原文題目(出處)：
Current Opinion on Drug-induced Oral Reactions:A Comprehensive Review (J Contemp Dent Pract 2008;8:1-15)
原文作者姓名：
Mohammad Abdollahi, Roja Rahimi, Mania Radfar通訊作者學校：
The faculty of pharmacy and pharmaceutical science research center of TUMS in Trhran, Iran.報告者姓名(組別)：
郭吉倫(Intern K)報告日期：
97/04/22內文：
Abstract
Aim: The aim of this comprehensive review is to present an update to our previous review about drug-induced
oral reactions. All drugs that may cause adverse effects in the mouth and related structures are reviewed.
Background: The mouth and associated structures can be affected by many drugs or chemicals. Drug reactions
can be categorized as to the parts of the oral complex such as the oral mucosa and tongue, periodontal tissues, dental structures, salivary glands, cleft lip and palate, muscles, and nerves.
Review Results: This review suggests the number of drugs and chemicals that can produce adverse or toxic
reactions in the oral cavity are on the rise. An updated listing of offending drugs is provided along with current strategies for dealing with adverse reactions.
Conclusion: Clinicians must constantly update their knowledge of drugs used by their patients. Attention must
be paid to their toxic and unwanted effects that in many cases may be similar to characteristics of common diseases.
Clinical Significance: Dentists and specialists of oral diseases should be aware of adverse drug oral reactions
for better diagnosis of oral diseases, administration of drugs, and patient compliance during drug therapy
Introduction
In theory, all drugs are capable of inducing adverse side effects, the three most frequent oral side-effects encountered were xerostomia, dysgeusia, and stomatitis with prevalence rates of 80.5%, 47.5%, and 33.9%. The 2003 review of drug-induced oral reactions published by Abdollahi and Radfar5 included the subjects:
Oral contact allergic reactions or stomatitis venennata has increased in recent years because of the increased use of oral hygiene products, esthetics related products, dental restorative materials, and the establishment of infection control procedures that mandate the wearing of latex gloves for dental treatment procedures. The gingiva is often the only site of
reaction or the most severely involved, perhaps because the antigen is in intimate contact with the gingiva during toothbrushing. In most instances the reactions appear to be induced by the flavoring agents in the dentifrices, often cinnamic aldehyde. Compounds with potential to cause oral contact allergic reactions are shown below.
Aphthous-Like Ulcers
Ulcers resembling recurrent aphthous stomatitis but have systemic causes are often termed aphthous-like ulcers. Recurrent aphthous stomatitis (also referred to as aphthae or canker sores) is one of the most common oral ailments. The term “recurrent aphthous stomatitis” should be reserved for recurrent ulcers confined to the mouth and seen in the absence of any systemic cause. Drugs with potential to cause aphthous-like ulcers are shown below.
Burning Mouth Syndrome
Burning mouth syndrome (BMS) is synonymous with stomatodynia, oral dysaesthesia, glossodynia, glossopyrosis, and stomatopyrosis characterized by oral mucosa pain, with or without inflammatory signs, and without a specific lesion. The pain feels like a moderate to severe burning sensation occurring more frequently on the tongue but can also occur on the gingiva, lips, and jugal (malar) mucosa. It can worsen during the day as a result of stress and fatigue, excessive speaking, or by ingesting spicy/hot foods. The burning can be diminished with cold food and leisure. This syndrome may occur due to xerostomia or radiotherapy; endocrine disease such as diabetes mellitus, hypothyroidism, and menopause; medication; nutritional deficiencies including iron, vitamin B complex, folic acid and zinc; neuralgia; dental prostheses; allergy; infection; and psychiatric disorders such as depression and anxiety. Angiotensin converting enzyme inhibitors (ACEIs) are a class of medications that can cause BMS. A list of drugs that can induce BMS is shown below.
Glossitis
Glossitis is inflammation of the tongue characterized by swelling and intense pain that may be referred to the ears. Drugs having the potential to cause glossitis are shown below.
Erythema Multiforme
Erythema multiforme (EM) is an acute reactive mucocutaneous inflammatory and hypersensitivity reaction characterized by a skin eruption, with symmetrical erythematous edematous or bullous lesions of the skin or mucous membranes. More than half the cases have no known cause, while half are caused by medications, infections, immunotherapy, or illnesses. Only 4% of EM reactions are caused by drugs. Drugs with potential to cause EM are shown below.
Oral Ulceration
Ulceration is a breach in the oral epithelium, which typically exposes nerve endings in the underlying lamina propria, resulting in pain or soreness, especially when eating spicy foods or citrus fruits. Ulcers and erosions can also be a final common manifestation of a spectrum of conditions. These conditions include the following:
• Epithelial damage resulting from trauma
• An immunological attack as in lichen planus
• Pemphigoid or pemphigus
• Damage due to an immune defect as in HIV disease and leukemia
• Infections such as herpes viruses
• Tuberculosis and syphilis
• Cancer
• Nutritional defects such as vitamin deficiencies
• Some gastrointestinal diseases
• Medications
Drugs and chemicals that may cause local irritation and ulceration of the mouth include those listed in the following table.
irritant. Patients using steroid inhalers for more than five years are more prone to the development of oral blistering. This type of reaction has also been reported for naproxen and penicillamine.
Oral Lichenoid Reactions
Lichen planus is a chronic systemic disease of established immune-mediated pathogenesis. It commonly involves the mucosa of the oral cavity but can involve other sites, such as the skin, vulvar and vaginal mucosa, the glans penis, the scalp, and the nails. Unlike true oral lichen planus, drug-induced oral lichenoid eruptions disappear after drug withdrawal. Such drugs are listed in the following table.
Color Changes of the Oral Mucosa and Teeth
Mucosal Pigmentation Extrinsic discoloration
• Use of tobacco or betel nut.
• Consumption of colored foods or beverages (such as liquorice, beet root, red wine, coffee, and tea).
• Use of drugs (such as chlorhexidine, iron salts, crack, cocaine, minocycline, bismuth subsalicylate, and lansoprazole).
Intrinsic mucosal hyperpigmentation
• Amalgam or other tattoo
• Nevus
• Melanotic macule
• Neoplasms (e.g., malignant melanoma or Kaposi’s)
• Pigmentary incontinence
• Peutz-Jegher’s syndrome
• Racial pigmentation
• Localized irritation such as the use of tobacco or betel nuts
• Drugs such as antimalarials and oral contraceptives
• Pregnancy
• Addison’s disease
Drugs and chemicals with potential to cause oral pigmentation are listed below.
Dental Discoloration
Tetracycline can cause the most common distracting, generalized type of intrinsic discoloration. Drugs and chemicals with potential to cause tooth discoloration are listed in the following table.
Black Hairy Tongue (Lingua villosa nigra)
An elongation of the filiform papillae of the tongue forms hair-like overgrowth which becomes stained brown or black due to the proliferation of chromogenic microorganisms. Drugs and chemicals with potential to cause black tongue include those listed below.
Oral Mucositis
Oral mucositis is a common toxicity associated with both head and neck radiation and chemotherapy used for the treatment of cancer. The early clinical sign of chemotherapy-induced mucositis is erythema presenting, burning and intolerance of spicy foods at about four to five days following chemotherapy infusion. Seven to ten days after chemotherapy ulcers may develop with marked discomfort often requiring opioid intervention and, in many cases, causing patients to alter their diet.
Chemotherapy-induced mucositis lasts approximately one week and generally heals spontaneously by 21 days after infusion. A healthy gingival status as well as good oral hygiene during chemotherapy is associated with a lower incidence and severity of mucositis.
題號 題目
1
Which of the following diseases may produce a burning sensation?(A) Burning mouth syndrome (B) Xerostomia
(C) Vitamin deficiencies (D) All of the above
答案(D)
出處：p.40, Differential Diagnosis of Oral and Maxillofacial Lesions, 5th edition題號
題目2
Which of the followings is included in generalized mucosities and vesiculobullous diseases?(A) Behcet’s syndrome (B) Erosive lichen planus (C) Erythema multiforme (D) All of the above
