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DRUGS-INDUCED ORAL REACTIONS - Coggle Diagram
DRUGS-INDUCED ORAL REACTIONS
PATHOGENESIS
immunologic mechanims
IgE-mediated reactions occur when the drug reacts with IgE antibodies bound to mast cells
Drug allergies can concern a cytotoxic reaction in which an antibody binds to a drug that is already attached to the cell surface
Drug allergy involves the circulation of the antigen for prolonged periods, allowing for the sensitization of the patient's immune system and the production of a new antibody
nonimunologic mechanims
Do not depend on antibodies and can directly affect mast cells causing the release of chemical mediators
Some non-immunological reactions are the result of a drug overdose or toxicity.
CLINICAL QUALITY
Acquired angioedema
IgE-mediated drug allergy that is commonly observed as drug and food reactions
Other cutaneous manifestations
urticaria
maculopapular rash
erythema
vesicles
ulcers
target lesions
Oral manifestations
may be of nature
erythematous
vesicular
ulcerative
may mimic
erosive lichen planus known as lichenoid drug reactions
HISTHOPATOLOGY
nonspecific reactions
lymphoid infiltrates
eosinophils
apoptotic keratinocytes
ulceration
spongiosis
infiltrations in a subepithelial or perivascular distribution
mononuclear
polymorphonuclear
basal cell destruction
edema
keratinocyte necrosis
DIAGNOSIS
requires a careful history taking
recent use of a drug
clinical expression of lesions is generally allergic in nature
INDUCTED BY
type of drug
drug dose
individual patient differences
EFECTS ON ORAL AND TOUNGE
Oral mucosal membranes
may be
only site involvement
more generalized skin reaction to the offending drug
hypersensitivity reaction
mediated by sensitized T lymphocytes
Drug stomatitis
occurs with the use of systemic medications
Reactions usually appear 24 hours after ingestion of the drug
Withdrawal of the offending drug results in resolution of the lesions
in mild cases
erythematous
in severe cases
ulcerated
Drugs with the potential to cause drug stomatitis
Barbiturates
Lidocaine
Clorhexidine
sulphonamides
Salicylates
Penicillamnie
Contact stomatitis
is a local reaction of the mucosa after repeated contact with the causative agent
reactions
erythematous lesions
ulcerative lesions
The patient may complain of a burning sensation in the mouth along with xerostomia
Compounds with the potential to cause contact stomatitis
Antibiotics
Antiseptic lozenges
Dental materials
amalgam, platinium, acrylic components, palladium
Topical anesthetics
Topical steroids
Toothpastes
specially those containing cinnamonaldehyde
Aphthous stomatitis
Lesions usually appear as painful, tiny, discrete, or grouped papules and vesicles
predominantly observed on the labial and oral mucosa
Reactions heal without scarring in 10 to 14 days
drugs with the potential to cause aphthous stomatitis
Captopril
Cyclosporine
Indinavir
Penicillamine
Losartan
Sulfonamides
Olanzapine
Burning Mouth Syndrome
occur due to psychogenic factors, hormonal withdrawal, folate, iron, pyridoxine deficiency, or hypersensitivity reactions to the materials utilized in dental prostheses
Glossitis
inflammation of the tongue characterized by swelling and severe pain
Drugs that have potential to cause glossitis
Astrovastatin
Benzodiazepines
Bleomycin
Captopril
Chephalosporines
Chlorhexidine
Enalapril
Metronidazole
Penicillamine
Penicillins
Tetracyclines
Erythema Multiforme (Stevens–Johnson Syndrome)
is a mucocutaneous disorder, the lips are swollen, crusted, and bleeding
when severe is termed Stevens–Johnson Syndrome
The oral lesions disappear within 14 days of drug withdrawal
4% of erythema multiforme reactions are caused by drugs, however, 80% of cases occur in Stevens– Johnson Syndrome
Drugs with potential to cause erythema multiforme
Barbiturates
Carbamazepine
Chlorpropamide
Clindamycin
Ginseng
Penicillamine
Penicillins
Rifampicin
Tetracyclines
Oral Ulceration
Drugs with potential to cause erythema multiforme
Aspirine
Barbiturates
Captopril
Chloramphenicol
Clonazepam
Cyclosporine
Erythromycin
Fluconazol
Ibuprofen
Warfarin
Naproxen
Penicillins
Vesiculo–bullous Lesions
it seems to be the consequence of a direct irritant effect
reaction has been reported for
Naproxen
Penicillamine
Lichenoid Eruptions
Lichenoid drug eruptions rarely affect the buc- cal mucosa
It is thought that drugs causing lichenoid reactions only uncover the latent disease of lichen planus, or amplify a previous disorder, rather than inducing the disease de novo
Drugs
Arsenical compounds
Angiotensin-converting enzyme inhibitors
Bismuth
Chloroquine
Mercury
Tetracyclines
Penicillamine
Propanolol