Adverse drug reaction: Dental structures

Question 1

Give examples of dental structures that can be affected by ADRs

Answer 1

1. Tooth and tooth development
2. periodontal tissue
3. Alveolar bone
4. Cleft lip and palate

Question 2

Give example of drugs that can affect tooth development

Answer 2

1. phenytoin (anti epileptic drug)
2. Lidocaine and prilocaine given intraligamentary
3. Chemotherapeutic agents

Question 3

What abnormalities can phenytoin cause

Answer 3

Abnormalities in the roots of the teeth.
Defects include:
- shortening of the root,
- root resorption
- increased deposition of cementum

Question 4

What can Intraligamentary injections of lidocaine and prilocaine cause

Answer 4

are cytotoxic to the enamel organ and will interfere with amelogenesis

Question 5

What ADRs can Chemotherapeutic agents cause

Answer 5

Can interfere with the formation of dental tosses leading to dental abnormalities such as
1. failure of the tooth to develop
2. microdontia
3. hypoplasia
4. enamel opacities
5. impaired root development

Question 6

Give example of drugs that can cause staining of dental structures

Answer 6

1. Chlorhexidine
2. Tetracycline and other antibiotics such as Ciprofloxacillin

Question 7

What problems are sugar based medicines associated with

Answer 7

Increased caries

Question 8

Give examples of conditions in children that may result in them taking sugary medication

Answer 8

epilepsy,
cystic fibrosis,
chronic renal failure
asthma

Question 9

What effect can systemic mediation have on the periodontal tissues

Answer 9

1. Direct adverse effect on the periodontium
2. Reducing the rate or periodontal breakdown
3. Increasing the response of the periodontal tissues to bacterial plaque

Question 10

Name the 2 most frequently recognised adverse effects that occur on the peridontium

Answer 10

drug-induced gingival overgrowth
drug- induced desquamative gingivitis.

Question 11

Name the 3 drugs that have been impacted in causing drug induced gingival overgrowth

Answer 11

1. Phenytoin (antiepileptic)
2. Ciclosporin (immunosuppressant)
3. Calcium channel blockers (eg nifedipine and amlodipine)

Question 12

Give examples of risk factors that may increase chances of developing drug induced gingival overgrowth

Answer 12

1. Age- young more susceptible
2. Drug variables
3. Concomitant medication
4. Periodontal variable and pts current periodontal condition

Question 13

How can we treat and manage drug induced gingival overgrowth

Answer 13

1. Improve plaque control
2. Gingival surgery (gingivectomy)
3. Change medication

Question 14

Which medication can cyclosporin be replaced for to minimise gingival overgrowth

Answer 14

tacrolimus

Question 15

Give examples of drugs commonly implicated in the development of desquamative gingivitis

Answer 15

1. β- adrenoceptor blockers e.g. atenolol
2. antidiabetic drugs e.g. chlorpropamide
3. some NSAIDs.

Question 16

Name the group of drugs most commonly associated with an increase in the expression of periodontal disease

Answer 16

Sex hormones and the oral contraceptive pill

Question 17

Give examples of drugs that can effect the alveolar bone

Answer 17

1. Bisphosphonate
2. Oral contaceptive pill

Question 18

What ADRs can Bisphosphonate have

Answer 18

Can lead to Bisphosphonate-induced osteonecrosis

Question 19

When are Bisphosphonate given to pt

Answer 19

To treat osteoporosis and osteolytic tumours

Question 20

How do Bisphosphonates work

Answer 20

They bind to accumulate in the bone and remain there for month after therapy is discontinued
They impair osteoclastic function and so osteocytes Arte not replaced and capillary network of bone in not maintained

Question 21

What are Bisphosphonates associated with

Answer 21

osteonecrosis of the jaw

Question 22

How can we prevent Bisphosphonate- induced osteonecrosis

Answer 22

1. Invasive dental procedures should be avoided while pts are taken Bisphosphonates
2. Thorough soft tissue and dental examination should be performed before a patient starts bisphosphonate therapy
3. If possible dental treatment should be completed before bisphosphoante therapy begins

Question 23

How can bisphosphonate-induced osteonecrosis be treated

Answer 23

combination of wound irrigations using povidoneiodine, daily rinsing with 0.12% chlorhexidine mouthrinse plus systemic antibiotics.

Question 24

What is the use of the oral contraceptive pill associated with

Answer 24

Significant increase in the frequency of dry socket

Question 25

How can we minimise the risk of dry socket in a pt takin the oral contraceptive pill

Answer 25

by doing the XLA on days 23-28 of the tablet cycle

Question 26

Give examples of drugs with teratogenic effects that coudl increase the possibility of a child being born with cleft lip and palate

Answer 26

benzodiazepines,
antiepileptics,
vitamin A analogues
sulfasalazine

Question 27

Give examples of common ACE inhibitors

Answer 27

nalapril and lisinopril

Question 28

Why are ACE inhibitors given

Answer 28

In the management of hypertension and heart failure

Question 29

What problem can arise from ACE inhibitors

Answer 29

Angioedema

Question 30

What is angioedema

Answer 30

Area of swelling in the upper layer of the skin

Question 31

What is the prime concern in management of angioedema

Answer 31

Protection of the airway

Question 32

What effect can drugs have on the muscles of facial expression and mastication

Answer 32

dyskinesias or
dystonia (involuntary movement of the facial muscles resulting in lip smacking, facial grimaces and tongue protrusions).

Question 33

Which drugs have been implicated in drug induced dyskinesias

Answer 33

The antipsychotics, e.g. phenothiazines and butyrophenones