Oral

1. ORALMANIFESTATIONS OF DRUG REACTIONS and its
treatment
BY-
J.RAHUL RAGHAVENDER
II YR B.D.S
PRIYADARSHINI DENTAL COLLEGE
4/26/2014

2. •Oral mucosa is frequently
involved in adverse reactions of
drugs.
•Three mechanism have been
proposed for drug allergies:
(1)IgE mediated reactions
(2)Cytotoxic reactions
(3)Circulation of the antigen
ETIOLOGY AND PATHOGENESIS OF ORAL
ADVERSE DRUG REACTIONS

3. 1) Drug-related Disorders of the Salivary Glands
2) Drug-related Disorders of Taste
3) Drug-related Mucosal Disorders
4) Drug-related Mucosal Pigmentation
5) Drug-related Swellings
6) Drug-related Neuropathies
7) Drug-related Oral Malodor (Halitosis)
8) Drug related Oral Infections
9) Drug-related Oral Teratogenic effects

4. (1) DRUG-REALTED DISORDERS OF SALIVARY GLANDS
XEROSTOMIA
SALIVARY GLAND SWELLING
SALIVARY GLAND PAIN
HYPERSALIVATION
DISCOLORATION OF SALIVA

5. XEROSTOMIA
Xerostomia is the subjective feeling of oral dryness,
which is often (but not always) associated with
hypofunction of the salivary glands.
Fissured tongue with atrophy of the filiform papillae
and a lobulated, erythematous appearance of the
tongue

6. CAUSES
Antidepressants
Antipsychotics
Antihistamines
Antihypertensives

7. TREATMENT
Drug Substitution with Other Medications:
Anticholinergics :Tolterodine
tartrate
Antiparkinson drugs : pramipexole, rapinirole
Pharmacologic Stimulant : Evoxac
Salagen

8. SALIVARY GLAND SWELLING
Painless, usually bilateral, salivary gland enlargement
DRUGS RELATED :
Phenylbutazone
Oxyphenbutazone
Chlorhexidin
Naproxen therapy
Clozapine, a novel antipsychotic agent

9. SALIVARY GLAND PAIN
DRUGS RELATED :
Antihypertensives
Anti-thyroid agents
Chlorhexidine
Cytotoxics
Ganglion-blocking agents
Iodides
Phenothiazines
Sulphonamides

10. HYPERSALIVATION
DRUGS RELATED
Anticholinesterases
Antipsychotic drug
Hypersalivation is excessive production of saliva.
TREATMENT :
Hypersalivation is
optimally treated by treating
or avoiding the underlying
cause.
Mouthwash and tooth
brushing may have drying
effects.

11. DISCOLORATION OF SALIVA
Rifampacin(red-orange discoloration of saiva)
Doxorubicin
Clofazimine(pink to brownish-black saliva)
L-Dopa(brownish discoloration of saliva)
Rifabutin(brown or orange discoloration of saliva)

12. (2)DRUG-RELATED DISORDERS OF TASTE
HYPOGEUSIA ( loss of taste acuity ) :
DRUGS:
Antirheumatic drugs like penicillamine,
antiproliferative drugs such as cisplatin, ACE
inhibitors, and other drugs including azelastine,
clarithromycin and zopiclone
AGEUSIA ( loss of taste sense )
DRUGS:
Penicillamine, cisplatin, ACE inhibitor, etc.

13. TREATMENT:
Pilocarpine,(effects of acetycholine)
Zinc supplementation
Zinc infusion in chemotherapy
DYSGEUSIA ( distortion of taste )
DRUGS:
Azelastine and emedastine, lithium carbonate and
Tetracyclines,penicillamine

14. (3)DRUGS RELATED MUCOSAL DISORDERS
ORAL ULCERATION
(a) Burning mouth syndrome
Aspirin
Potassium tablets
Clonazepam
(b) Aphthous stomatitis
Labetolol
Alendronate

15. (c) Fixed drug eruptions
Anesthetics, antibiotics, antiseptics, barbiturates
(d) Drug-related erythema multiforme
 Edematous papules
 Barbiturates, cephalosporins, NSAIDs, phenothiazines
(e) Oral mucositis
Chemotherapy and radiotherapy
•5-fluorouracil
•Methotrexate
•Doxorubicin
•Cyclophosphamide

16. (f) Glossitis
•Glossitis is inflammation of the
tongue that is characterized by
swelling and intense pain.
•Atrovastatin,
Benzodiazepines,
Captopril
(g)Vesiculo-bullous lesions
 Blisters
 Vesiculo-bullous lesions are
reported for naproxen and
penicillamine.

17. (h) Stevens-Johnson Syndrome (SJS)
• Milder form of toxic epidermal necrolysis
• Ulcers and lesions start to appear in the
mucous membrane, starting in mouth and lips.
• Extremely painful and reduce the ability of
the person to eat or drink
• DRUGS:Sulfonamide
Penicillins
Quinolones
Phenytoin
NSAIDS
Allopurinol
•TREATMENT:
Antibiotic therapy
Removal of the offending agent

18. DRUG-RELATED WHITE LESIONS
•Lichenoid eruptions
 beta blockers
 traditional
antimalarials
 thiazide
diuretics
 furosemide
 spironolactone
 Metformin
 penicillamine

19. •Elimination of precipitating factors
and improving oral hygiene.
•Treatment usually involves topical
corticosteroids such as
Betamethasone
clobetasol
dexamethasone
triamcinolone
TREATMENT

20. (4)DRUG RELATED MUCOSAL PIGMENTATION
(1) Drug-related superficial transient
discoloration ( black hairy tongue )
• Discoloration of the dorsum of the tongue
and other soft tissues and teeth may be of
various colors, typically yellowish or brown.
• DRUGS RELATED : Iron salts, bismuth,
chlorhexidine, or antibiotics

21. (2) Drug-related intrinsic pigmentation
Mucosal pigmentation : Amalgam
Gingival pigmentation : Gold or
metal alloys
(3)Pink-red colouration
Hemolysis and exudation of
hemoglobin to dental pulp.
overdoses with barbiturates and
carbon monoxide

22. (5)DRUG RELATED SWELLINGS
•Drug-related gingival enlargement
Phenytoin
Ciclosporin
calcium-channel-blockers ,nifedipine
Erythromycin

23. •Drug-related lip and mucosal swelling
•Penicillins, local anesthetic agents, cephalosporin
derivatives, angiotensin-converting enzyme
inhibitors(ACE), aspirin, and barbiturates.
•REASON: rise in levels of bradykinins and/or altered
levels or function of C1 esterase inhibitor .

24. (6)DRUGS RELATED NEUROPATHIES
(1)Drug-related trigeminal neuropathies:
DRUGS : acetazolamide, labetalol, sulthiame, vincristine.
TREATMENT: Anticonvulsant carbamazepine is the first line
treatment.
(2) Drug-related involuntary facial movements:
DRUGS : Butyrophenones, phenothiazines, tricyclic
antidepressants
TREATMENT : Carbzmazepine, Botulinum Toxin.
(3) Drug-related orofacial pain and oral dysesthesia:
DRUGS : Benztropine ,Biperidin ,Griseofulvin
TREATMENT : Antidepressants

25. (7)DRUG RELATED ORAL MALODOR (HALITOSIS)
Bad breath
DRUGS:
Isosorbide dinitrate
Dimethyl sulphoxide
Disulfiram
TREATMENT:
Cleaning the tongue
Mouthwashes

26. (8)DRUG RELATED ORAL INFECTIONS
Alveolar osteitis (dry socket)
ACE inhibitors
Facial edema (angioedema)
Adrenomimetic bronchodialators
Enalapril
Stomatodynia (pain in the mouth)
Bentropine
Penicillins
Cheilitis (inflammation and cracking of lips)
Busulfan
Atrovastatin

27. (9)DRUG RELATED ORAL TERATOGENIC EFFECTS
(1)Cleft lip
(2)Cleft palate
DRUGS : Anticonvulsant drugs
Accutane
Methotrexate
(3)Tooth discoloration
DRUGS : Cadmium
Minocycline
Tetracycline

28. CONCLUSION
In most cases , the oral reaction will be resolved
by symptomatic treatment.
Many clients take multiple medications
,therefore , dentists must be aware of the issues
related to drug use including indications ,
interactions and adverse drug effects.
As a final note , rapid progress in
pharmacotherapeutics requires clinicians to
constantly update their knowledge of drugs used
by their patients.