DRUGS-INDUCED ORAL REACTIONS

Color Changes of Oral Mucosa and Teeth

Discoloration can occur after direct contact
with or following systemic absorption of a drug

Black Hairy Tongue (Lingua villosa nigra)

there is an elongation of the filiform papillae of the tongue to form hair-like over- growth that becomes stained brown or black due to proliferation of chromogenic microorganisms

can be seen

poor dental hygiene

excessive smoking in adults

administration of oral antibiotics

Drugs and chemicals with potential to cause black tongue

Cephalosporines

Claritrhomycin

Clonazepam

Corticoesteroids

Streptomycin

Penicillins

Sulfonamides

Tobacco

Tetracyclines

Vegetable dyes

Postmortem Pink–Red Coloration

Tooth staining is due to hemolysis and the exudation of hemoglobin into the dental pulp

Drug Induced Gingival Hyperplasia

growth starts as a painless

Plaque removal and good oral hygiene may benefit in a fast recovery and limits the severity of the lesion but the lesion does not completely resolve

causative drugs inhibit Ca+ uptake on gingival fibroblasts that correlates with the rate of fibroblast proliferation

drugs with potential to cause gingival hyperplasia

Erythormycin

Ketokonazole

oral contraceptives

Lithium

calcium channel blockers

Sodium valproate

Cyclosporine-A

phenobartital

Phenytoin

Vigabatrin

increase the fibroblast production of collagen and protein,

Nifedipine

resolves when the drug is withdrawn

cell mediated androgen action in the gingiva in response to phenytoin could contribute to gingival overgrowth

Inhibition of apoptosis by nifedipine and resultant epithelial hyperplasia

inhibits both adherence and lipoploysaccharide-stimulated macrophage-induced death of fibroblasts which results in gingival overgrowth

Specific conditions of death associated with this phenomenon

Drowning

Aspiration pneumonitis

Asphyxia

Barbiturate overdoses

Carbon monoxide overdoses

Salivary Glands

can be affected by a variety of drugs that can produce xerostomia or ptyalism

caused by such drugs as amphetamines

reduced salivary flow rate and to a decrease in salivary calcium and phosphate concentration

salivary mucins and growth factors

are involved

maintenance of mucosal integrity due to their ability to trap water

tissue regeneration

epidermal growth factor

potential role in oral wound healing

Common oral manifestations from decreased salivary flow

Increased dental caries

Bacterial infections

Fungal infections

Aphthous lesions

Dysphagia

Systemic drug therapy can also produce pain and swelling of the salivary glands

drugs and chemicals with potential to inhibit the function of salivary glands

Benzodiazepines

Sjogren’s Syndrome

includes parotid swelling

seen in association with other autoimmune rheumatic diseases

parotid enlargement in Sjogren’s Syndrome occurs relatively late in the course of rheumatoid arthritis

Cadmium

Cyclosporine

Diltiazem

Lead

Lihium

Morphine

Nifedipine

Nitric oxide inhibitors

Verapamil

Rubidium

Drugs that can cause dryness of mouth

Anticholinergics

Antihistamines

Antineoplastic drugs

Anti-HIV protease inhibitors

Amphetamine

Omeprazole

Tricyclic antidepressants

Tramadol

Drugs that can cause sialorrhea

Gentamicyn

Clozapine

Alprazolam

Iodides

Kanamycin

Levodopa

Mercurial salts

Pilocarpine

Tobramycin

Drugs that have potencial to cause swelling or pain in salivary

Methyldopa

Naproxen

Clonidine

Ranitidine

Cimetidine

Chhlorhexidine

Catecholamine inhalation

Sulfonamides

Warfarin

Effects on Dental Structure

common problems associated with dry mouth

constant sore throat

burning sensation

problems in speaking

difficulties in swelling

hoarseness or dry nasal passage

Systemic drug therapies can also affect the oral environment, most notably when causing xerostomia Left untreated, dry mouth can damage teeth structure

Without adequate saliva to lubricate mouth, wash away food, and neutralize the acids produced by plaque, extensive decay can occur

Drugs may can xerostomia

tricyclic antidepressants

benzodiazepines

lithium

isotretinoin

morphine

therapy for acne

Dryness of mouth and severely dry lips are the side effects

Muscular and Neurological Disorders

Drugs to cause sensation of numbness, tingling, or burning in the face or mouth

Pentamidine

Polymyxin B

Nicotinic acid

Propanodol

Streptomycin

Hydralazine

Tolbutamide

Ergotamine

Chlorpropamide

Acetazolamine

patients taking antipsychotic drugs for many years, is an uncommon and sometimes unrecognized cause of orofacial pain

but secondary orofacial pain can result from chronic mild trauma between a denture-bearing mucosa and dentures with abnormal movement

Taste disturbance

Modification
in taste it can be

decrease in sensitivity in the perception of taste (hypogeusia)

simply a dullness

a total loss of the ability to taste (ageusia)

distortion in the perception of the correct taste of a substance (dysgeusia)

A wide range of drugs interfering the chemical composition or flow of saliva

Sulfhydryl compounds are a common cause of taste disturbances

drugs with potential to cause ageusia

Sulfadoxine

Spironolactone

Ritonavir

Rifabutin

Phenytoin

Losartan

Methimazole

Penicillamine

Enalapril

Cocaine

Clidinium

Captopril

Aspirin

Veniafaxine

Durgs with potencial to cause dysgeusia

Alprazolam

Amoxicillin

Acyclovir

Aspirin

Acetaminophen

Captopril

Cephalosporines

Carbamazepine

Penicillins

Chlorhexidine

Clonazepam

Diclofenac

Ketoprofen

Ketorolac

Merfomin

Vancomycin

Tramadol

Taste Disturbance

penicillamine causes partial or total loss of taste

In patients treated for Wilson’s disease, Loss of taste has been found to be dose related. It appears that taste disturbance is reversible within a period of 8-10 weeks

Am impaired salty taste is a frequent complaint associated with Captopril

The extent of Captopril- induced dysgeusia seems to be related to dose and renal function and can be compounded by smoking

drugs that used for gastrointestinal disorders may cause some degree of loss

Drugs with potencial to cause altered taste

Tripotassium dicitrato bismuthate chelate

Clarithromycin

lansoperazole

anti-HIV protease inhibitors

Terbinafine

Intravenous pentamidine,

Isotretinoin

Halitosis

offensive breath resulting from

dental or oral infections

ingestion of certain foods

poor oral hygiene

use of tobacco

some systemic diseases

Disulfiram and sublingual isosorbide dinitrate can cause halitosis

Drugs causing xerostomia may indirectly cause or aggravate this problem

Oral Infections Induced or Aggravated by Drugs

systemic drug therapy can alter oral flora and, therefore, predispose the mouth to bacterial or fungal infection

Drugs that have been implicated in this problem

antimicrobials

anticancer drugs

corticosteroids

immunosuppressive agents

oral contraceptives

Drugs causing xerostomia may also potentiate the initiation of oral infections

Alveolar Osteitis (Dry Socket)

The use of contraceptives has been associated with a significant increase in the frequency of alveolar osteitis after removal of impacted lower third molars

The probability of dry sockets increases with the estrogen dose in the oral contraceptive

Facial Edema/Angioedema


manifestation of drug- induced hypersensitivity reactions, and angioten- sin converting enzyme inhibitors (ACEIs) are the most common cause

usually occurs within hours or at most weeks

ACEIs implicated in this reaction are

Enalapril

Lisinopril

Captorpil

drugs that can cause facial edema

Adrenomimetic bronchodilators

Droperidol

Mianserin

Intravenous clindamycin

Stomatodynia

is pain in the mouth and can be a consequence of drug reaction

Drugs with potencial to cause stomatodynia

Benztropine

Biperidin

Griseofulvin

Lithium

Penicillins

Potassium iodide

Ticarcillin

Vitamina A

Cheilitis

abnormal condition of the lips characterized by inflammation and cracking of the skin

almost always associated with fungal infections

frequently occurs with xerostomia that is drug-induced

Drugs with potential to. cause chelitis

Atrovastatin

Busulfan

Clofazimine

Cyanocobalamin

Gold compounds

Ritonavir

Saquinavir

Simvastatin

Streptomycin

Sulfasalazine

Tetracycline

Vitamin A

seen along the gingival margins and are caused by the formation of metallic sulphides as a result of reactions with plaque products in gingival pockets

in long-term use produce widespread mucosal pigmentation which is caused by accumulation of a drug metabolite in the tissue

Phenothiazines

chlorpromazine

the deposit of melanin or iron in mucosal tissues has been suggested with drugs

quinolones

chloroquine

mepacrine

can be caused by the use of oral contraceptives, and cessation of the drug does not produce complete regression of the pigmentation

dark macular patches are reported to occur in heroin addicts who inhale the smoke

Minocycline-induced oral pigmentation

represent minocycline staining of the underlying bones without involvement of the overlying oral mucosa surfaces

Smokers’ melanosis, characterized by increased melanin formation especially in the attached gingiva, has been described

Three possible mechanisms for chlorhexidine–induced staining

non-enzymatic browning reactions

Formation of pigmented metal sulphides

dietary factors

Extrinsic stains are located on the surface of the tooth and are most easily removed by external cleaning

Intrinsic stains are located within the tooth and are accessible only by bleaching

Tetracycline can cause the most common