Core72: Drug-induced adverse reaction: dental and oral cavity adverse reactions

🦷 High-yield / 要点：Drug toxicity can produce tooth discoloration, oral mucosal lesions, salivary disturbance, taste changes, gingival overgrowth, and oral infections.

1. Tooth discoloration / 歯の変色

Appearance	Associated substances
Black spots	Pb, Hg, Bi, Sb, As
Orange spots	Fluoride, nitric acid
Green spots	Copper
Brown spots	Tetracyclines
Yellow spots	Cadmium
Corrosion	Acids; chronic As/P; subacute Hg

2. Buccal mucosa and salivation / 口腔粘膜と唾液

Buccal mucosa findings

• Pigmentation
  • Red: CO, cyanide.
  • Yellow: hepatotoxic compounds, chromium salts.
• Scurf / coating
  • White: HCl, phenol.
  • Brown-black: sulfuric acid, phenol.
  • Yellow: nitric acid.
• Ulceration
  • Metal ions: Hg, As, Pb.
• Gingivitis
  • Phenytoin, cytostatics.

Salivation disorders

• Decreased salivation
  • Parasympatholytics
  • Phenylbutazone
  • Clonidine
  • Astringents
• Increased salivation
  • Bromide, mercury, fluoride, ether
  • Parasympathomimetics (neostigmine, muscarine, organophosphates)

3. Taste disturbances / 味覚障害

Drug / class	Example	Symptom
Antihypertensive	Captopril	Ageusia
Diuretic	Ethacrynic acid	Hypogeusia
Antiasthmatic	Ipratropium	Bitter taste
Antiepileptics	Carbamazepine, phenytoin	Ageusia
Local anesthetic	Procaine	Ageusia
Antibiotics	Ampicillin, cefamandole, doxycycline, metronidazole	Hypogeusia / unpleasant or metallic taste / dysgeusia
Antifungal	Griseofulvin	Dysgeusia
Cytotoxics	Azathioprine, doxorubicin, methotrexate	Ageusia / dysgeusia
Metals	Hg, Cu, Fe, I, As, Pb compounds	Metallic taste

4. Important oral adverse effects / 重要な口腔有害反応

• Secondary infections (candidiasis, recurrent herpes):
  • Corticosteroids, antibiotics, immunosuppressants, cytostatics.
• Agranulocytosis:
  • Metamizole, cytostatics.
• Gingival hyperplasia:
  • Phenytoin, cyclosporine A, calcium channel blockers.
• Allergy:
  • Lidocaine, antibiotics.

5. Drug-drug interactions relevant to dentistry / 歯科で重要な相互作用

• TCA + adrenaline → increased adrenaline effect.
• MAO inhibitor + adrenaline → increased adrenaline effect.
• MAO inhibitor + morphine → increased morphine effect.
• Antihypertensives + sedatives → orthostatic hypotension.
• Antihistamines + sedatives → additive sedation.
• Antidiabetics + salicylates → hypoglycemia.
• Antacids + tetracyclines → reduced tetracycline effect.

Remember / 覚え方

• Tetracycline = brown teeth
• Phenytoin = gingivitis/gingival overgrowth + taste/oral effects
• Metronidazole = metallic taste
• Dentistry-relevant drug interactions are exam-favorite