The effects of anabolic-androgenic steroids administration on oral health in humans: a scoping review.

Abstract

Background: This scoping review aimed to evaluate the effects of anabolic-androgenic steroids (AAS) administration on oral health in humans, distinguishing between medical indications (e.g., replacement therapy) and abuse, while mapping their impact on oral conditions and identifying gaps in knowledge.

Methods: A systematic search was conducted using PubMed, Cochrane Library, and Virtual Health Library databases. Search terms included keywords related to AAS, testosterone and specific oral health conditions such as dental caries, tooth loss/edentulism, periodontal disease, oral trauma, and oral cancer. Studies were screened and selected based on inclusion criteria: adult humans, AAS use and reported oral health outcomes, with findings interpreted separately according to medical indication (replacement vs. abuse).

Results: After screening, eight studies met the inclusion criteria. In the context of AAS abuse, users exhibited poorer periodontal health, with higher rates of severe periodontitis, increased gingival inflammation, and greater gingival thickness. Oral trauma studies indicated a higher frequency of temporomandibular dysfunction and malocclusion among users. A severe adverse event (Stevens-Johnson Syndrome) was also reported in one case of AAS abuse. Conversely, studies addressing medical indications found that therapeutic AAS administration was associated with reduced mucosal toxicity, decreased pain, and remission of aphthous lesions. No studies evaluating dental caries, tooth loss/edentulism, or cleft lip and palate were identified. The effect of AAS on human oral health is critically dependent on the context of administration. AAS abuse is associated with significant oral pathology, notably the increased severity of periodontal disease and risk of severe mucocutaneous adverse events.

Conclusions: Conversely, AAS administered under medical indication demonstrated therapeutic potential in reducing treatment-related toxicity (e.g., in oral cancer) and promoting the resolution of recurrent soft tissue lesions (e.g., aphthous ulcers). It is recommended that future studies adopt well-designed sampling strategies in longitudinal studies to enhance clinicians' and researchers' understanding of its effects and mechanisms, ultimately enabling evidence-based recommendations or advisories for or against its use for oral conditions. Health professionals should be aware of the distinct oral health risks and benefits associated with AAS. AAS abuse represents a critical risk factor for severe periodontal pathology and potential mucocutaneous adverse events. Conversely, low-level evidence supports recognizing the therapeutic potential of medically indicated AAS as supportive care for conditions like chemotherapy/radiotherapy-induced mucositis and recurrent soft tissue lesions. Identifying gaps in the literature highlights the need for broader research to ensure the safe monitoring of individuals who use these substances.