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The Effect of Drugs in the Oral Cavity-A Review

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The Effect of Drugs in the Oral Cavity-A Review Trophimus Gnanabagyan Jayakaran /J. Pharm. Sci. & Res. Vol. 6(2), 2014, 89-96 The Effect of Drugs in the Oral Cavity - A Review Trophimus Gnanabagyan Jayakaran Saveetha Dental College and Hospitals, Saveetha University, Chennai, India Abstract: It is estimated that more than 2-4% of hospital admissions are related to drug induced reactions. There is an ever expanding list of medications linked to pathologic reactions in the oral and perioral region. Several patterns of diseases have been identified, and these can assist the clinician in determining a possible cause and effect relationship with a particular or a group of drugs. The mechanism of drug induced reaction is not always known or not always predictable since aspects other than pharmacodynamics and/or pharmacokinetics, as well as various interacting variables contribute to the final outcome. Drug induced oral reactions clinically present as Xerostomia, Swelling, Dysguesia, Nonspecific Ulceration, Vesiculobullous or ulcerative mucositis, pigmentation of mucosa, Gingival enlargement, oral malodor, taste alterations, discoloration of teeth. This review gives an update of the various drug induced oral reactions, so that Dentists and oral health professionals increase their knowledge for a better diagnosis and therapy. Key Words: Adverse drug reactions, Oral reactions, Oral manifestations, Mucosal lesions, Drug pharmacodyanamics, INTRODUCTION: bronchodilators, muscle relaxants, methyldopa, laxatives, Several systemic factors are known to contribute to oral betablockers, narcotics, guanabenz, and clonidine. diseases or conditions and among those are the intake of Furthermore the possibility of an underlying autoimmune drugs. An adverse drug reaction is defined by WHO as ‘a etiology(eg. Sjogren Syndrome) should also be considered in response to a drug which is noxious and unintended, and Xerostomic patients, especially those who also present with which occurs at doses normally used in man for the Xerophthalmia or evidence of parotid gland swelling. prophylaxis, diagnosis, therapy of diseases or for the Common oral manifestations resulting from decreased modification of physiological function’. [1]. Fortunately salivary flow include increased dental caries, fungal several patterns of diseases have been identified and these infections, bacterial infections, aphthous lesions, and can assist the clinician in determining a possible cause and dysphagia. Pilocarpine and Bethanechol have been suggested effect relationship with a particular medication or a group of to be of potential use in the management of drug induced medications. The clinical patterns of drug induced oral Xerostomia [5]. Drugs with potential to cause xerostomia are reactions include. Considering the ageing of the population shown in Table 1. and widespread and increased use of presciptions, over the B] PTYALISM: counter drugs and herbal remedies, dentists can expect to Ptyalism or sialorrhoea , is the condition of increased salivary encounter oral side effects among their patients due to the flow, and it is uncommon. Salivary hypersecretion is usually usage of these medications. Since many patients take caused by physiological factors such as menstruation or early prescriptions and nonprescription medications, dentists pregnancy, local factors such as teething, oral inflammatory should take a thorough medical history and be aware of lesions, food, medication, or by nasogastric intubation.[6]. medication related problems and their potential effects on Sialorrhoea is also caused by certain heavy metal toxins diagnosis and treatment planning [2-4]. (mercury and thallium),from exposure to irreversible acetylcholinesterase inhibitors (insecticides and nerve agents) SALIVARY GLAND DISORDERS: and by a few other drugs such as yohimbine, mucosa Salivary gland function can be affected by a variety of drugs irritanting antibiotics.[7]. Drugs causing ptyalism are listed in that can produce xerostomia, ptyalism, Salivary gland pain Table 2. and discolouration of saliva. C] SALIVARY GLAND PAIN: A] XEROSTOMIA: Antihypertensives, anti-thyroid agents, chlorhexidine, Dryness of mouth or Xerostomia, results from diminished cytotoxics, ganglion-blocking agents, iodides, secretions of saliva and a decrease in salivary calcium phenothiazines, and sulphonamides may cause salivary gland phosphate concentration. More than 250 medications claim pain, as may drugs causing dry mouth.[8]. Salivary gland xerostomia as a side effect. Few of the drugs are, pain is rarely associated with guanethidine or guanacline. anticholinergics, antidepressants, anti-Parkinson’s drugs, Drugs causing salivary gland pain and swelling are listed in antihistamines, antipsychotics, diuretics, hypnotics, systemic Table 3 89 Trophimus Gnanabagyan Jayakaran /J. Pharm. Sci. & Res. Vol. 6(2), 2014, 89-96 Table 1: Drugs Causing Xerostomia. [30,34,43-45]. Table 2: Drugs Causing Ptyalism.[30,34,43-45]. Alizapride Ofloxacin Alprazolam Mefenamic acid Ambroxol Olanzapine Ambroxol Mercurial salts Amphetamines Ondansetron Amiodarone Modafinil Antihistamines Opioids Bethanechol Neostigmine Antimigrain agents Orphenadrine Buprenorphine Nicardipine Antineoplastics Oxybutynin Buspirone Niridazole Antiparkinson drugs Paricalcitol Clozapine Nitrazepam Atropine Phenothiazines Desfluorane Ofanzapine Benzodiazepines Phenylpropanola Diazoxide Organophosphates Beta blockers mine Digoxin Pentoxifylline Bladonna alkaloids Posaconazole Ethoinamide Physostigmine Botulinum toxin-A Pregabalin Edrophonium Pilocarpine Bupropion Propantheline Galantamine Remoxipride Cadmium Proton pump Gentamycin Risperidone Calcium channel blockers inhibitors Guanethidine Rivestigmine Ciprofloxacin Radioiodine Haloperidol Sildenafil Clidinium Reboxetine Imipenem/cilastatin Succinylchloride Clozapine Selegiline Iodides Tacrine Cyclobezaprine Sertraline Kanamycin Theophylline Cyclopentolate Sibutramine Ketamine Tobramycin Cyclosporine Solifenacin Lamotrigine Venlafaxine Cytokines Sotalol Levodopa Zaleplon Dexmedetomidine Spiramycin Zonisamide Ephedrine Sucralfate Fenfluramine Tadalafil Table 3: Drugs Causing Salivary Gland Swelling and Gentamycin Tamsulosin Pain.[30,34,43-45]. Glycopyrolate Tadalafil Bethanidine Isoprenaline Guanabenz Terazosin Bretylium Methyldopa Guanfacine Terodiline Catecholamine Naproxen Hyoscine Thiabendazole inhalation Nifedipine Insulin Thioridazine Cimetidine Nitrofurantoin Ipratropium Tiamenidine Clonidine Oxyphenylbutazone Isotretinoin Tiapride Clozapine Phenylbutazone Ketanserin Tiotropium Deoxycycline Phenytoin Ketotifen Tizamidine Famotidine Ranitidine L-dopa Tolterodine Guanethidine Ritodrine Lead Tramadol Iodine Sulofonamides Lithium Tranylcypromine Insulin Trimepramine Lubiprostone Trazodone Interferon Warfarin Mazindol Trepium chloride Methdilazine Triamterene Modafinil Trimipramine D] DISCOLORATION OF SALIVA: Molindone Tropicamide Discoloration of saliva and other body fluids into red or orange colour may be seen in patients treated with Nabilone Trospium clofazimine, levodopa, rifampicin, and rifabutin therapy.[9]. Nefazodone Venlafaxine Nefopam Viloxazine ORAL ULCERATION: Vigabatrin Nicotine Ulceration is a breach in the oral epithelium, which typically Nitric oxide inhibitors Zuclopenthixol exposes nerve endings in the underlying lamina propria, Zopiclone resulting in pain or soreness especially when eating spicy foods or citrus fruits. Oral Ulcers are Inflammatory lesions of the oral mucosa that affect approximately 20% of the 90 Trophimus Gnanabagyan Jayakaran /J. Pharm. Sci. & Res. Vol. 6(2), 2014, 89-96 population.[10]. Numerous causes of these ulcers include, corrugated, with erosion and ulceration of the more severely immunological alterations, infections, nutritional damaged areas.[12]. deficiencies, repetitive trauma to the mucosa, food and B]. APHTHOUS ULCERATION: contact allergies, autoimmune diseases and neoplasms, as Ulcers resembling recurrent aphthous stomatitis but have well as psychosomatic, genetic and environmental systemic causes are often termed Aphthous like ulcers. factors.[11]. Drugs with potential to cause oral ulceration are Examples include Behcet’s syndrome, gastrointestinal shown in Table 4. diseases, such as gluten-sensitive enteropathy or inflammatory bowel disease, immunodeficiency syndromes such as infection with HIV, cyclic neutropenia and adverse Table 4: Drugs Causing Oral ulceration. [17,37,46]. reactions to medications.[13-15]. A number of drug are Anti HIV drugs Imipramine implicated in the development of nonspecific ulceration and Antineoplastics Indomethacin oral mucositis, and the lesions are often associated with an Alendronate Interferons equally nonspecific histologic appearance at biopsy. These Allopurinol Interleukin-2 include barbiturates, beta-blockers, dapsone, NSAIDs, Alprazolam Isoprenaline phenazone derivatives, thiazide derivatives, phenolphthalein, Asprin Ketorolac sulfonamides, tetracyclines, and sirolimus.[16]. Ulceration of the mucosa is a common adverse effect of a wide variety of Atrovastatin Lamotrigine antineoplastic agents, including methotrexate, 5-fluoroucil, Aurothiomalate Levamisole doxorubicin and melphalan. Azathiopurine Lithium C].FIXED DRUG ERUPTIONS: Aztreonam Losartan Fixed drug eruptions in the oral cavity often initially appear Barbiturates Mesalamine as areas of edema and erythema that lead to the localized, Captopril
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