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PROBLEMS IN ORAL MEDICINE
ORLANDO, FL (March 3, 1998) - Adverse drug reactions involving the mouth are less common than those affecting the skin, but they can cause extreme discomfort, and perhaps permanent damage to gums and teeth. The most common oral problems experienced are due to the side effects of prescribed medication. The diagnosis of these reactions require, in some instances, a high index of suspicion as they can mimic other diseases such as erythema multiforme (redness, inflammation) or contact stomatitis.
Roy S. Rogers, III, MD, Professor of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN, spoke today at the American Academy of DermatologyÃs 56th Annual Meeting, in Orlando, and explored adverse reactions in oral medicine.
These problems often affect the elderly, or individuals taking certain types of medications. Numerous drugs commonly prescribed to older patients can lead to xerostomia (dry mouth) or candidiasis (fungal infections). Some drugs can cause an allergic reaction that simulates lichen planus, a common mucocutaneous disease.
"The clinical interview is the single most helpful aid to the diagnosis of the adverse drug reaction affecting the mouth. As with cutaneous drug eruptions, certain drugs are much more likely to cause reactions than others." For example, phenytoins and the antirheumatic agents may be taken for weeks or months before a reaction develops. "For most reactions, drugs recently administered should receive the highest suspicion and serve as the starting point. But a full medicinal rundown should not be ruled out," Dr. Rogers said.
Dry mouth can be caused by pharmacological agents, radiation to the head or neck, or systemic conditions. Patients may complain of a burning in the mouth, sore tongue and lips, difficulty swallowing or wearing dentures, and ulcerations induced by trauma, antihistamines, muscle relaxants, sedatives psychotropic drugs, and many others. One of the most commonly prescribed antidepressants, tricyclics, can dry the mouth overnight.
Untreated, dry mouth can quickly lead to rampant tooth decay, gum problems, fissuring, inflammation with consequent infection of the salivary glands, and candidiasis.
Identifying the underlying cause is key to treating candidiasis, the most common oral infection. Frequently induced by dry mouth or from taking antibiotics, it is also a problem among patents with uncontrolled diabetes.
There is no laboratory examination to assist in establishing the diagnosis of an adverse drug reaction in the mouth. A biopsy of the mucosa can help classify the mechanism of damage, such as vasculitis, and exclude other conditions such as pemphigus, yet still cannot establish a drug causation. A biopsy should be taken of any lesion that does not go away.
Rogers If pharmaceuticals are the cause, changing or reducing them may be possible. Once the drugs are modified, patients may then be given medication to combat the disorder in addition to the agent causing it. Removal of the offending drug or agent is the primary form of treatment. In many instances, improvement will be noted within seven days. In some cases several weeks may be necessary. Careful oral hygiene is a cornerstone of therapy .
Erosions and ulcerations may be protected with milk of magnesia or antacid mouthwashes. Mucosal protectants such as Orabase may be used for discrete lesions, and pain relief may be provided by solutions or by topical antihistamines. Systemic treatment with analgesics may be necessary. For severe conditions, the administration of systemic corticosteroids may reduce the severity of the inflammatory process. In the case of postantibiotic stomatitis associated with acute candidiasis, the topical administration of antiyeast antimicrobial therapy is important , but the physician should avoid introducing another antibiotic, and stress the importance of good oral hygiene while awaiting the return of the natural balance of the mouth.
The treatment of an adverse drug reaction involving the mouth is often an in-depth process beginning with the clinical history and coupled with a high index of suspicion. Together, this is the single best tool for the diagnosis and subsequent treatment of the problem.
The American Academy of Dermatology is the worldÃs largest medical society representing 10,000 physicians who treat hair, skin and nail disorders.
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