Iatrogenic disease


Iatrogenic disease

INTRODUCTION

A number of medical and surgical treatments and dental interventions (Table 54.1) can result in iatrogenic (from the Greek iatros = doctor) diseases affecting various orofacial tissues and/or oral healthcare. A surprisingly wide range of infections, materials and drugs can affect the orofacial tissues on occasion and the astute diagnostician will always search the literature for such possibilities.

Table 54.1

Iatrogenic orofacial disease

Cause Specifics Disorders
Cancer treatments See text  
Dental appliances Dentures/obturators Denture-related stomatitis
Angular stomatitis
Denture-induced hyperplasia
Traumatic ulceration
Caries
Orthodontic appliances* Traumatic ulceration
Stomatitis
Pain
Root resorption
Decalcification
Caries
Dental interventions Cross-infection Various agents
Local analgesic injections Transient diplopia
Transient facial palsy
Nerve damage
Haematoma
Trismus
Infection
Tissue damage Mainly soft tissue haematomas, lacerations or ulceration
Tissue infection Various
Inhaled foreign bodies Respiratory obstruction or infection
Swallowed foreign bodies Typically pass without consequence
Foreign body in tissues Granulomatous reaction
Air in tissues Surgical emphysema
Psychological sequelae Dental anxiety
Dental phobia
Dental materials Amalgam Amalgam tattoo
Lichenoid reactions
Other materials Foreign body gingivitis
Corrosives Burns
Allergens Angioedema
Drugs See Tables 54.354.31 Wide range of disorders
Immunosuppressive treatments See text  
Restorative dental procedures Damage to teeth or soft tissues Fracture or trauma
Root perforation
Pulp damage Non-vital teeth
Dental abscess
Odontogenic infections
Endodontic material extrusion Nerve damage
Sinus infection
Osteochemonecrosis
Endodontic instrument breakage Endodontic failure
Surgery Infection Localized osteitis (dry socket)
Osteomyelitis
Bisphosphonate osteonecrosis
Osteoradionecrosis
Nerve injury Sensory loss
Facial palsy
Bone fracture Alveolar bone or jaw fracture

image

** Suggestedly implicated in Alzheimer disease but no reliable evidence available.

*Although some TMJ pain-dysfunction has been attributed to orthodontic treatment no reliable evidence is available.

The most dramatic effects of iatrogenic disease however, are usually seen in cancer and transplant patients especially in those treated with radiotherapy to the head and neck region; in patients on cytotoxic chemotherapeutic agents; in patients on immunosuppressive therapy; or in those on combinations of these regimens.

IATROGENIC INFECTIONS

Fortunately, iatrogenic infections apart from opportunistic infections, are uncommon in the practice of oral medicine. Opportunistic infections, such as candidosis and herpesvirus infections, are common in immunocompromised patients, or those treated with some agents causing hyposalivation, antimicrobials, and some topical corticosteroid and other agents. Tuberculosis is an increasing issue in immunocompromised people, and people on immunosuppressive drugs including those treated with biologic agents (Ch. 5). The blood-borne agents such as hepatitis viruses, HIV, syphilis and prions should not be transmitted if standard infection control procedures are implemented. Hospital acquired infections have thus far not been a major issue in oral medicine (Table 54.2).

Table 54.2

Some relevant iatrogenic infections

Infection Examples Comments
Fungi Candida species Implicated in candidosis and some cases of angular cheilitis and denture-related stomatitis
Implicated in orofacial infections mainly in immunocompromised patients
Deep mycoses Implicated in orofacial infections mainly in immunocompromised patients
Bloodborne viruses Hepatitis B Immunization indicated for clinical personnel
Hepatitis C Implicated in some cases of lichenoid reactions and sicca syndrome
HIV See Ch. 53
Other viruses Herpesviruses See Ch. 43
Bacteria Various Wound infections
Staphylococcus aureus Implicated in some cases of angular cheilitis, sialadenitis, osteomyelitis, lymphadenitis and other infections
Meticillin-resistant Staphylococcus aureus (MRSA) May be community- (CA-MRSA) or hospital-acquired (HA-MRSA)
Vancomycin-resistant Staphylococcus aureus (VRSA) May also be resistant to meropenem and imipenem
Mycobacterium tuberculosis and non-tuberculous mycobacterioses A serious issue in immunocompromised people
Implicated in some cases of ulceration and cervical lymphadenopathy
Prions Creutzfeldt-Jakob and new variant Creutzfeldt–Jakob disease Infectious agent composed of protein in a misfolded form, highly resistant to sterilization

image

DRUG ADVERSE REACTIONS

It is important for the clinician to take a comprehensive drug history and always consider whether a drug may behind the clinical problem in question, since drugs can sometimes give rise to a range of adverse orofacial manifestations (Table 54.3), particularly salivary changes – notably hyposalivation, but also other features. Amongst the most common and important reactions and drugs implicated are:

Table 54.3

Main adverse drug effects in the orofacial region

Effects Examples See Table
Salivary changes Hyposalivation Tricyclic antidepressants 54.4
Salivary gland swelling or pain Antihypertensives 54.5
Sialorrhoea Anticholinesterases 54.6
Halitosis Halitosis Disulfiram 54.7
Taste disturbances Taste acuity loss (hypogeusia) or distortion (dysgeusia) Protease inhibitors 54.8
Mucosal Burns Caustics, such as lime
Cocaine
Aspirin
Potassium tablets
Pancreatic supplements
Trichloracetic acid
Hydrogen peroxide
Sodium lauryl sulfate,
 
Aphthous-like ulceration Cytotoxic agents
Immunosuppressive agents
Nicorandil
NSAIDS
54.9
Mucositis Cytotoxic drugs especially methotrexate, 5-fluorouracil, doxorubicin, melphalan, mercaptopurine or bleomycin 54.9
Candidosis Corticosteriods
Antibiotics
54.10
Contact stomatitis or stomatitis venenata
Granulomas
Cosmetic fillers
Antibiotics 54.11
Lichenoid eruptions Antimalarials
Beta blockers
NSAIDs
Phenothiazines
Sulfonylureas
54.12
Erythema multiforme Allopurinol
Carbamazepine
Barbiturates
NSAIDs
Protease inhibitors
54.15
Pemphigoid Furosemide 54.13
Pemphigus Rifampicin 54.14
Lupus-like (lupoid) disorders Hydralazine 54.16
Discolouration and pigmentation Amalgam
Betel
Chlorhexidine
Crack cocaine
Heavy metal salts
Imatinib
Tobacco
54.17
Cheilitis Contact cheilitis Protease inhibitors
Retinoids
54.18
Swellings Gingival enlargement Calcium channel blockers
Ciclosporin
Phenytoin
54.19
Angioedema ACE inhibitors
Aspirin
Penicillins
54.20
Neurological Neuropathies Protease inhibitors 54.21
Abnormal facial movements Dopa
Metoclopramide
Phenothiazines
54.22
Pain ACE inhibitors
Vinca alkaloids
54.23
Burning sensation ACE inhibitors
Protease inhibitors
54.24
Bruxism
Trismus
Ecstacy
Metoclopramide
54.25
Lymph nodes Swelling Carbamazepine
Phenytoin
54.26
Tooth Jaw development Cytotoxic agents
Phenytoin
54.27
Hypersensitivity Hydrogen peroxide or carbamide peroxide 54.28
Damage Tetracyclines 54.29
Discolouration (Fig. 54.1) Tetracyclines 54.30
Bone Osteochemonecrosis Bisphosphonates 54.31

image

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The osteochemonecrosis resulting from bisphosphonates; adverse effects from recreational drugs; and opportunistic infections secondary to cytotoxic chemotherapy and increased prevalence of dysplastic and malignant lip and oral lesions in immunosuppressed patients and those using photosensitisers such as antihypertensive drugs are discussed below and in Ch. 31. Other possible reactions are shown in Tables 54.454.31.

Table 54.4

Drug-related hyposalivation

Drugs most commonly implicated Drugs occasionally implicated
Alpha receptor antagonists for treatment of urinary retention
Anticholinergics
Antidepressants (serotonin agonists, or noradrenaline and/or serotonin re-uptake blockers)
Antipsychotics such as phenothiazines
Atropinics
Diuretics
Muscarinic receptor antagonists for treatment of overactive bladder
Protease inhibitors
Radioiodine
Amphetamines
Antihistamines
Antihypertensive agents
Antimigraine agents
Appetite suppressants
Benzhexol
Benzodiazepines, hypnotics, opioids and drugs of abuse
Benztropine
Biperiden
Bronchodilators
Bupropion
Clonidine
Cyclobenzaprine
Cytokines
Cytotoxics
Decongestants and ‘cold cures’
Dideoxyinosine
Diuretics
Fenfluramine
Fluoxetine
Ganglion-blocking agents
Histamine 2 antagonists and proton pump inhibitors
Interleukin-2
Ipratropium
Isotretinoin
Leva-dopa
Lithium
Monoamine oxidase
Omeprazole
Opiates
Orphenadrine
Phenothiazines
Propantheline
Retinoids
Selegiline
Skeletal muscle relaxants
Thiabendazole

Table 54.5

Drug-related salivary gland swelling or pain

Drugs most commonly implicated Drugs occasionally implicated
Antihypertensives
Chlorhexidine
Cytotoxics
Iodides
Antithyroid agents
Bretylium
Cimetidine
Clonidine
Clozapine
Deoxycycline
Famotidine
Ganglion-blocking agents
Insulin
Interferon
Isoprenaline
Methyldopa
Naproxen
Nifedipine
Nitrofurantoin
Oxyphenbutazone
Phenothiazines
Phenylbutazone
Phenytoin
Ranitidine
Ritodrine
Sulfonamides
Trimepramine

Table 54.6

Drug-related sialorrhoea/hypersalivation

Drugs most commonly implicated Drugs occasionally implicated
Anticholinesterases
Clozapine
Alprazolam
Amiodarone
Buprenorphine
Buspirone
Clonazepam
Diazoxide
Ethionamide
Gentamicin
Guanethidine
Haloperidol
Imipenem/cilastatin
Iodides
Kanamycin
Ketamine
Lamotrigine
Leva-Dopa
Mefenamic acid
Mercurials
Nicardipine
Niridazole
Nitrazepam
Pentoxifylline
Remoxipride
Risperidone
Rivastigmine
Tacrine
Tobramycin
Triptorelin
Venlafaxine
Zaleplon

Table 54.7

Drug-related halitosis

Drugs most commonly implicated Drugs occasionally implicated
Drugs causing hyposalivation Dimethyl sulfoxide (DMSO)
Disulfiram
Isorbide dinitrate

Table 54.8

Drug-related taste abnormalities

Drugs most commonly implicated Drugs occasionally implicated
Antithyroids
Aurothiomalate
Aztreonam
Baclofen
Biguanides
Calcitonin
Captopril
Cilazapril
Metronidazole
Penicillamine
Protease inhibitors
Acarbose
Acetazolamide
Amitryptiline
Aspirin
Atrovastatin
Ceftirizine
Cisplatin
Clidinium
Clomipramine
Cocaine
Diazoxide
Dicyclomine
Enalapril
Etidronate
Fluoxetine
Fluvoxamine
Histone deacetylase inhibitors
Imatinib
Indometacin
Isotretinoin
Leva-dopa
Losartan
Pentamidine
Phenytoin
Propantheline
Rifabutin
Rivastigmine
Sorafenib
Spironolactone
Topiramate
Venlafaxine

Table 54.9

Drug-related oral ulceration

Drugs most commonly implicated Drugs occasionally implicated
Cytotoxics
Immunosuppressive agents
Nicorandil
NSAIDs, e.g. Indometacin
Alendronate
Aurothiomalate
Aztreonam
Captopril
Clarithromycin
Cocaine
Dapsone
Emepromium
Everolimus
Gold
Interferons
Isoprenaline
Losartan
Mycophenolate mofetil
Naproxen
Olanzapine
Pancreatin
Penicillamine
Phenindione
Phenylbutazone
Phenytoin
Potassium chloride
Proguanil
Protease inhibitors
Sertraline
Sirolimus
Spironolactone
Sulfonamides
Tetracyclines

Table 54.10

Drug-related oral candidosis

Drugs most commonly implicated Drugs occasionally implicated
Broad-spectrum antimicrobials
Corticosteroids
Cytotoxics
Drugs causing hyposalivation
Immunosuppressives

Table 54.11

Drug-related contact stomatitis (stomatitis venenata)

Drugs most commonly implicated Drugs occasionally implicated
Anaesthetics
Antibiotics
Antiseptics
Barbiturates
Dentifrices
Mouthwashes
Phenacetin
Sulfonamides
Tetracyclines
Chewing gum
Cosmetics
Dental materials

Table 54.12

Drug-related lichenoid reactions

Drugs most commonly implicated Drugs occasionally implicated
Antihypertensives
Antimalarials
NSAIDs
ACE inhibitors
Amiphenazole
Beta blockers
Captopril
Carbamazepine
Carbimazole
Chloroquine
Chlorpropamide
Cimetidine
Clofibrate
Daclizumab
Dapsone
Dipyridamole
Ethionamide
Gaunoclor
Gold
Griseofulvin
Labetalol
Lincomycin
Lithium
Mepacrine
Mercury (amalgam)
Metformin
Methyldopa
Metronidazole
Niridazole
Oxprenolol
Para-aminosalicylate
Penicillamine
Phenindione
Phenothiazines
Practolol
Propranolol
Prothionamide
Quinidine
Quinine
Streptomycin
Sulfonamides
Tetracycline
Thiazides
Tolbutamide
Triprolidine

Table 54.13

Drug-related pemphigoid-like reactions

Drugs most commonly implicated Drugs occasionally implicated
Furosemide
Penicillamine
NSAIDs
Captopril
Clonidine
Sulfonamides

Table 54.14

Drug-related pemphigus-like reactions

Drugs most commonly implicated Drugs occasionally implicated
Diclofenac
Penicillamine
Rifampicin
Captopril
Cephalexin
Ethambutol
Glibenclamide
Ibuprofen
Penicillamine
Practolol

Table 54.15

Drug-related erythema multiforme (and Stevens–Johnson syndrome and toxic epidermal necrolysis)

Drugs most commonly implicated Drugs occasionally implicated
Allopurinol
Anticonvulsants
Barbiturates
Carbamazepine
Co-trimoxazole Hydantoins
NSAIDs
Penicillin
Phenytoin
Sulfonamides
Adalimumab
Bupropion
Candesartan
Busulphan
Cephalosporins
Chlorpropamide
Clindamycin
Codeine
Ethambutol
Furosemide
Gold
Metformin
Minoxidil
Oestrogens
Phenothiazines
Phenylbutazone
Progestogens
Protease inhibitors
Quinolones
Rifampicin
Tetracyclines
Tolbutamide
Vancomycin
Verapamil

Table 54.16

Drug-related lupoid reactions

Drugs most commonly implicated Drugs occasionally implicated
Hydralazine
Procainamide
Ethosuximide
Gold
Griseofulvin
Isoniazid
Methyldopa
Para-aminosalicylate
Penicillin
Phenothiazines
Phenytoin
Streptomycin
Sulfonamides
Tetracyclines

Table 54.17

Drug-related oral mucosal pigmentation

Drugs most commonly implicated Drugs occasionally implicated
Amalgam
Chlorhexidine
Smoking/tobacco
ACTH
Amiodarone
Amodiaquine
Anticonvulsants
Arsenic
Betel
Bismuth
Bromine
Busulphan
Chlorhexidine
Chloroquine
Clofazimine
Coal
Copper
Cyclophosphamide
Doxorubicin
Gold
Heroin
Hydroxycarbamide
Hydroxychloroquine
Imatinib mesylate
Iron
Ketoconazole
Lead
Manganese
Menthol
Mepacrine
Methyldopa
Minocycline
Oral contraceptives
Palifermin
Phenolphthalein
Phenothiazines
Quinacrine
Quinidine
Silver
Thallium
Tin
Vanadium
Zidovudine

Table 54.18

Drug-related cheilitis

Drugs most commonly implicated Drugs occasionally implicated
Etretinate
Indinavir
Isotretinoin
Protease inhibitors
Vitamin A
Atrovastatin
Busulphan
Clofazimine
Clomipramine
Cyancobalamin
Gold
Methyldopa
Psoralens
Streptomycin
Sulfasalazine
Tetracycline

Table 54.19

Drug induced gingival overgrowth (DIGO)

Drugs most commonly implicated Drugs occasionally implicated
Amlodipine
Ciclosporin
Diltiazem
Felodipine
Lacidipine
Nifedipine
Oral contraceptives
Phenytoin
Verapamil
Amphetamines
Cotrimoxazole
Erythromycin
Ethosuximide
Ketoconazole
Lamotrigine
Lithium
Phenobarbitone
Primidone
Sertraline
Topiramate
Valproate
Vigabatrin

Table 54.20

Drug-related angio-oedema

Drugs most commonly implicated Drugs occasionally implicated
ACE inhibitors
Aspirin
Penicillin
Sulfonamides
Angiotensin II antagonists
Antidepressants
Bupropion
Clindamycin
COX-II inhibitors
Droperidol
Mianserin
NSAIDs
Proton pump inhibitors
Statins
SSRIs
Vaccines

Table 54.21

Drug-related trigeminal paraesthesia or hypoaesthesia

Drugs most commonly implicated Drugs occasionally implicated
Acetazolamide
Articaine
Labetalol
Protease inhibitors
Vincristine
Amitryptiline
Chlorpropamide
Colistin
Ergotamine
Gonadotropin-releasing hormone analogues
Hydralazine
Interferon alpha
Isoniazid
Mefloquine
Methotrexate
Methysergide
Monoamine oxidase inhibitors
Nalidixic acid
Nicotinic acid
Nitrofurantoin
Pentamidine
Phenytoin
Prilocaine
Propofol
Propranolol
Stilbamidine
Streptomycin
Sulfonylureas
Sulthiame
Tolbutamide
Tricyclics
Trilostane

Table 54.22

Drug-related involuntary facial movements

Drugs most commonly implicated Drugs occasionally implicated
L-dopa
Metoclopramide
Phenothiazines
Butyrophenones
Carbamazepine
Ecstacy
Lithium
Methamphetamine
Methyldopa
Metirosine
Phenytoin
Tricyclic antidepressants
Trifluoroperazine

Table 54.23

Drug-related orofacial pain

Drugs most commonly implicated Drugs occasionally implicated
ACE inhibitors
Nitrites
Vinca alkaloids
Benztropine
Biperidin
Griseofulvin
Lithium
Penicillins
Phenothiazines
Stilbamidine
Ticarcillin
Vitamin A

Table 54.24

Drug-related burning mouth

Drugs most commonly implicated Drugs occasionally implicated
Cytotoxic drugs
ACE inhibitors
HRTProtease inhibitors
Proton pump inhibitors
Antidepressants
Clonazepam

Table 54.25

Drug-related bruxism or trismus

Drugs most commonly implicated Drugs occasionally implicated
Ecstacy Duloxetin
Fluoxetine
Metoclopramide
Phenothiazines
Pregabalin
Propofol
Suxamethonium
Tricyclic antidepressants

Table 54.26

Drug induced gingival hypersensitivity

Drugs most commonly implicated Drugs occasionally implicated
Allopurinol
Carbamazepine
Lamotrogine
Phenobarbitone
Phenytoin
Sulfasalazine
Sulfonamides
Abacavir
Atenolol
Azathioprine
Captopril
Dapsone
Diltiazem
Gold salts
Isoniazid
Mexiletine
Minocycline
Nevirapine
Oxicam
Trimethoprim

Table 54.27

Drugs used in pregnancy that may induce cleft palate

Drugs most commonly implicated Drugs occasionally implicated
Alcohol
Anticonvulsants
Cocaine
Fluconazole
Heroin
Phenytoin
Retinoids
Tobacco
Topiramate
Antihypertensives
Corticosteroids
Cytotoxic agents
Thalidomide

Table 54.28

Drugs that may induce tooth hypersenstitivity

Drug Examples
Tooth whiteners Carbamide peroxide
Hydrogen peroxide

Table 54.29

Drugs that may lead to tooth structure damage

Drug Examples Possible damage to tooth structure
Sugar-containing oral (liquid) medication Various Caries
Drugs that result in decreased salivary secretion (hyposalivation) See Table 54.4 Caries
Drugs with a low pH Aspirin, antiasthmatic drugs Erosion
Drugs causing gastro-oesophageal reflux Theophylline, anticholinergics, progesterone, calcium channel blockers, antiasthmatics Erosion
Drugs inducing bruxism Dopamine agonists, dopamine antagonists, tricyclic antidepressants, selective serotonin reuptake inhibitors, alcohol, cocaine, amphetamines Attrition
Drugs used for internal tooth bleaching Hydrogen peroxide and sodium perborate Cervical root resorption
Drugs used for treatment of childhood cancers Cytotoxic agents Abnormal dental development
Anticonvulsants Phenytoin Abnormal dental development
Fluorides Any Fluorosis

Table 54.30

Drug-related extrinsic tooth discolouration

Drugs most commonly implicated Drugs occasionally implicated
Chlorhexidine
Ciprofloxacin
Fluorides
Iron
Tetracyclines
Antibiotics
Clarithromycin
Enalapril
Essential oil
Etidronate
Fosinopril
Imipenem
Lisinopril
Metronidazole
Penicillin
Pentamidine
Perindopril
Propafenone
Quinapril
Ramipril
Terbinafine
Trandolopril
Zopiclone

Table 54.31

Drug-related osteonecrosis

Drugs most commonly implicated Drugs occasionally implicated
Bisphosphonates Denosumab
Bevacizumab
Sunitinib

OSTEOCHEMONECROSIS

Bisphosphonates (BP) are drugs used to prevent osteoporosis and bone resorption in, for example, metastatic malignant disease. Bisphosphonates are intravenously used (IV-BPs) for treatment of hypercalcaemia of malignancy, as well as prevention of skeletal-related events (SREs) and reduction of bone pain in cancer patients with osteolytic lesions. They are most commonly used in patients with multiple myeloma, breast, prostate, and lung cancers. Oral BPs are used mainly for prophylaxis of osteoporosis, and so are widely prescribed.

Bisphosphonates were recognized from a series of case reports to be responsible for osteochemonecrosis of the jaw (bisphosphonate-related osteonecrosis of the jaw (BRONJ)) – defined as ‘exposed necrotic bone appearing in the jaws of patients treated by BPs never irradiated in the head and neck area and that has persisted for >8 weeks’. BRONJ was very similar to the ‘phossy jaw’ reported in previous centuries as a result of occupational exposure to red phosphorus in makers of matches.

Most cases (>90%) of BRONJ have been in patients with cancer who received IV-BPs, in particular the nitrogen-containing BPs pamidronate and zoledronate, the cumulative incidence ranging from 1:10 to 1:1000 but the risk from oral BPs is far lower (<1:10 000). In addition, nitrogen-containing BPs induce mucosal cell damage and impede wound healing.

Aetiology and pathogenesis

BPs act especially by blocking the osteoclast HMG-CoA reductase (mevalonate) path, inhibiting the cell activities, as well as directly inhibiting osteogenesis in bone-healing. BPs remain in bone and exert these effects for many years or even decades. Risk factors for BRONJ include systemic and local factors (Table 54.32), especially tooth extraction.

Table 54.32

Risk factors for osteochemonecrosis

Systemic risk factors Local risk factors
Duration of BP exposure
i.v. administration
Potent nitrogen-containing BPs (i.e. zoledronate, pamidronate and ibandronate)
Smoking
Diabetes mellitus
Rheumatoid arthritis
CYP2C8 gene diversity or reduced interleukin-17
Possibly chemotherapeutic agents, thalidomide, or bortezomib
Denosumab (monoclonal antibody for treating osteoporosis)
Dental extractions: increase risk at least 16-fold and up to 44-fold
Denture wearing: an almost 5-fold increased risk for patients taking zoledronate and also wearing dentures
Periodontal disease: as a risk factor remains controversial

Prevention

Prevention of BRONJ is fundamental, since no cure is known, and should include:

image Risk assessment.

image Patient counselling about risks.

image Avoiding elective oral surgery: including extractions or endosseous implant placement, or carrying out the treatment well before commencing BPs, or after a 6-month drug holiday.

image Preventive measures (dental screening, all dental work done at least 6 weeks before starting BPs) can produce a three-fold reduction of BRONJ related to zoledronate in myeloma patients. One protocol suggested to prevent BRONJ includes the raising of a flap before tooth extraction associated with a broad-spectrum antibiotic started three days before, and advancing the flap for primary closure.

image Serum collagen telopeptide (CTX) levels: a reliable index of bone turnover rates might predict BRONJ risk but this is controversial. Perhaps CTX monitoring could help determine the best timing for a ‘drug holiday’.


RECREATIONAL DRUGS

Although not causing iatrogenic disease, a range of recreational drugs can damage the orofacial region (Table 54.33)

Table 54.33

Maxillofacial consequences of use of specific recreational drugs

Drug Possible complications
Alcohol Leukoplakia, carcinoma, tooth erosion, glossitis/oral ulcers/angular stomatitis from malnutrition, sialosis, foetal alcohol syndrome
Amphetamine Picking at the face, bruxism, hyposalivation and increased caries incidence
‘Meth mouth’ is the term given to the neglect and poor oral hygiene seen in methamphetamine users
Barbiturates Facial pain, bullous reactions
Betel Submucous fibrosis, leukoplakia, carcinoma
Cannabis White lesions (burns), hyposalivation, possible leukoplakia, carcinoma
Cocaine Temporarily numbness of lips and tongue, gingival erosions, dry mouth, bruxism dental erosion
Caries and periodontal disease, especially acute necrotizing gingivitis, are more frequent
Cocaine may precipitate cluster headaches
Oronasal fistulae
Ecstasy Tooth clenching, bruxism, TMJ dysfunction, dry mouth, attrition, dental erosion, mucosal burns or ulceration, circumoral paraesthesiae and periodontitis
Khat Leukoplakia, carcinoma
Nicotine Due to tobacco: leukoplakia, carcinoma, dry socket, necrotizing gingivitis, periodontitis, impaired wound healing and implant success
Opiates Hyposalivation
Solvents Perioral dermatitis, foetal gasoline/petrol syndrome


CANCER THERAPY AND COMPLICATIONS

See Ch. 31 and Table 54.34.

Table 54.34

Orofacial complications of cancer therapy

Therapy Oral complications
Radiotherapy Pain, mucositis, hyposalivation, candidosis, caries, sialadenitis, osteoradionecrosis, fibrosis
Chemotherapy Pain, mucositis, hyposalivation, candidosis, herpesviruses, neuropathy
Surgery Pain, neuropathy, disfigurement, impaired speech and swallowing
Scarring
Carotid blow-out (haemorrhage), chyle leakage, salivary leakage

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