],"prefix":"10.1186","volume":"26","author":[{"given":"Jinhee","family":"Ha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"June Hong","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Geol","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minkyeong","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minae","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sojeong","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong Cheol","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Won","family":"Ra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"8583_CR1","unstructured":"Global Strategy for the Prevention, Diagnosis and Management of COPD: 2026 Report. https:\/\/goldcopd.org\/2026-gold-report-and-pocket-guide\/."},{"key":"8583_CR2","unstructured":"Global Strategy for Asthma Management and Prevention. Updated 2026. https:\/\/ginasthma.org\/2026-gina-strategy-report\/."},{"key":"8583_CR3","doi-asserted-by":"publisher","first-page":"461","DOI":"10.2147\/TCRM.S160365","volume":"15","author":"OS Usmani","year":"2019","unstructured":"Usmani OS. Choosing the right inhaler for your asthma or COPD patient. Ther Clin Risk Manag. 2019;15:461\u201372.","journal-title":"Ther Clin Risk Manag"},{"issue":"3","key":"8583_CR4","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000059331","volume":"36","author":"CP Aires","year":"2002","unstructured":"Aires CP, Tabchoury CP, Del Bel Cury AA, Cury JA. Effect of a lactose-containing sweetener on root dentine demineralization in situ. Caries Res. 2002;36(3):167\u20139.","journal-title":"Caries Res"},{"issue":"12","key":"8583_CR5","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1016\/0003-9969(90)90013-Z","volume":"35","author":"M Ryberg","year":"1990","unstructured":"Ryberg M, M\u00f6ller C, Ericson T. Saliva composition in asthmatic patients after treatment with two dose levels of a beta 2-adrenoceptor agonist. Arch Oral Biol. 1990;35(12):945\u20138.","journal-title":"Arch Oral Biol"},{"issue":"3","key":"8583_CR6","first-page":"212","volume":"99","author":"M Ryberg","year":"1991","unstructured":"Ryberg M, M\u00f6ller C, Ericson T. Saliva composition and caries development in asthmatic patients treated with beta 2-adrenoceptor agonists: a 4-year follow-up study. Scand J Dent Res. 1991;99(3):212\u20138.","journal-title":"Scand J Dent Res"},{"key":"8583_CR7","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.2147\/COPD.S81266","volume":"10","author":"AD D\u2019Urzo","year":"2015","unstructured":"D\u2019Urzo AD, Kerwin EM, Chapman KR, Decramer M, DiGiovanni R, D\u2019Andrea P, Hu H, Goyal P, Altman P. Safety of inhaled glycopyrronium in patients with COPD: a comprehensive analysis of clinical studies and post-marketing data. Int J Chron Obstruct Pulmon Dis. 2015;10:1599\u2013612.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"8583_CR8","doi-asserted-by":"publisher","first-page":"175346661882401","DOI":"10.1177\/1753466618824010","volume":"13","author":"D Dusser","year":"2019","unstructured":"Dusser D, Ducharme FM. Safety of tiotropium in patients with asthma. Ther Adv Respir Dis. 2019;13:1753466618824010.","journal-title":"Ther Adv Respir Dis"},{"issue":"5","key":"8583_CR9","doi-asserted-by":"publisher","first-page":"415","DOI":"10.2165\/00002512-200825050-00005","volume":"25","author":"P Gupta","year":"2008","unstructured":"Gupta P, O\u2019Mahony MS. Potential adverse effects of bronchodilators in the treatment of airways obstruction in older people: recommendations for prescribing. Drugs Aging. 2008;25(5):415\u201343.","journal-title":"Drugs Aging"},{"issue":"9","key":"8583_CR10","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.14219\/jada.archive.2010.0335","volume":"141","author":"G Maupom\u00e9","year":"2010","unstructured":"Maupom\u00e9 G, Shulman JD, Medina-Solis CE, Ladeinde O. Is there a relationship between asthma and dental caries? a critical review of the literature. J Am Dent Assoc. 2010;141(9):1061\u201374.","journal-title":"J Am Dent Assoc"},{"issue":"4","key":"8583_CR11","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.prosdent.2013.07.014","volume":"111","author":"VK Kutsch","year":"2014","unstructured":"Kutsch VK. Dental caries: an updated medical model of risk assessment. J Prosthet Dent. 2014;111(4):280\u20135.","journal-title":"J Prosthet Dent"},{"issue":"9","key":"8583_CR12","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.4187\/respcare.05501209","volume":"50","author":"MJ Telko","year":"2005","unstructured":"Telko MJ, Hickey AJ. Dry powder inhaler formulation. Respir Care. 2005;50(9):1209\u201327.","journal-title":"Respir Care"},{"issue":"1\u20132","key":"8583_CR13","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.ijpharm.2003.10.039","volume":"270","author":"H Steckel","year":"2004","unstructured":"Steckel H, Bolzen N. Alternative sugars as potential carriers for dry powder inhalations. Int J Pharm. 2004;270(1\u20132):297\u2013306.","journal-title":"Int J Pharm"},{"issue":"2","key":"8583_CR14","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5644\/ama2006-124.80","volume":"42","author":"A Rugg-Gunn","year":"2013","unstructured":"Rugg-Gunn A. Dental caries: strategies to control this preventable disease. Acta Med Acad. 2013;42(2):117\u201330.","journal-title":"Acta Med Acad"},{"issue":"4","key":"8583_CR15","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.archoralbio.2003.11.006","volume":"49","author":"R Tootla","year":"2004","unstructured":"Tootla R, Toumba KJ, Duggal MS. An evaluation of the acidogenic potential of asthma inhalers. Arch Oral Biol. 2004;49(4):275\u201383.","journal-title":"Arch Oral Biol"},{"issue":"4","key":"8583_CR16","doi-asserted-by":"publisher","first-page":"272","DOI":"10.4103\/0970-2113.85689","volume":"28","author":"N Godara","year":"2011","unstructured":"Godara N, Godara R, Khullar M. Impact of inhalation therapy on oral health. Lung India. 2011;28(4):272\u20135.","journal-title":"Lung India"},{"issue":"6","key":"8583_CR17","doi-asserted-by":"publisher","first-page":"1407","DOI":"10.1208\/s12248-015-9802-0","volume":"17","author":"SS Leung","year":"2015","unstructured":"Leung SS, Tang P, Zhou QT, Tong Z, Leung C, Decharaksa J, Yang R, Chan HK. De-agglomeration Effect of the US Pharmacopeia and Alberta Throats on Carrier-Based Powders in Commercial Inhalation Products. AAPS J. 2015;17(6):1407\u201316.","journal-title":"AAPS J"},{"issue":"1","key":"8583_CR18","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/coa.12912","volume":"43","author":"CY Chuang","year":"2018","unstructured":"Chuang CY, Sun HL, Ku MS. Allergic rhinitis, rather than asthma, is a risk factor for dental caries. Clin Otolaryngol. 2018;43(1):131\u20136.","journal-title":"Clin Otolaryngol"},{"issue":"6","key":"8583_CR19","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1093\/aje\/kwr129","volume":"174","author":"S Alavaikko","year":"2011","unstructured":"Alavaikko S, Jaakkola MS, Tjaderhane L, Jaakkola JJ. Asthma and caries: a systematic review and meta-analysis. Am J Epidemiol. 2011;174(6):631\u201341.","journal-title":"Am J Epidemiol"},{"issue":"3","key":"8583_CR20","doi-asserted-by":"publisher","first-page":"357","DOI":"10.4103\/ejd.ejd_65_17","volume":"11","author":"A Arafa","year":"2017","unstructured":"Arafa A, Aldahlawi S, Fathi A. Assessment of the oral health status of asthmatic children. Eur J Dent. 2017;11(3):357\u201363.","journal-title":"Eur J Dent"},{"issue":"1","key":"8583_CR21","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1902\/jop.2001.72.1.50","volume":"72","author":"FA Scannapieco","year":"2001","unstructured":"Scannapieco FA, Ho AW. Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III. J Periodontol. 2001;72(1):50\u20136.","journal-title":"J Periodontol"},{"issue":"10","key":"8583_CR22","doi-asserted-by":"publisher","first-page":"e46508","DOI":"10.1371\/journal.pone.0046508","volume":"7","author":"XT Zeng","year":"2012","unstructured":"Zeng XT, Tu ML, Liu DY, Zheng D, Zhang J, Leng W. Periodontal disease and risk of chronic obstructive pulmonary disease: a meta-analysis of observational studies. PLoS ONE. 2012;7(10):e46508.","journal-title":"PLoS ONE"},{"issue":"10","key":"8583_CR23","doi-asserted-by":"publisher","first-page":"e14026","DOI":"10.1111\/pai.14026","volume":"34","author":"PE N\u00f8rrisgaard","year":"2023","unstructured":"N\u00f8rrisgaard PE, Haubek D, Schoos AM, K\u00fchnisch J, Chawes BL, Stokholm J, Bisgaard H, B\u00f8nnelykke K. Asthma medication and risk of dental diseases in children - A prospective cohort study. Pediatr Allergy Immunol. 2023;34(10):e14026.","journal-title":"Pediatr Allergy Immunol"},{"issue":"4","key":"8583_CR24","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1159\/000047463","volume":"35","author":"AM Meldrum","year":"2001","unstructured":"Meldrum AM, Thomson WM, Drummond BK, Sears MR. Is asthma a risk factor for dental caries? Finding from a cohort study. Caries Res. 2001;35(4):235\u20139.","journal-title":"Caries Res"},{"issue":"3","key":"8583_CR25","first-page":"254","volume":"12","author":"S Ehsani","year":"2013","unstructured":"Ehsani S, Moin M, Meighani G, Pourhashemi SJ, Khayatpisheh H, Yarahmadi N. Oral health status in preschool asthmatic children in Iran. Iran J Allergy Asthma Immunol. 2013;12(3):254\u201361.","journal-title":"Iran J Allergy Asthma Immunol"},{"issue":"2","key":"8583_CR26","first-page":"113","volume":"11","author":"SM Alaki","year":"2013","unstructured":"Alaki SM, Ashiry EA, Bakry NS, Baghlaf KK, Bagher SM. The effects of asthma and asthma medication on dental caries and salivary characteristics in children. Oral Health Prev Dent. 2013;11(2):113\u201320.","journal-title":"Oral Health Prev Dent"},{"issue":"2","key":"8583_CR27","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.ijpharm.2016.05.057","volume":"514","author":"J Shur","year":"2016","unstructured":"Shur J, Price R, Lewis D, Young PM, Woollam G, Singh D, Edge S. From single excipients to dual excipient platforms in dry powder inhaler products. Int J Pharm. 2016;514(2):374\u201383.","journal-title":"Int J Pharm"},{"issue":"8","key":"8583_CR28","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1177\/00220345870660082401","volume":"66","author":"M Ryberg","year":"1987","unstructured":"Ryberg M, Moller C, Ericson T. Effect of beta 2-adrenoceptor agonists on saliva proteins and dental caries in asthmatic children. J Dent Res. 1987;66(8):1404\u20136.","journal-title":"J Dent Res"},{"issue":"12","key":"8583_CR29","doi-asserted-by":"publisher","first-page":"816","DOI":"10.5812\/ircmj.4658","volume":"14","author":"M Boskabady","year":"2012","unstructured":"Boskabady M, Nematollahi H, Boskabady MH. Effect of inhaled medication and inhalation technique on dental caries in asthmatic patients. Iran Red Crescent Med J. 2012;14(12):816\u201321.","journal-title":"Iran Red Crescent Med J"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-08583-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08583-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08583-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:03:30Z","timestamp":1787742210000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12903-026-08583-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8583"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-08583-1","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"assertion":[{"value":"29 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Ulsan University Hospital (IRB approval number: UUH 2019-01-006). The requirement for informed consent was waived by the Institutional Review Board of Ulsan University Hospital due to the retrospective nature of the study and the use of de-identified data. This study was conducted in accordance with the principles of the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1595"}}