DENTAID Oral Health
News for pharmacy professionals
ADVERSE REACTIONS TO MEDICATIONS IN THE ORAL CAVITY
29 Sep 2016
There are a great number of drugs that may produce certain kinds of undesirable effects in the oral cavity, resulting in various diseases and disorders that must be treated.
Adverse drug reactions are those that produce a harmful, unintended response. They can be classified into two types:
Type “A” reactions: directly related to an enhanced
pharmacological action of the drug administered (e.g. hypoglycaemia from an
anti-diabetic drug).
Type “B” reactions: those that are unexpected from the know pharmacological action of the drug (e.g., anaphylaxis from penicillin).
Just as in the rest of the body, these adverse reactions may occur in
the oral cavity affecting different parts of the mouth.
ADVERSE DRUG REACTIONS ARE THOSE THAT PRODUCE A HARMFUL, UNINTENDED RESPONSE
There are over 500 drugs that may cause dry mouth - or xerostomia - up
to 80% of those most commonly prescribed. Salivary glands are very sensitive to
strict anticholinergics (atropine, belladonna, scopolamine, etc.). Other
pharmacological groups which also produce xerostomia are: antidepressants and
antipsychotics (serotonin reuptake inhibitors, tricyclic and heterocyclic
antidepressants), antihypertensives (ACE inhibitors, diuretics, beta blockers,
etc.), anxiolytics and sedatives, muscle relaxants, analgesics (CNS/opioids),
antihistamines, appetite suppressants, acne medications, anticonvulsants,
antiparkinson agents, bronchodilators, migraine medications and hypnotics.
A reduction in saliva has consequences for the oral cavity, since its pH buffer effect and microbial inhibition is lost. It may thus lead to the development of diseases such as caries and periodontal disease or disorders like halitosis and dental hypersensitivity.
Ptyalism
There are other drugs that can cause the opposite
effect—hypersalivation—also known as ptyalism or sialorrhea. This is much less
frequent and less severe, although it may be bothersome for those who have to
endure it. It is fundamentally attributed to parasympathomimetic drugs, which
act directly on the acetylcholine receptors (pilocarpine, cevimeline,
bethanechol, carbachol) or by inhibiting acetylcholinesterase (neostigmine,
physostigmine). In some countries pilocarpine is in fact used as a treatment
for xerostomia, although it is necessary to evaluate the side effects that may
arise. Catecholamines and other drugs that act on the central nervous system
(CNS) also cause this effect through other mechanisms of action, such as
epinephrine, clonazepam, bromine, mercury and iodine compounds.
THERE ARE OVER 500 DRUGS THAT MAY CAUSE DRY MOUTH OR XEROSTOMIA
Inflammation and pain in the salivary glands
Chemical burns to the mucosa are produced most commonly by misuse of
analgesics and antiseptics. An example is acetylsalicylic acid, which is used
topically to relieve dental pain and produces a superficial necrosis of the
epithelium, with the appearance of white lesions with irregular edges on an
area showing painful erythema.
Other drugs such as phenylbutazone, indomethacin, silver nitrate, hydrogen peroxide, isoproterenol and potassium chloride also cause ulcers if applied in the same way. In addition, these may be produced by the use of products with high alcohol content, like some mouthwashes (if abused) or certain benzocaine-based anaesthetic solutions.
Mucositis
Chemotherapy may cause mucositis (inflammation and ulceration of the
mucosa with pseudomembrane formation) after 5-7 days of treatment. The antineoplastics
that produce these reactions most frequently are methotrexate and
5-fluorouracil. They cause such pain as to interfere with patients' daily lives,
affecting their eating habits. Topical anaesthetics and oral analgesics are
used to treat mucositis.
Allergic stomatitis
Allergic stomatitis may be due to the systemic administration of, or
direct contact with, certain drugs. Drugs with which this occurs most often are
barbiturates, acetaminophen, phenacetin, pyrazolones, sulfonamides and tetracyclines.
Lichenoid reactions
Certain medications may cause lichenoid reactions; these are similar to
lichen planus, but are associated with the use of medicines. Their aetiopathogenesis
is undetermined, and the reactions disappear after ceasing medication. They may
mainly be caused by non-steroidal anti-inflammatory drugs (NSAIDs) (such as
piroxicam) and angiotensin-converting enzyme inhibitors (ACE inhibitors), but
may also be produced by antimalarials, other antihypertensive agents (diuretics
such as hydrochlorothiazide, beta blockers, etc.), psychotropic drugs, metal
salts (gold- or bismuth-based) and drugs for rheumatoid arthritis (monoclonal
antibodies).
PIGMENTATION
Oral iron supplements (in the form of ferrous salts), used for the treatment of iron deficiency anaemia may cause the appearance of black spots on the teeth.
Cisplatin, a drug used for certain antineoplastic therapies, may produce a linear bluish staining on the gum margin.
GINGIVAL HYPERPLASIA
OSTEONECROSIS
Bisphosphonates are the drugs most commonly associated with
osteonecrosis, especially if used intravenously. This condition occurs with the
exposure of the maxillary bone due to a lack of blood supply, and inhibition of
bone resorption. Most cases occur in patients taking bisphosphonates in cancer
therapy, as tumours such as multiple myeloma or breast carcinoma tend to
involve the skeleton. However, osteonecrosis may also occur with the use of
biphosphonates for osteoporosis. Multidisciplinary management of these patients
is required to prevent occurrence of this very serious complication.
TASTE ALTERATIONS
There are over 200 drugs that produce alterations to the sense of taste, either diminishing it (hypogeusia), distorting it (dysgeusia) or causing its total loss (ageusia). The list of drugs that produces this is very long, and may include antibiotics, anti-rheumatics, anti-inflammatories, antithyroid drugs, antihypertensives, diuretics, local anaesthetics, antineoplastic treatments, oral antiseptics, anxiolytics, antidepressants, etc. These problems disappear after discontinued use of the drug responsible for causing the alteration.
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Sign up for the DENTAID Oral Health newsletter
| Data controller | DENTAID, S.L. LABORATORIOS DE PREVENCIÓN E HIGIENE BUCAL, SLU (“PHB”). |
|---|---|
| Purpose of data processing | To respond to a query from the interested party with the advice of a specialist. |
| Legitimisation of data processing | Your consent to process your personal data. |
| Recipients of disclosure or transfer | Data is not disclosed or transferred internationally. |
| Rights of the interested persons | To access, rectify and delete their data, and to exercise other rights as set out in the additional information. |
| Additional information | You can consult additional and detailed information on data protection at this link. |
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