______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
Adverse oral manifestations which develop from the use of one or more cardiovascular agents exhibit a wide range of occurrence in frequency and magnitude. These adverse oral manifestations can range from those which are benign to those which are deleterious and discourage the patient from the continued use of the medication(s). Dentists cannot advise a patient to discontinue the use of any medication prescribed by their physician, even when there are adverse oral manifes- tations. Rather, the dentist should refer the patient to their physician to determine if an alternative medication with com- parable pharmacologic efficacy can be prescribed. Similarly, patients cannot make a unilateral decision to discontinue any prescribed medication due to an adverse oral effect.
ORAL PRESENTATIONS AND SYMPTOMS RESULTING FROM THE USE OF COMMON CARDIOVASCULAR AGENTS Physicians prescribe such cardiac agents as anticoagulants, antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers, cholesterol- lowering drugs, digitalis preparations, diuretics, and vasodila- tors to manage cardiac conditions (AHA, 2023). A number of these cardiovascular drugs have the potential to induce adverse reactions in the oral cavity (see Table 1).
OVERVIEW OF POTENTIAL ORAL REACTION PATTERNS, DISEASES, OR SYNDROMES RESULTING FROM CARDIOVASCULAR DRUG EXPOSURE
Drug Class
Type of Oral Adverse Drug Reaction Culprit Drug
Alphaadrenergic blockers
Dry mouth
Class effect Methyldopa Unspecified Class effect
Lichen planus Angioedema
Beta-adrenergic blockers
Dry mouth
Aphthae or ulcerations
Labetalol, unspecified
Thrombocytopenia
Propranolol
Lichen planus
Atenolol, oxprenolol Practolol, propranolol
Oculo-mucocutaneous syndrome
Practolol Carvediol
SJS
Mouth paresthesia
Propranolol (sublingual)
Antiarrhythmics, class I (sodium channel blockers)
Dry mouth
Class effect Phenytoin Phenytoin Phenytoin Phenytoin Quinidine Quinidine Amiodarone Amiodarone
Agranulocytosis
Hypersensitivity reaction syndrome
SJS, TEN
Gingival hyperplasia
FDE
Thrombocytopenia
Antiarrhythmics, class III (potassium channel blockers)
Angioedema
Taste disturbances
Calcium channel blockers
Angioedema
Nifedipine, diltiazem Diltiazem, verapamil
Aphthae or ulceration Gingival hyperplasia
Class effect Amlodipine
Lichen planus EM, SJS, TEN
Diltiazem, verapamil
Taste disturbances
Class effect Class effect
Dry mouth
Table 1 continued on next page
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