35. Complications of systemic drug treatment

CHAPTER 35. Complications of systemic drug treatment
Table 35.1 Examples of prescribed drugs having dentally relevant adverse effects
aBenzodiazepines (‘minor tranquillisers’) have few adverse effects apart from sedation, additive effects with other CNS depressants, and slight respiratory depression which is not signi. cant in normal persons. However, they are addictive.
bDo not cause signi. cant interactions with adrenaline (epinephrine) in local anaesthetics.
Type of drug Dentally relevant adverse effects
Superinfection (usually candidosis)
Allergy (mainly penicillin) (Figs 35.1 and 35.2)
Anticoagulants Risk of postoperative haemorrhage
Calcium channel blocker antihypertensives (e.g. nifedipine) and diltiazem (an antidysrhythmic) Gingival hyperplasia
Gingival hyperplasia
Lymphadenopathy occasionally
Folate deficiency occasionally
Potentiation of any haemorrhagic tendencies
Avoid in children because of risk of
Other non-steroidal anti-inflammatory analgesics Oral lichenoid reactions rarely
Hypnotics and sedativesa Potentiation of general anaesthetics and other sedating drugs
Barbiturates Risk of erythema multiforme
Phenothiazine antipsychotics (‘major tranquillisers’)
Dry mouth
Tardive dyskinesia (uncontrollable facial movements)
Parkinsonian tremor
Postural hypotension
Oral mucosal pigmentation
Metoclopramide Clenching of jaw muscles
Tricyclic antidepressants (e.g. amitriptyline) b Dry mouth
Monoamine oxidase inhibitorsb
Dry mouth
Dangerous interactions with opioids, particularly pethidine
Insulin Risk of hypoglycaemic coma
Dry mouth
Potentiate sedatives
Opportunistic infections
Risk of circulatory collapse (see also Box 31.10)
Other immunosuppressive and cytotoxic drugs
Oral ulceration (especially methotrexate)
Opportunistic infections
Cisplatin can cause grey gingival line
Vincristine can cause jaw pain and weakness of the facial muscles
Ciclosporin Gingival hyperplasia
Bisphosphonates Necrosis of mandible and maxilla (see Ch. 6)
B9780443101250500403/f35-01-9780443101250.jpg is missing
Fig. 35.1

Collapse caused by type I hypersensitivity to penicillin.
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Fig. 35.2

Hypersensitivity to penicillin. There is a generalised slight oedema of the face, pallor and a macular rash.
Box 35.1

Significance of (conventional) drug treatment to dental management
• Drugs may complicate dental treatment itself (Table 35.1)
• Drugs may react with drugs given for dental purposes
• Drugs may cause stomatitis (Ch. 13) or have other oral effects


Many drugs can occasionally cause oral reactions. They are varied in type, but frequently lichenoid or ulcerative (Figs 35.3 and 35.4).
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Fig. 35.3

Lichenoid reaction to captopril. In this milder reaction, there are several small ulcers, but the main effect is the production of striae covering the whole ventral surface of the tongue.


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Jan 9, 2015 | Posted by in Oral and Maxillofacial Pathology | Comments Off on 35. Complications of systemic drug treatment
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