Drug Reaction Lec True

8/2/2019 Drug Reaction Lec True

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Local reaction to drug

Chemical burnsthe best known example is that ofaspirin tablet held against the

mucosa close to an aching toothit will cause superfacial necrosisand a white patch ,deadepithelium is shed and the mucosaheals.

Other irritant chemicals are acidetchants or phenol dropped on the

mucosa.


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Interferance with the oral flora:super infection:

prolonged topical use of antibiotic in themouth kills off sensitive organisms and allow

resistant ones, particularly candidaalbicans, to proliferate, causing thrush insusceptable patients. Use of a topicalantibiotic may precipitate candidal infectionwithin 48hrs.


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SYSTEMICALLY MEDIATEDREACTIONS

1-DEPRESSION OF MARROW FUNCTION :A- few drugs significally depress red cellproduction alone, though any drug which

cause anemia might give rise to oral signs.the main example is prolonged use ofphenytoin (for epilepsy) which in susceptiblepatients, can cause folate deficiency and

macrocytic anemia.This inturn can cause severe aphthousstomatitis, response promotly followsadministration of foliate, and the blood

picture returns to normal


5/18

B- white cell production depressions:

white cell production is depressed by avariety of drugs. Leucopenia may be severeenough to produce the clinical picture ofagranulocytosis, with necrotising ulceration

of the gingivae and throat which can go onto a severe prostrating illness andsepticaemia if untreated,

-Drugs which may have this effect include:

antibacterial.particularly co-trimoxazole.

Chloramphenicolanalgesics, particularlyamidopyrime ,phenothiazines

antithyroid agents.


6/18

When the main effect is on

granulocytes, low-grad oralpathogens, particularly of the

gingival margins, are able toovercome local resistance andproduce necrotising ulceration.


7/18

C- Other drugs may affect haemostasis

and cause oral purpura.Drug-induced purpura is often also an earlysign of aplastic anaemia caused by drugssuch aschloramphenicol. which depress

marrow function.Purpura can produce severe spontaneousgingival bleeding or blood blisters andwidespread submucosal ecchymoses.


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medical immunity.-Depression of cell-Dlmmunosuppression by drugs as suchcorticosteroidsis induced in patientshaving organ transplants or withimmunologically-mediated diseases.Viral and fungal infections of the mouth are

common in immunosuppressed patients andcan be severe.Recurrences of childhood viral infections suchas measles and chickenpox are also possible.


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E- Lichenoid reactions.

Several drugs:-gold and antimalarials(both used in thetreatment of rheumatoid arthritis or othercollagen diseases),

the antihypertensive agent methyldopacancause disease indistinguishable from lichenplanus, both clinically and histologically.The mechanism of such reactions isunknown.


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F- ACUTE ERYTHEMA MULTIFOME:

as discussed earlier,Sulphonamides,barbiturates

or other drugsare occasionallyimplicated, but the mechanisms areunknown and more frequently there isno evidence of a drug reaction.


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TOXIC EPIDERMAL NECROLYSIS:-Gthis, which probably represents the extreme

end of the spectrum of the erythemamultiforme,It is one of the most dangerous and severetypes of drug reaction.mucosal involvement is common and causewidespread erosions due to epithelialdestructions.Oral ulceration may precede the dermalchanges, and cause the patient to seek

treatment for the extreme sorness of themouth.Early diagnosis and treatment is important asthe reaction can be lethal.


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Example :-

Metals such asgold saltsare importantcauses butphenylbutazone,barbituratesand other drugs havealso been implicated.

Healing of oral lesions may leave apattern of lichen planus.


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FIXED DRUG ERUPTIONS:-Hthese consist of sharply circumscribed skinrecurring in the same site or sites eachtime the drug is given.many drugs are capable of causing this reaction :-

co-trimixazole ,tetracyclinebut phenolphthaline, awidly use component of

purgatives,is one of the more causes .Involvement of the oral mucous memberane has beendescribed but is exceedingly rare.

OTHER DRUG EFFECT


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OTHER DRUG EFFECTS

1- GINGIVAL HYPER PLASIA:

phenytoin (Dilantine), Nifidipine (Adalat), Cyclosporine antineoplastic

can cause fibrous hyperplasia .Particularly concentrated at theinter dental papillae

ORAL PIGMENTATION2


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ORAL PIGMENTATION:-2 heavy metals such as mercury,bismuth,andlead can cause black or brown deposite in

the gingival sulcus by interaction withbacterial productes to form sulphides.The blue lead line may be particularly

sharply defined and indicate the level ofthe floor of the pocket.

These effects are rarly seen now thatmercry and bismuth are no longer used inmedicine and lead is no longer a majorindustrial hazard.

How ever , cisplatine, a cytotoxic drug,can cause a blue line.

Topical antibiotic & antiseptic may causedark pigmentaion. Particularly of the

dorsum of the tongue, due to over growthof the i ment formin bacteria


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DRY MOUTH:-3

is a relatively common side effect ofdrugs, particularly those with anatropine like action, such as thetricyclic anti depressants which arewidely used.


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MANAGEMENT CONSIDERATIONS:oral reactions to drugs are not overall

common, nevertheless they may beimportant as an early sign of a dangerousor lethal reaction.However , a drug being taken by a patient is

not necessarily the cause of any oralsymptoms.Coincidence is often difficult to exclude,

particularly with common oral disease such

as lichen planus.The problem is made more difficult bymultiple drug treatment. However it isessential to get a detailed history of drug

treatment as this may affect other aspectsof dental treatment.


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Composition of emergency dentalkit

Aromatic spirits of ammonia

Atropine Sulfate 0.5mg Sc or I.V

Diazepam

Diphenhydramine (Antistine)25-50 mg

Epinephrine (Adrenaline) 0.5 ml of 1:1000

Glucogon I.M ,I.V,S.c 1mg

Hydrocortisone sodium succinate 100 mg I.V I.M

Nitroglycerine 0.6 mg sub lingual

Drug Reaction Lec True

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