By:1-Muhammad Rasull Ahmed2-Rawan Mashud Sleman3-Yasser Ammar4-Avak Strak Mesak

School Of Dentistry3rd stage

Drugs That Induce Oral Diseases

Suppervision By Dr.Hussen

Oral Cavity (Mouth)

Extends from the lips to the oropharyngeal isthmus

• The oropharyngeal isthmus:• Is the junction of mouth

and pharynx.• Is bounded:

• Above by the soft palate and the palatoglossal folds

• Below by the dorsum of the tongue

Subdivided into Vestibule & Oral cavity proper

The Roof is formed by the hard palate anteriorly and the soft palate posteriorlyThe Floor is formed by the mylohyoid muscle. The anterior 2/3rd of the tongue lies on the floor.

What Is the Function of the Mouth?

The mouth is a body organ that is adapted to receiving food and kicking off the digestion process. In the mouth, there are other organs like the tongue and teeth, which roll the food around and crush it respectively,(chewing) breaking it down to smaller pieces for swallowing.and speech , appearance

Oral diseases Stomatitis Ulceration Bullous disorders Swelling/ angioedema Salivary gland enlargement Xerostomia Gingival hyperplesia White patches Abnormal pigment Hemorrhage Halitosis

Stomatitis

• Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor of the mouth.

The inflammation can be caused:1-poor oral hygiene2-dietary protein deficiency3-poorly fitted denture4-from mouth burns from hot food or drinks5-toxic plants 6-by conditions that affect the entire body, such as medications, allergic reactions, radiation therapy, or infections

Ulceration

An oral ulcer is a sore that emerges on the gums, lips, or inner cheeks of the mouth. An open sore may appear for several reasons, including a bacterial infection, a burn, an injury, or a more severe viral infection such as the herpes simplex virus.

Swelling/ angioedema

• is the rapid edema (swelling) of the deep layers of skin - the dermis, subcutaneous tissue, mucosa and submucosal tissues.

Salivary Gland Enlargement

Xerostomia is not a disease but can be a symptom of certain diseases

Tetracycline

• Tetracycline is a potent antibiotic used to target bacterial infections. use to treat Urinary Tract Infections(UTI), Acne, Pneumonia or even some skin infections could possibly be prescribed tetracycline

• The have adverse effect on primary and permanent teeth

•The vast majority of children below 7 years of age are extremely prone to this side effect of tetracycline due to the fact that the enamel is still undergoing development.

•Adults can also be affected by this side effect of tetracycline however, this is only likely when taking daily doses of more than 100mg.

•Tetracycline staining only occurs in approximately 5% of people who are prescribed this antibiotic.

How does tetracycline cause teeth staining?

When teeth are still growing, the enamel is also developing. This means that a young person’s teeth are particularly vulnerable to discoloration. Tetracycline can cause teeth stains in children when it becomes stuck in the gum line.

When tetracycline takes hold in the tooth, it results in a deeply rooted stain that forms in the tooth’s enamel.

Pregnant women can use tetracycline??

Antiepileptic, Calcium Channel Blockers

Non-neoplastic enlargement or overgrowth of the gingival tissues was initially recognized in patients who were using phenytoin and calcium channel blockers(, nifedipine, diltiazem, verapamil, and amlodipine)

Gingival enlargement is not observed in all patients. The prevalence is 25-50%, and no clear relationship has been established between the dose of the drug and the severity of the overgrowth

Tissue enlargement typically occurs by 1-3 months after drug therapy is initiated and begins in the superficial gum tissues between the teeth (interdental papillae). Anterior segments are more frequently involved than posterior areas, but generalized involvement is not uncommon.

ACE-inhibitors, NSAIDs and antidepressants •This drugs can cause angioedema•the lips are the most typical site of involvement.

Angioedema how can occur??

• This reaction, which is possibly secondary to alterations in local bradykinin levels or C1 esterase inhibitor function, is reported in less than 1% of patients.

• The oedema is caused by an increase in capillary leakage as a result of inflammatory mediators. This can be a manifestation of a consequence of deficiency in C1-esterase inhibitor — an enzyme that 'damps down' complement activa-tion; or because of failure to metabolise mediators such as bradykinin.

Antidepressants and Antipsychotics, Antihypertensives, and Anticholinergics

•General drug classes that are strongly associated with xerostomia include antidepressants and antipsychotics, antihypertensives, and anticholinergics

•Xerostomia has been associated with more than 500 medications

•This drugs have sympathomimetic action

Thus, drugs that have an anticholinergic action reduce the volume of serous saliva

Drugs with sympathomimetic actions produce a more viscous, mucinous saliva with less volume.

Drugs may also exert their neural effects in the higher centers of the brain; stimulation of certain adrenoreceptors in the frontal cortex can produce inhibitory effects on salivary nuclei.

Antipsychotic

Olanzapine, a derivative of clozapine can cause hypersailvation

This drug that have a cholinergic action either by acting directly on parasympathomimetic receptors or by acting on cholinesterase inhibitors.

It has been suggested that stimulation of both M3 and M4 muscarinic receptors present in salivary glands lead to saliva production. The balance of clozapine's opposing effects on M3 and M4receptors may mediate hypersalivation

Antimalarial agents

•antimalarial agents cane cause oral mucosal pigmentation particularly chloroquine, hydroxychloroquine, quinacrine, and quinidine

•Typically, such pigmentation is most notable on the midposterior regions of the hard palate, appears bluish-black to brown, and may be bilateral

How pigmentation occur?

may be due to: direct melanocytic stimulation, the deposition of pigmented drug metabolites

REFERENCES

POCKET ATLAS OF ORAL DISEASES http://

emedicine.medscape.com/article/1080772-overview http://www.drugs.com/sfx/ http://

emedicine.medscape.com/article/1080772-overview http://www.blackwellmunksgaard.com

Any questions ?

Thank You