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Current Opinion on Drug-induced Oral Reactions - Coggle Diagram
Current Opinion on Drug-induced Oral Reactions
Oral Allergic Reactions
Systemic medications can cause allergic reactions in the mouth as a fixed drug eruption called
stomatitis medicamentosa
are localized hypersensitivity reactions that recur in the same site each time the causative drug is ingested
usually appear within 24 hours post-ingestion of the drug
Withdrawal of the causative drug results in resolution of the lesions
They feature erythematous eruptions on the skin and mucous membranes heal with residual hyperpigmentation
also be erosive and ulcerated
May occur on
buccal mucosa, lips, and tongue are more frequently involved
gingiva and palate
Drugs with potential to cause fixed drug eruptions
Chlorhexidine
Dapson
Barbiturates
Gold
Ampicillin
Ibuprofen
Lidocaine
Pencicillamine
Salicylates
Sulphonamides
Tetracyclines
Oral contact allergic reactions or
stomatitis venennata
has increased for
increased use of oral hygiene products
In most instances the reactions appear to be induced by the flavoring agents in the dentifrices, often cinnamic aldehyde
esthetics related products
dental restorative materials
wearing of latex gloves
The reaction may develop from days to years post-exposure to the causative agent
types of oral contact allergic reactions
Allergic gingivo-stomatitis
features intense hyperemic inflammation of the gingiva
angular cheilitis and glossitis
involvement of the vermilion border of the lips and perioral skin
Compounds with potencial to cause contact allergic reactions
Antibiotics
Antiseptic lozenges
Chewing gum
Food additives
Mouthwashes
Toothpastes(with cinnamonaldehyde, formalin and herbal components)
Topic anesthetics
Topical steroids
Aphthous-Like Ulcers
aphthous-like ulcers
have systemic causes
Behçet’s syndrome
gastrointestinal diseases
gluten-sensitive enteropathy
inflammatory bowel disease
immunodeficiency syndromes
HIV
cyclic neutropenia
Drugs with potential to cause aphthous-like ulcers
NSAIDs
Sulfonamides
Penicillamine
Losartan
Interferons
Indinavir
Gold compounds
Docetaxel
Cyclosporine
Captopril
Beta-Blockers
recurrent aphthous stomatitis
have not systemic cause
It is a common condition which is characterized by multiple recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors
The proper treatment of aphthous ulcers depends on the frequency, size, and number of the ulcers
minor aphthous ulcers
appropriate topical therapy such as tannic acid (zilactin), orabase, diclofenac
more severe disease
topical glucocorticoid is an effective therapy
Burning Mouth Syndrome
The pain feels like a moderate to severe burning sensation occurring more frequently on the tongue but can also occur on the gingiva, lips, and jugal (malar) mucosa
It can worsen as a result of stress and fatigue, excessive speaking, or by ingesting spicy/hot foods
may occur due to
xerostomia
radiotherapy
endocrine disease
diabetes mellitus
hypothyroidism
menopause
medication
Angiotensin converting enzyme inhibitors (ACEIs)
Lisinopril
Enalapril
Captopril
nutritional deficiencies
neuralgia
dental prostheses
allergy
infection
psychiatric disorders
depression
anxiety
Treatments proven to be effective in controlled double-blind studies are
cognitive behavior therapy
topical or systemic clonazepam
alpha lipoic acid
Drugs with potential to cause burning mouth syndrome
ACEIs
Antiretroviral drugs
Cephalosporine
Chloramphenicol
Penicillin
Clonazepam gabapentin
Tricyclic antidepressants
Glossitis
inflammation of the tongue characterized by swelling and intense pain that may be referred to the ears
Salivation, fever, and enlarged regional lymph nodes may develop during an infectious disease, after a burn, or other injury
Drugs that have potential to cause glossitis
Enalapril
Methotrexate
Cyclosporine
Mianserin
Corticosteroids
NSAIDs
Penicillamine
Penicillins
Cephalosporine
Tetracyclines
Chlorhexidine
Captopril
Xerostomizing medications
Benzodiazepines
Erythema Multiforme
acute reactive mucocutaneous inflammatory and hypersensitivity reaction characterized by a skin eruption, with
symmetrical erythematous edematous
bullous lesions of the skin
mucous membranes
with minimal oral involvement to a progressive,with extensive mucocutaneous epithelial necrosis (Stevens-Johnson syndrome and toxic epidermal necrolysis)
caused by
medications
infections
immunotherapy
Stevens–Johnson syndrome
it can be difficult to differentiate between
viral stomatitis
pemphigus
toxic epidermal necrolysis
sub-epithelial immune blistering disorders
Treatment
(care by specialist)
A liquid diet and even intravenous fluid therapy may be necessary
topical corticosteroids
treatment with systemic corticosteroids or other immunomodulatory drugs
0.2% aqueous chlorhexidine mouthwash
Drugs with potential to cause erythema multiforme
Captopril
Cephalosporins
Barbiturates
Clindamycin
Aspirin
Cocaine
Antimalarials
Cyclosporine
Erythromycin
Famciclovir
Ketorolac
NSAIDs
Penicillins
Rifampin
Oral Ulceration
is a breach in the oral epithelium, which typically exposes nerve endings in the underlying lamina propria, resulting in pain or soreness
can be a final common manifestation of
Epithelial damage resulting from trauma
An immunological attack as in lichen planus
Pemphigoid or pemphigus
Damage due to an immune defect as in HIV
disease and leukemia
Infections such as herpes viruses
Tuberculosis and syphilis
Cancer
Nutritional defects such as vitamin
deficiencies
Some gastrointestinal diseases
Medications
Cocaine
NSAIDs
Tetracyclines
Tooth paste solutions (menthol, phenol,camphor, chloroform
Aspirin
Anti HIV drugs
Barbirutares
Captorpril
Clonazepam
Cyclosporine
Enalapril
Ibuprofen
Naproxen
Penicillins
Warfarin
Sulfonamides
Streptomycin
Treatment
chlorhexidine 0.2% mouthwash
maintaining good oral hygiene
a benzydamine mouthwash or spray
topical lidocaine solution or carboxymethylcellulose
Vesiculo–Bullous Lesions
it appears to be the consequence of a direct irritant
consequence of
steroid inhalers
naproxen
penicillamine
treatment
use of analgesics
prevention or treatment of a superimposed infection
Oral Lichenoid Reactions
Lichen planus is a chronic systemic disease of established immune-mediated pathogenesis
involves
mucosa of the oral cavity
skin
ulvar and vaginal mucosa
the glans penis
scalp
nails
Some drugs can induce oral disorders resembling lichen planus (
lichenoid drug reactions
)
disappear after drug withdrawal
rarely affect the buccal mucosa
treatment
withdrawal or replacement of the offending medication
corticosteroids
tacrolimus
psoralens
Drugs with Potential to cause oral lichenoid changes
B-blockers
Mercury (amalgam)
Arsenical compounds
NSAIDs
Antiretrovirals
Palladium
Antibiotics
Tetracyclines
Oral Mucositis
is a common toxicity associated with both head and neck radiation and chemotherapy used for the treatment of cancer
Methods to reduce exposure of the mucosa to chemotherapeutic drugs
cryotherapy
Propantheline
fluconazole
Palifermin
Benzydamine
povidone
present different levels of severity
large and painful ulcers
minor erythema, edema
is common with
doxorubicin
vinblastine
taxanes
methotrexate
Chemotherapy-induced mucositis occurs on
movable mucosa
dorsum of the tongue,
hard palate
gingiva
Gingival Hyperplasia
accumulation of extracellular matrix within the gingival connective tissue, particularly the collagenous component
main causative agents of drug-induced gingival hyperplasia
Phenytoin
cyclosporine-A
increase collagen and protein production by fibroblasts
calcium channel blockers
Nifedipine
accompany submandibular gland dysfunction
inhibits fibroblast death induced by adhesion-stimulated macrophages and lipoploisaccharides, resulting in gingival overgrowth
Amlodipino
diltiazem
felodipine
nitrendipine
verapamil
oral contraceptives
resolves when
the drug is withdrawn
Maintenance of adequate plaque control is important for gingival health during the administration
drugs inhibit Ca2 + uptake by gingival fibroblasts, which correlates with the rate of fibroblast proliferation
It begins as a pearl-like of the interdental papilla and extends to the facial and lingual gingival margins
It begins as a pearl-like in the interdental papilla and extends to the facial and lingual gingival margins. The enlargement is usually generalized throughout the mouth, but is more severe in the anterior maxillary and mandibular regions
Removing plaque and maintaining good oral hygiene can provide benefits in terms of rapid recovery and limit the severity of the injury
treatment
possibility of discontinuing the drug or of changing medication
plaque control
good oral hygiene
periodontal surgery