What Are the Dental Effects of ACE Inhibitors?

October 10, 2025 •

4 min read

Affecting between 0.1% and 0.7% of recipients, ACE inhibitor-induced angioedema is a serious, potentially life-threatening dental side effect that requires immediate medical attention. However, other less severe but still significant dental effects of ACE inhibitors can impact a patient's daily life and long-term oral health.

Quick Summary

A review of the oral side effects of ACE inhibitors, including angioedema, dry mouth, taste disturbances, and oral lichenoid reactions, with dental implications and management.

Key Points

Life-Threatening Angioedema: ACE inhibitor use can cause rapid, deep swelling of the lips, tongue, or throat, a medical emergency requiring immediate attention due to airway obstruction risk.
Common Xerostomia: Dry mouth is a frequent side effect that increases the risk for dental caries, periodontal disease, and oral infections.
Taste Alterations: Patients may experience dysgeusia, such as a metallic or altered taste, which can affect appetite and quality of life.
Oral Lesions: ACE inhibitors are associated with oral lichenoid reactions, which are inflammatory lesions that can cause discomfort.
Increased Periodontitis Risk: Some studies suggest a link between ACE inhibitor use and an increased risk or severity of periodontal disease.
NSAID Interaction: Long-term use of NSAIDs can reduce the effectiveness of ACE inhibitors and increase the risk of kidney issues, requiring careful consideration for pain relief.

Common Oral Side Effects of ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications widely used to treat cardiovascular conditions such as hypertension and heart failure. While effective, they are associated with several oral and dental side effects that patients and dental professionals should be aware of. These effects can range from relatively mild but bothersome symptoms to severe, life-threatening emergencies.

Angioedema

One of the most serious and potentially fatal side effects of ACE inhibitors is angioedema, a rapid and localized swelling of the deeper layers of skin and mucous membranes. In the oral region, this swelling most commonly affects the lips, tongue, and throat. Unlike a typical allergic reaction, ACE inhibitor-induced angioedema is a non-itchy swelling that is bradykinin-mediated, not histamine-mediated. This means standard allergy treatments like antihistamines are often ineffective.

Emergency Recognition: Swelling of the tongue or throat can quickly lead to airway obstruction, which is a life-threatening emergency.
Delayed Onset: The onset of angioedema is not always immediate and can occur weeks, months, or even years after starting the medication, which can lead to misdiagnosis.
Recurrence: Episodes can be recurrent, and if the medication is not discontinued, subsequent events may become more frequent and severe.

Xerostomia (Dry Mouth)

Dry mouth, or xerostomia, is a frequent oral side effect reported with many antihypertensive drugs, including ACE inhibitors. It results from a reduction in salivary flow and can have significant implications for oral health. Saliva plays a crucial role in maintaining oral hygiene by flushing away food debris, neutralizing acids, and providing antibacterial properties.

Risk of Complications: Chronic dry mouth increases the risk of tooth decay (caries), periodontal disease, and oral candidiasis (yeast infections).
Discomfort: Patients may experience difficulty speaking, swallowing (dysphagia), and wearing dentures due to a lack of lubrication.

Dysgeusia (Taste Disturbances)

Taste disturbances, or dysgeusia, are a well-documented side effect of ACE inhibitors, particularly with older agents like captopril due to their interaction with zinc. However, newer ACE inhibitors can also cause similar taste alterations, such as a metallic, bitter, or salty taste, or a general blunting of taste sensation.

Impact on Nutrition: Persistent dysgeusia can lead to a reduced appetite, impacting a patient's overall nutrition and quality of life.
Varied Presentation: Some patients may experience ageusia (complete loss of taste) while others report a constant, unpleasant taste.

Oral Lichenoid Reactions

Oral lichenoid reactions are inflammatory lesions that resemble oral lichen planus, characterized by white, lacy patches, red areas, and ulcers on the oral mucosa. ACE inhibitors have been strongly associated with the development of these lesions.

Symptomatic Relief: The lesions can cause a burning or stinging sensation, which can be exacerbated by hot or spicy foods.
Resolution: These reactions often resolve upon discontinuation or substitution of the causative ACE inhibitor, as highlighted in case reports.

Dental Management for Patients on ACE Inhibitors

Dental practitioners need to be aware of the oral side effects of ACE inhibitors and adapt patient management accordingly. A thorough medical history review is essential to identify patients at risk. Collaboration with the patient's physician is crucial, especially when side effects are severe or require medication changes.

Key Management Strategies

Emergency Preparedness: Recognize the signs of angioedema (non-pitting swelling of lips, tongue, throat) and be prepared for immediate emergency referral, as it can be life-threatening.
Xerostomia Management: Suggest using sugar-free lozenges, chewing gum, or saliva substitutes. Advise increased water intake and regular use of high-concentration fluoride toothpaste or rinses to prevent caries.
Dysgeusia Awareness: Inform patients that taste changes are possible and usually reversible upon medication change, which should be discussed with their physician.
Periodontal Care: As studies suggest a potential link to increased periodontitis severity, intensify preventive periodontal care, including meticulous oral hygiene instructions and more frequent cleanings.
NSAID Interaction: Be aware of the potential interaction between ACE inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs). Long-term NSAID use can diminish the antihypertensive effect of ACE inhibitors and increase the risk of acute kidney injury. Consider alternative pain management strategies.

Comparison of ACE Inhibitor Oral Side Effects


Side Effect	Key Characteristics	Dental Implications
Angioedema	Rapid, non-pitting swelling of lips, tongue, throat. Not itchy. Can be delayed.	Life-threatening airway obstruction risk. Requires immediate medical referral.
Xerostomia	Reduced salivary flow, sensation of dry mouth. Increased risk of dental caries, gum disease.	Increased risk for dental infections. Need for moisture aids and fluoride therapy.
Dysgeusia	Altered taste sensation (metallic, bitter) or complete loss of taste. Can impact diet.	Affects patient comfort. Need for medical consultation to consider alternative medications.
Oral Lichenoid Reaction	White, lacy patches or ulcers on oral mucosa. Can cause burning sensation.	Potential for misdiagnosis as other oral lesions. Often resolves upon drug cessation.
Increased Periodontitis Risk	Systemic link suggested between ACE inhibitor use and increased risk or severity of periodontitis.	Need for aggressive preventive and therapeutic periodontal management.

Conclusion

While ACE inhibitors are an essential medication for managing conditions like hypertension, their potential dental side effects must not be overlooked. Dental practitioners play a critical role in recognizing and managing these issues, from the common nuisances of dry mouth and taste disturbances to the emergency nature of angioedema. By understanding the specific oral manifestations and collaborating with prescribing physicians, dental teams can help patients navigate these challenges and maintain optimal oral health. Patient education on the potential for delayed-onset side effects like angioedema is also vital to ensure prompt action in an emergency. For example, the risk of NSAID interactions highlights the need for careful drug history and communication with the medical team for pain management. For more information on ACE inhibitor-induced angioedema, a thorough review is available on UpToDate.

Frequently Asked Questions

Yes, ACE inhibitors can cause angioedema, which is a rapid, non-itchy swelling of the lips, tongue, and throat. This is a serious side effect that requires immediate medical attention, especially if it compromises breathing.

Yes, dry mouth (xerostomia) is a common side effect of ACE inhibitors, which can lead to other oral health problems such as tooth decay and gum disease due to reduced saliva flow.

To manage dry mouth, you can use saliva substitutes, chew sugar-free gum or lozenges, and drink plenty of water. Regular use of fluoride products is also recommended to prevent cavities.

Yes, some ACE inhibitors can cause dysgeusia, a disturbance of the sense of taste, which may manifest as a metallic or different taste sensation. This often improves if the medication is changed.

White, lacy patches or ulcers in the mouth could indicate an oral lichenoid reaction. You should consult your dentist or physician, as this can be linked to ACE inhibitor use and may resolve if the medication is switched.

Recent studies have indicated a potential association between the use of ACE inhibitors and an increased risk or severity of chronic periodontitis, or gum disease.

Caution is advised, as NSAIDs can interact with ACE inhibitors, potentially reducing their blood pressure-lowering effect. Long-term use should be discussed with your physician.