A patient came to see me many years ago—let’s call her Carol.
She was 58, took great care of her teeth, and had been on a statin for her cholesterol for the past five years.
“Dr. B, I don’t understand,” she said, clearly frustrated. “I brush twice a day. I floss every night. I even use that fancy electric toothbrush you recommended. But my gums bleed every single time.”
I looked at her chart. Then I looked at her medication list.
And there it was: Atorvastatin. 40mg daily.
“Carol,” I said, “when did the bleeding start?”
She thought for a moment. “Maybe… six months after I started the cholesterol medication?”
Bingo.
That same week, I had seen a 32-year-old patient—we’ll call him Jake—who’d been on Zoloft for anxiety for the past year. Same complaint. Bleeding gums. Perfect oral hygiene. Completely confused about why it was happening.
This newsletter is not about whether you need the medication—that’s between you and your doctor. This is about understanding the side effects nobody talks about, and what you can do to protect your oral health while you’re on them.
Let me walk you through the most common culprits:
1. Statins (Cholesterol Medications)
Drugs like Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin) are taken by over 40 million Americans.
Statins lower cholesterol by blocking an enzyme in your liver called HMG-CoA reductase. Great for heart health.
The problem? That same pathway is responsible for making Coenzyme Q10 (CoQ10)—a nutrient your body needs for cellular energy production.
Your gum tissue is incredibly metabolically active. It’s constantly healing, fighting bacteria, and regenerating. That takes a lot of energy.
When your body doesn’t have enough CoQ10, your gums can’t produce the energy they need to stay healthy, fight inflammation, and heal properly.
The result: bleeding, inflammation, and eventually… periodontal disease.
Studies have found that 60% of patients with gum disease show a CoQ10 deficiency in their gum tissue.
And when researchers gave CoQ10 to people with periodontal disease, they saw significant improvements in bleeding, pocket depths, and inflammation.
This is the CoQ10 my wife and I take every day.
2. Antidepressants (SSRIs)
Medications like Zoloft (sertraline), Prozac (fluoxetine), Lexapro (escitalopram), and Paxil (paroxetine) are lifesaving for millions of people dealing with depression and anxiety.
SSRIs affect platelet function—specifically, how your blood clots. They interfere with serotonin uptake in platelets, which can make you bleed more easily.
Add to that another common SSRI side effect—dry mouth—and you’ve got a perfect storm for gum problems.
Less saliva = more bacteria = more inflammation = bleeding gums.
3. Blood Thinners
Aspirin, warfarin (Coumadin), Eliquis, Xarelto—these medications do exactly what they’re designed to do: prevent dangerous blood clots.
But your gums? They bleed more easily. It’s not because they’re diseased (though they might be). It’s because your blood doesn’t clot as quickly.
I’ve had patients on Coumadin whose gums bled for days after a deep cleaning. It’s scary, but it’s expected given the medication.
4. Blood Pressure Medications (Calcium Channel Blockers)
Drugs like amlodipine (Norvasc) and nifedipine (Procardia) can cause gum overgrowth (called “gingival hyperplasia”). Your gums literally start growing over your teeth, trapping bacteria and causing inflammation.
5. Diabetes Medications
When combined with high blood sugar, certain diabetes medications can create the perfect environment for gum disease. High glucose in your saliva feeds bad bacteria. Your immune system is already compromised by diabetes. And some medications can cause dry mouth.
It’s a triple threat.
The Part That Makes Me Frustrated…
How many doctors warn their patients about these oral side effects when they write the prescription?
In 40+ years of practice, I can count on one hand the number of patients whose cardiologist told them to supplement with CoQ10 when starting a statin.
Or whose psychiatrist mentioned that their SSRI might cause dry mouth and bleeding gums.
Please don’t read this as me blaming doctors. They’re doing their best in a broken system. But the reality is: they’re not trained to think about how medications affect the mouth. Just as we dentists aren’t trained to think about how oral health impacts the rest of the body!
That’s where functional dentistry comes in.
Here’s the tragic irony…
People take statins to protect their heart. But gum disease increases your risk of heart attack by nearly 50%.
So if your statin is depleting your CoQ10, causing gum disease, which increases your cardiovascular risk… we’ve created a vicious cycle.
Your gums are not separate from the rest of you. The inflammation in your mouth affects your entire cardiovascular system, your brain health, your metabolic health.
If you’re on a statin:
✅ Supplement with CoQ10 – 100-200mg daily of ubiquinol (the active form)
This directly addresses the nutrient depletion caused by the medication. Research shows it can significantly improve gum health in statin users.
➤ This is the CoQ10 I take daily – ubiquinol form for maximum absorption
If you’re on an SSRI:
✅ Address dry mouth immediately – This is the bigger issue
- Sip water throughout the day
- Use a xylitol-containing gum to stimulate saliva
- Consider a saliva substitute spray at night
- Avoid antibacterial or essential oil mouthwashes (they make it worse)
✅ Be extra gentle when brushing – Your platelets aren’t functioning normally, so bleeding happens more easily
✅ Support overall gum health with nutrition
CoQ10 might still help with overall tissue healing and energy, but it won’t reverse the platelet effect. That’s just the reality of the medication.
If you’re on blood thinners:
✅ Expect more bleeding – It doesn’t mean your gums are diseased
✅ Tell your dentist and hygienist – They need to know so they can adjust treatment and give you proper aftercare instructions
✅ Use gentle pressure when brushing – Electric toothbrushes with pressure sensors (or just use your non. Dominant hand) are your friend
For EVERYONE on these medications…
1. Don’t Stop Your Medication
Please hear me: I am NOT telling you to stop your prescription. That’s a conversation for you and your doctor.
But I AM telling you to support your mouth and tell your doctor/dentist about your symptoms while you’re on it.
You can work with your physician. Ask if it would be a good idea to take the same medication but at a different strength, titrated down, or even changing manufacturers of the medication. Again, please don’t do this on your own—collaborate with your doctor. Everyone responds differently to different medications.
2. Support Your Oral Microbiome
• Floss daily (I prefer PFAS-free floss)
• Use nano-hydroxyapatite toothpaste like Fygg (code ATD15)
• Avoid mouthwash – even the “natural” kinds disrupt your oral microbiome
• Tongue scrape daily
3. Add These Nutrients
• CoQ10 (especially if you’re on a statin or over 40)
• Magnesium – supports healthy gums and cellular energy.
• Vitamin C – critical for gum tissue repair
• Vitamin D3/K2 – K2 helps direct minerals where they need to go
4. Fix Your Breathing
If you’re a mouth breather (especially at night), no supplement in the world will fully protect your gums. Dry mouth = gum disease.
If your dentist isn’t talking to you about this kind of thing, it might be time for a new dentist! Find one near you via my Functional Dentist Directory or through AADSM.org.
5. Tell Your Dentist
Bring your medication list to every dental appointment. Your dentist needs to know what you’re taking so they can adjust your treatment plan accordingly.
If you’re on any of these medications and your doctor never mentioned the oral side effects, you’re not alone. It’s one of the most overlooked connections in medicine. But now you know—and you can do something about it.
This is why I love functional dentistry. We don’t just treat symptoms. We ask why. We connect the dots between your medications, your nutrition, your sleep, your microbiome—and we address the root cause.
– Mark
P.S. Forward this to anyone you know who’s on these medications and struggling with bleeding gums. This information could change everything for them.
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