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Discuss the lesions of the oral mucosa, which may be caused by drugs. How would you manage these conditions?

Introduction:

Stress on the pharmacodynamic action of drugs: - effect of the drugs on the body. Although the specific drugs were originally meant for a certain disease it may have detrimental effect on the oral mucosa.

Major side effects to the mucosa can be neatly summed up into:

Ulcers

Reduction of salivary gland secretion

Lichenoid reaction

Mucositis

Opportunistic infections

Hyperplasia

Ulcers

Medication such as aspirins and other NSAIDS if kept prolonged in the mouth can cause caustic or chemical trauma

Management: education- inform patients on the danger of administration of aspirin as lozenges

Chemotherapy drugs in the treatment of neoplastic lesion, not necessarily in the mouth, may also cause ulcers of the oral mucosa. Such medications are:

Management: symptomatic to relieve the pain associated with the pain by prescribing Difflam

(Benzydamine HCl 0.15%)

Reduction in salivary secretion

Main drugs that causes reduction in salivary secretions are:

Mono-Amine Oxidate Inhibitor (MAOI)

Tricylic anti-depressant

Chemotharapy

Management: Alternative medications which side effect in terms of xerostomia to be discussed with medical practitioner, if conditions are found to be unbearable. Alternative drugs to MAOI and Tricyclic antidepressant are SSRI's such Fluoxetene, which has lower xerostomic effects.

In the event that the these medications cannot be compromised such as chemotherapy for cancer treatment, and xerostomia is not tolerable , medication such as sialogogues and artificial saliva can be utilised.

Lichenoid reactions:

Drugs such as Allopurinol for the treament of gout cause these reactions. Management of such patients is reassurance and perhaps biopsy of the area to discount more sinister causes.

4. Mucositis:

Chemotherapy using cytotoxic agents such as vincristine causes general inflammation of the mucosa, which result in extremely painful mouth. Management of such cases is similar to the case of the ulcers, which are the anaesthetic mouthwash such as Difflam and 0.2% Chlorohexidine mouthwash to prevent infection.

Opportunistic infections:

The so-called "Blind" antibiotic therapy utilizing mega-spectrum antibiotic cause opportunistic infections, most common of which is the acute atrophic candidiasis often known as "antibiotic tongue". This is caused by proliferation of Candida albicans as the local indigenous microorganism has been wiped out. Cytotoxic drugs may also cause similar conditions.

Management of such cases is to identify the cause of infection, whether it is bacterial, viral or fungal in nature. A C&S test would be helpful and a careful selection of antibiotic regime to be used.

Gingival Hyperplasia:

Drugs such as Phenytoin (antiepileptic) and Nifedipine (Calcium channel blocker) often causes ginigival hyperplasia. Since reduction or the stoppage of the medication would be detrimental to the patient's health, the management of such case would be:

Good oral hygiene and regular scaling. Research has shown that , with good OH , hyperplasia would not proliferate.

Surgical option for excessive hyperplasia by performing gingivectomy with conventional blade or CO2 laser and follow-up with good OH

Reduction or replacement of medication to the alternatives with consultation of physicians: Lamotrigine in place of phenytoin, Verapamil in place of Phenytoin.

Copyright 1999, Ahmad Fariz Hanapiahcontentepi.gif (144 bytes)