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DRUGS-INDUCED ORAL REACTIONS - Coggle Diagram
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
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
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
Specific conditions of death associated with this phenomenon
Drowning
Aspiration pneumonitis
Asphyxia
Barbiturate overdoses
Carbon monoxide overdoses
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
resolves when the drug is withdrawn
Lithium
calcium channel blockers
Nifedipine
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
Sodium valproate
Cyclosporine-A
increase the fibroblast production of collagen and protein,
phenobartital
Phenytoin
cell mediated androgen action in the gingiva in response to phenytoin could contribute to gingival overgrowth
Vigabatrin
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
Cadmium
Cyclosporine
Diltiazem
Lead
Lihium
Morphine
Nifedipine
Nitric oxide inhibitors
Verapamil
Rubidium
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
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
therapy for acne
Dryness of mouth and severely dry lips are the side effects
morphine
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
Tramadol
Diclofenac
Ketoprofen
Ketorolac
Merfomin
Vancomycin
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