Adverse drug reaction: Dental structures Flashcards
Give examples of dental structures that can be affected by ADRs
- Tooth and tooth development
- periodontal tissue
- Alveolar bone
- Cleft lip and palate
Give example of drugs that can affect tooth development
- phenytoin (anti epileptic drug)
- Lidocaine and prilocaine given intraligamentary
- Chemotherapeutic agents
What abnormalities can phenytoin cause
Abnormalities in the roots of the teeth.
Defects include:
- shortening of the root,
- root resorption
- increased deposition of cementum
What can Intraligamentary injections of lidocaine and prilocaine cause
are cytotoxic to the enamel organ and will interfere with amelogenesis
What ADRs can Chemotherapeutic agents cause
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
Give example of drugs that can cause staining of dental structures
- Chlorhexidine
- Tetracycline and other antibiotics such as Ciprofloxacillin
What problems are sugar based medicines associated with
Increased caries
Give examples of conditions in children that may result in them taking sugary medication
epilepsy,
cystic fibrosis,
chronic renal failure
asthma
What effect can systemic mediation have on the periodontal tissues
- Direct adverse effect on the periodontium
- Reducing the rate or periodontal breakdown
- Increasing the response of the periodontal tissues to bacterial plaque
Name the 2 most frequently recognised adverse effects that occur on the peridontium
drug-induced gingival overgrowth
drug- induced desquamative gingivitis.
Name the 3 drugs that have been impacted in causing drug induced gingival overgrowth
- Phenytoin (antiepileptic)
- Ciclosporin (immunosuppressant)
- Calcium channel blockers (eg nifedipine and amlodipine)
Give examples of risk factors that may increase chances of developing drug induced gingival overgrowth
- Age- young more susceptible
- Drug variables
- Concomitant medication
- Periodontal variable and pts current periodontal condition
How can we treat and manage drug induced gingival overgrowth
- Improve plaque control
- Gingival surgery (gingivectomy)
- Change medication
Which medication can cyclosporin be replaced for to minimise gingival overgrowth
tacrolimus
Give examples of drugs commonly implicated in the development of desquamative gingivitis
- β- adrenoceptor blockers e.g. atenolol
- antidiabetic drugs e.g. chlorpropamide
- some NSAIDs.
Name the group of drugs most commonly associated with an increase in the expression of periodontal disease
Sex hormones and the oral contraceptive pill
Give examples of drugs that can effect the alveolar bone
- Bisphosphonate
- Oral contaceptive pill
What ADRs can Bisphosphonate have
Can lead to Bisphosphonate-induced osteonecrosis
When are Bisphosphonate given to pt
To treat osteoporosis and osteolytic tumours
How do Bisphosphonates work
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
What are Bisphosphonates associated with
osteonecrosis of the jaw
How can we prevent Bisphosphonate- induced osteonecrosis
- Invasive dental procedures should be avoided while pts are taken Bisphosphonates
- Thorough soft tissue and dental examination should be performed before a patient starts bisphosphonate therapy
- If possible dental treatment should be completed before bisphosphoante therapy begins
How can bisphosphonate-induced osteonecrosis be treated
combination of wound irrigations using povidoneiodine, daily rinsing with 0.12% chlorhexidine mouthrinse plus systemic antibiotics.
What is the use of the oral contraceptive pill associated with
Significant increase in the frequency of dry socket
How can we minimise the risk of dry socket in a pt takin the oral contraceptive pill
by doing the XLA on days 23-28 of the tablet cycle
Give examples of drugs with teratogenic effects that coudl increase the possibility of a child being born with cleft lip and palate
benzodiazepines,
antiepileptics,
vitamin A analogues
sulfasalazine
Give examples of common ACE inhibitors
nalapril and lisinopril
Why are ACE inhibitors given
In the management of hypertension and heart failure
What problem can arise from ACE inhibitors
Angioedema
What is angioedema
Area of swelling in the upper layer of the skin
What is the prime concern in management of angioedema
Protection of the airway
What effect can drugs have on the muscles of facial expression and mastication
dyskinesias or
dystonia (involuntary movement of the facial muscles resulting in lip smacking, facial grimaces and tongue protrusions).
Which drugs have been implicated in drug induced dyskinesias
The antipsychotics, e.g. phenothiazines and butyrophenones
