Unwanted Oral Effects of Drugs Flashcards
Definition of drug induced oral disease
a noxious and unintended effect affecting the oral region arising from a drug dosage given in the recommended dosage
Possible effects on oral mucosa
- Necrosis/slough
- Erythema
- Vesicle/Bulla
- Ulceration
- Stomatitis
- Lichenoid reaction
- Pigmentation
- If has effect on oral mucosa, likely to also affect skin, GI tract or eyes
What other areas of oral cavity can drugs affect
- Salivary glands: dry mouth
- Teeth: staining
- Periodontium: gingival hyperplasia
- Taste buds: e.g. Tamoxifen
Possible mechanisms for oral effects
- Pharmacologic (e.g. xerostomia)
- Toxic (mucosal erosion e.g. aspirin)
- Intolerance (gingival hyperplasia)
- Allergy (erythema multiforme)
- Ecologic (some drugs can alter microbiota)
- Indirect (bone marrow suppression in chemo)
What can oral ulceration be a result of
- Xerostomia
- Oral chemical damage
- Tissue ischaemia
- Cytotoxicity
- Indirect (blood dyscrasia)
- Exact mechanism of why ulcers occur in many drugs still unclear
- drugs:
aspirin, nicorandil, NSAIDs, captopril, pancreatic supplements
What is associated with chemotherapeutic agents
Associated with oral mucositis
- widespread sloughing and ulceration
- ulceration may be due to loss of cell proliferation
- pain requires opioid therapy
- portal for entry for infection
Drugs:
methotrexate, doxorubicin, Bleomycin, 5-flurouracil
Fixed drug eruption oral effects
- Ulceration, bullae, erythematous patches or superficial erosions
- Initially solitary but may become multiple
- Drugs: paracetamol, barbiturates, phenacetin
Causes of lichenoid reactions
- Clinically similar to LP
- Toothpaste, cosmetics, periodontal packs, denture fixatives, amalgam, nickel prosthesis
Erythema multiforme clinical features and causes
- Generally affects skin and mouth
- vesicular/bullous eruption
- erythema/ulceration
- bleeding and crusting of lips
Drugs:
sulphonamides, barbiturates, tetracycline
Mercurialism (mercury poisoning) features
- Intense salivation
- Loose teeth
- Oral ulceration
- Gangrene
- Osteomyelitis
Drugs that cause gingival hyperplasia and treatment of it
- Phenytoin (anticonvulsant)
- Cyclosporin (immunosuppressant)
- Nifedipine (calcium-channel blockers)
- Tx: plaque control, alternate medication, possible gingivectomy
What can cause taste abnormalities
- ACE inhibitors, Anti HIV protease inhibitors, Lansoprazole, isotretinon (acne)
- Burning sensation, neuropathy
Which drug has reported to be associated with oral carcinoma
- Malignancy following immunosuppression with cyclosporin therapy is reported
what types of Oral pigmentation can occur
- Melanin pigmentation (anti-malarial)
- Blue grey deposits (bismuth, gold, lead)
- amalgam tattoos
Which drugs are associated with xerostomia
- Over 500 drugs
- Analgesics
- Anti-hypertensives
- Anti-histamines
- Anti-depressants
- Appetite suppressants
- H2 antagonists/ proton pump inhibitors
- Anticholinergic and sympathomimetic drugs
- Social drugs (caffeine and alcohol)
