Unwanted Oral effects of Drugs

Question 1

What parts of the oral cavity may a drug effect?

Answer 1

• Oral mucosa
• Salivary glands (xerostomia)
• Teeth (staining)
• Periodontium (gingival hyperplasia)
• Taste buds (altered taste)

Question 2

Name some drugs which cause local oral reactions

Answer 2

• Aspirin burn
• Pancreatic supplements: oral ulceration
• Captopril: oral ulceration
• Nicorandil: yellow necrotic ulcer
• NSAIDS

Question 3

What is the name effect of chemotherapy on the oral mucosa?
What is the scale for this condition (1-4)?

Answer 3

Mucositis
Drugs:
- Methotrexate
- Doxorubicin
- Bleomycin

Side effect: widespread sloughing and ulceration. Ulceration may be due to loss of cell proliferation. Pain requires opioid therapy. Becomes a portal of entry of infection.

Mucositis scale:
- Grade 1 = soreness and erythema
- Grade 2 = ulcers, patients can swallow food
- Grade 3 = ulcers with extensive erythema, patient cannot swallow food
- Grade 4 – extent of mucositis that patient alimentation (nourishment) is not possible

Question 4

What can be seen intra-orally as the reaction to a fixed drug eruption?

Answer 4

Ulceration, bullae, erythematous patches or superficial erosions

Question 5

What is the mechanism for a lichenoid reaction? What are the signs/symptoms? What materials can cause a lichenoid reaction? What drugs can cause a lichenoid reaction?

Answer 5

Type 4 hypersensitivity reaction.

Signs/symptoms = erythema, vesicle formation/ulceration, loss of lingual papillae

Materials = toothpaste, cosmetics, mouthwashes, periodontal packs, denture fixatives, amalgam, nickel

Drugs = anti-hypertensives, anti-malarial, metals, NSAIDs, hypoglycemia

Question 6

What are the 3 main drugs which cause erythema multiforme?

Answer 6

Sulphonamides, barbiturates, tetracyclines

Question 7

What is the clinical appearance for erythema multiforme?

Answer 7

Blisters, erythema, ulceration, bleeding, crusting of lips

Question 8

What syndromes can erythema multiforme lead to in severe cases?

Answer 8

Stevens Johnson Syndrome
Toxic epidermolysis necrolysis

Question 9

What 3 drugs common cause gingical hyperplasia?

Answer 9

1. Cyclosporin
2. Amlodipine
3. Phenytoin

Question 10

What may oral pigmentation be caused by and what part of the oral cavity is commonly affected?

Answer 10

• Melanin pigmentation (race, antimalarials)
• Blue grey deposits
• Amalgam tattoo

Question 11

What drugs can lead to impaired taste?

Answer 11

ACE inhibitors.
Anti HIV protease inhibitors.
Lansoprazole

Question 12

What drugs commonly cause xerostomia?

Answer 12

• Analgesics
• Anti-hypertensives
• Anti-histamines
• Anti-depressants
• Antipsychotics
• Appetite suppressants
• Proton pump inhibitors
• Atropinics (travel sickness)