A review of drug-induced oral reactions

Every drug can produce untoward consequences, even when used according to standard or recommended methods of administration. Adverse drug reactions can involve every organ and system of the body and are frequently mistaken for signs of underlying disease. Similarly, the mouth and associated structures can be affected by many drugs or chemicals. Good oral health, including salivary function, is very important in maintaining whole body health. Regarding different parts of the oral system, these reactions can be categorized to oral mucosa and tongue, periodontal tissues, dental structures, salivary glands, cleft lip and palate, muscular and neurological disorders, taste disturbances, drug-induced oral infection, and facial edema. In this article, the drugs that may cause adverse effects in the mouth and related structures are reviewed. The knowledge about drug-induced oral adverse effects helps health professionals to better diagnose oral disease, administer drugs, improve patient compliance during drug therapy, and may influence a more rational use of drugs.     

Current opinion on drug-induced oral reactions: a comprehensive review

AIM: The aim of this comprehensive review is to present an update to our previous review about drug-induced oral reactions. All drugs that may cause adverse effects in the mouth and related structures are reviewed. BACKGROUND: Every drug can produce untoward consequences even when used according to standard or recommended methods of administration. Adverse drug reactions can involve every organ and system of the body and are frequently mistaken for signs of underlying disease. The mouth and associated structures can also be affected by many drugs or chemicals. Good oral health including salivary function is very important in maintaining whole body health. Drug reactions can be categorized as to the parts of the oral complex such as the oral mucosa and tongue, periodontal tissues, dental structures, salivary glands, cleft lip and palate, muscles, and nerves. REVIEW RESULTS: This review suggests the number of drugs and chemicals that can produce adverse or toxic reactions in the oral cavity are on the rise. An updated listing of offending drugs is provided along with current strategies for dealing with adverse reactions. CONCLUSION: Clinicians must constantly update their knowledge of drugs used by their patients. Attention must be paid to their toxic and unwanted effects that in many cases may be similar to characteristics of common diseases. CLINICAL SIGNIFICANCE: Dentists and specialists of oral diseases should be aware of adverse drug oral reactions for better diagnosis of oral diseases, administration of drugs, and patient compliance during drug therapy.     

Oral and inhalation conscious sedation.

Many patients can benefit by having dental procedures carried out with conscious sedation administered by the oral or inhalation routes. Dentists who employ these techniques must be familiar with the pharmacology of the agents selected, cognizant of the risks and benefits of the technique employed, and able to manage adverse events that may arise with its use. Careful patient selection and prudent administration of one of the drugs described here is the basis for successful use of these techniques.     

Anti-plaque agents. Rationale and prospects for prevention of gingivitis and periodontal disease

Oral health surveys have shown that even in countries with established patterns of oral hygiene habits, most individuals have relatively poor gingival health. This is due to a low interest in complying with oral health procedures. A number of factors are apparent when investigating compliance to oral hygiene habits, viz only approximately 50% of the population brushes twice a day or more, brushing time is probably much too short and use of dental floss is not very prevalent. Studies of the effect of motivation on oral hygiene suggest that improvements can be achieved, but these are not maintained unless motivation is continuously reinforced. This suggests that topically applied anti-plaque agents should be used to augment mechanical plaque control. A number of product forms are available to delivery anti-plaque agents i.e., mouthrinses, dentifrices, aqueous gels, and additionally floss, chewing gum and lozenges. Any product form should provide a physically, chemically and microbiologically stable environment for the agent concerned. It should facilitate optimal bioavailability of the agents at the site of action and encourage patient compliance. Anti-plaque agents for topical administration should have the following properties: high intrinsic efficacy against a broad spectrum of oral organisms, toxicological and ecological safety, oral substantivity, no adverse reactions and good chemical stability. A number of classes of anti-plaque agents have been identified such as positively charged organic molecules, metal salts, phenols, enzymes, peroxides, sugar substitutes, fluorides and surface modifying agents. In order to achieve optimal bioavailability, the agent to be dosed should be compatible with the product form used. The 2 major product forms are rinses and dentifrices.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cholinsalicylate gel induced oral lesion: report of case

Salicylic acid and its derivatives are extensively used medications for the treatment of systemic and local diseases. However, injudicious use of aspirin as well as other derivatives of salicylic acid, may cause systemic and oral complications such as mucosal burns and oral ulcers. In children, topical administration of these drugs, even in small dosages, may cause adverse reactions. This report shows a case of an 8 year old boy with G6PD deficiency, who had a mucosal burn caused by application of a cholinsalicylate paste. Three days later, the child developed oral ulcers, malaise and fever. The present case is characteristic of the enigmatic nature of the etiology and diagnosis of oral lesions, and the possible connection between cholinsalicylate systemic absorption and hemolytic anemia is discussed.     

Targeted cancer therapies: Oral health care implications

Background

Targeted treatments have been incorporated into oncology protocols, often with more traditional therapies, and are not totally free of adverse reactions, some of which affect the orofacial region.

Orofacial effects of antiretroviral therapies

This paper summarises some of the oral adverse effects of antiretroviral agents. Some are related to bone marrow suppression which may also predispose to mouth ulcers. Erythema multiforme and toxic epidermal necrolysis are especially well recognized in HIV disease, particularly as reactions to sulphonamides and to antiretroviral agents. Oral lichenoid reactions have been described in HIV disease often relating to zidovudine use. Didanosine has also produced erythema multiforme and not unusually induces xerostomia, again by an unknown mechanism. Xerostomia may be seen in up to one-third of patients taking didanosine. Taste abnormalities are common with the protease inhibitors and oral and perioral paraesthesia can be a disturbing adverse effect. Ritonavir in particular can give rise to circumoral paraesthesia in over 25% of patients. Indinavir can also produce cheilitis.     

Glukokortikoide zur Reduktion postoperativer Beschwerden in der Oralchirurgie

Background

Oral surgical interventions are associated with post-interventional pain, trismus and swelling of varying degrees; therefore, the occurrence of a postinterventional inflammatory reaction is of major importance.

Methoden

To reduce such symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) are used routinely. Additionally, glucocorticoids can be applied as adjuvants in the management of postoperative complaints due to their anti-inflammatory potency. This use of glucocorticoids is still being controversially discussed. The aim of this paper is to describe the mechanisms and indications for administration of glucocorticoids after oral surgical procedures.     

Antineoplastic agents and their oral manifestations.

The use of antineoplastic agents is rapidly increasing. A general classification of these drugs and their mechanisms of action is presented. Many of the drugs have an adverse effect on oral tissue, and the practicing dentist today must be well acquainted with these effects. A discussion of the features of these reactions and their management is presented.     

Prevention and treatment of chemo- and radiotherapy-induced oral mucositis

The administration of many chemo-radiotherapy regimens in patients with cancer may be complicated by toxicities that limit the clinicians' abilities to deliver the most effective doses of active agents. Oral mucositis is a major dose-limiting toxic effect and the most important cause of morbidity in patients undergoing chemo-radiotherapy for head and neck cancers, in patients undergoing bone marrow transplantation and those receiving certain chemotherapeutic agents for a variety of human malignancies. The intent of this paper is to review preventive strategies and treatment approaches for patients with established oral mucositis. Many agents of differing mechanisms of action have been used in the prevention and treatment of oral mucositis induced by anticancer therapies. Currently, no intervention is completely successful at preventing or treating oral mucositis. The several solutions, drugs and methods used and studied in the prophylaxis and therapy of chemotherapy or radiotherapy-induced oral mucositis reflects the need of new, more efficient tools in the management of this complication. Current studies and our increasing understanding of the etiology and pathogenesis of oral mucositis will lead to new approaches to the management and improved quality of life for these patients.     

The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder

BACKGROUND: Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications. TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications. RESULTS: ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.S. population. Its symptoms include inattention, hyperactivity and impulsivity that can cause personal, social, occupational and leisure-time dysfunction. Medications used to treat the disorder include stimulants, selective noradrenergic uptake inhibitors and tricyclic antidepressants. CLINICAL IMPLICATIONS: The oral health of people with ADHD may be compromised by inattention and impulsivity that impair home care regimens and can lead to cigarette addiction, which may cause oral cancer and damage the periodontium, and excessive ingestion of caffeinated sugar-laden soft drinks that promote dental caries. To safely care for this patient population, dentists must be familiar with the stimulant and nonstimulant medications used to treat adult ADHD, because these drugs can cause adverse orofacial and systemic reactions and interact adversely with dental therapeutic agents.     

Agents for the management of plaque and gingivitis.

Numerous chemical agents have been evaluated for the supplementation of patient-dependent mechanical plaque control and thus the reduction or prevention of oral diseases. Agents discussed in this paper are those most frequently evaluated in recent studies and include chlorhexidine, essential oils, triclosan, sanguinarine, fluorides, oxygenating agents, quaternary ammonium agents, prebrushing rinses, enzymes, and antibiotics. Of the agents discussed, the greatest effect on the reduction of plaque and gingivitis can be expected from chlorhexidine, essential oils, and triclosan-containing products. These chemical agents vary in dosage form and include mouthrinses, gels, and dentifrices. Some may also be of value as irrigants. Adverse effects vary according to the chemical agent and include poor taste, burning sensation of oral tissue, staining of teeth and soft tissues, excess supragingival calculus, oral lesions in young patients, and allergic reactions. When a product is selected for a patient, consideration should be given to necessity, efficacy, adverse effects, and cost-effectiveness.     

Morphological alterations in the epithelium of the oral mucosa of rats (Rattus norvegicus) submitted to long-term systemic nicotine treatment

Smoking is considered to be the most albeit preventable cause of diseases and premature deaths in the history of mankind. The local action of tobacco on the oral mucosa can cause precancerous and cancerous lesions. However, there is not enough evidence to establish all the systemic effects caused by nicotine on the organism. Thus, the aim of the present study was to characterize the cellular changes of the cheek mucosa of rats submitted to long-term systemic nicotine treatment. Twenty male rats were divided into two experimental groups: a nicotine group and a control group, each consisting of 10 animals. The nicotine group was injected daily with 0.250 mg of nicotine per 100 g of body weight. All animals received a solid diet and water ad libitum. After 90 days of treatment, all animals were weighed and sacrificed. Samples of cheek mucosa were collected for light and transmission electron microscopy. The results revealed oral epithelium containing atypical cells that were characterized by atrophy, cell membrane disorganization and tissue damage. It was concluded that systemic administration of nicotine damaged the cellular integrity of the oral mucosa, impairing tissue function and predisposing the tissue to the action of different pathogenic agents and also to that of other carcinogenic substances present in tobacco.     

A review and guide to drug‐associated oral adverse effects—Oral mucosal and lichenoid reactions. Part 2

Dental practitioners and other health professionals commonly encounter and manage adverse medicine effects that manifest in the orofacial region. Numerous medicines are associated with a variety of oral adverse effects. However, due to lack of awareness and training, these side effects are not always associated with medicine use and are underreported to pharmacovigilance agencies by dentists and other health professionals. This article aims to inform health professionals about the various oral adverse effects that can occur and the most commonly implicated drugs to improve the management, recognition and reporting of adverse drug effects. This article follows on from Part 1; however, the focus here is on lichenoid reactions and oral mucosal disorders including oral aphthous‐like ulceration, mucositis and bullous disorders such as drug‐induced pemphigus, pemphigoid, Stevens‐Johnson syndrome and toxic epidermal necrolysis.     

Oral adverse reactions due to cinnamon‐flavoured chewing gums consumption

Cinnamon‐flavoured products (toothpaste, chewing gum, food, candy and mouthwash) can cause oral adverse reactions; among these, the most common is contact stomatitis (cinnamon contact stomatitis, CCS). Signs and symptoms of contact allergic reactions affecting the oral mucosa can mimic other common oral disorders, making diagnosis difficult. As CCS may be more prevalent than believed and its clinical features can frequently determine misdiagnosis, we reviewed case reports and case series of oral adverse reactions due to cinnamon‐containing chewing gums, emphasizing clinical aspects, diagnostic and management procedures. We also proposed an algorithm to perform a diagnosis of CCS as in the previous published literature the diagnostic approach was not based on a harmonized and shared evidence‐based procedure. Moreover, as patients can refer to different specialists as dentists, dermatologists and allergists, a multidisciplinary approach is suggested.     

Antifungal agents in the treatment of oral candidiasis]

Oral candidiasis is the symptomatic development of superficial infection with many forms of clinical manifestation. The treatment of choice should include the antifungal agents which act topically in the oral cavity so that the systematic adverse effects are minimal. They should have good impregnation to the oral mucosa and prolonged effect. In patients with chronic or recurrent infection or being immunological compromised, successful treatment can be achieved by increased dosage and extended duration of antifungal therapy.     

Clinical efficacy of prednisone in the treatment of patients with oral inflammatory ulcerative diseases: a study of fifty-five patients

An objective evaluation of 55 patients with chronic vesiculoerosive oral diseases was made to compare the beneficial and adverse effects of prednisone treatment. Patients were divided into groups of high, intermediate, and low drug dosages, as well as short and long periods of administration. Prednisone benefited 49 patients in spite of the fact that 55% had some adverse side effects. The duration of prednisone administration appeared to have a larger impact on side effects than the daily amount given. The most common side effects were gastrointestinal disturbances, mood alterations, polyuria and insomnia. There were no significant changes in blood pressure, blood sugar level, weight, or white blood cell counts. This study confirmed that systemic prednisone is a useful and beneficial treatment modality for patients with chronic oral inflammatory diseases.     

Angioedema associated with angiotensin-converting enzyme inhibitors

A review of two cases of angioedema associated with therapeutic doses of the angiotensin-converting enzyme inhibitor enalapril are presented along with a review of the relevant literature. Although angioedema of the facial and oral pharyngeal regions is a relatively rare occurrence with the use of ACE inhibitors, recognition of these agents as the cause of such a condition, when subacute, can lead to a rapid cure. Knowledge of these effects may also be helpful in the management of an acute clinical manifestation and, as importantly, may help prevent a recurrent episode due to the ill-guided continuation of the drug.     

Oral symptoms of immunologic disorders. Part I. Systemic autoimmune diseases

Polysystemic autoimmune diseases often cause orofacial and stomatognathic symptoms. Inflammation of the temporomandibular joint only rarely and slightly reduces the range of mouth opening (rheumatoid arthritis), which is much more restricted in systemic sclerosis due to fibrosis of perioral soft tissues. Weakness of masticatory and pharyngeal muscles in idiopathic inflammatory myopathies results in dysphagia and dystonia. Ulcerations, petechiae, teleangiectasia, and lichenoid lesions are the characteristic symptoms of oral mucosal involvement, but drugs used in systemic treatment can also cause very similar side effects. Salivary gland hypofunction (Sj?gren's syndrome) is common, and in addition to the subjective complaints, leads to objective pathologic alterations such as oral mycotic infections, purulent sialadenitis, and increased caries prevalence. The side effects of steroid administration should be taken into account also during dental treatments. Regular dental follow-up and treatment is a basic part of the complex care of these patients in order to diagnose and cure oral abnormalities and salivary gland hypofunction in time. Impairment of hand functions (rheumatoid arthritis, scleroderma) reduces the oral hygienic activity and therefore special devices, local antiseptics and local fluoride preparations are necessary.