The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
OVERVIEW OF POTENTIAL ORAL REACTION PATTERNS, DISEASES, OR SYNDROMES RESULTING FROM CARDIOVASCULAR DRUG EXPOSURE (CONTINUED)
Drug Class
Type of Oral Adverse Drug Reaction Culprit Drug
ACE inhibitors
Angioedema
Class effect (captopril, enalapril, lisinopril, zofenapril, omapatrilat)
Aphthae or ulcerations
Captopril Lisinopril Class effect Captopril Enalapril Captopril
Dry mouth
Neutropenia or agranulocytosis
Lichen planus
Sloughing of epithelium
Pemphigus
Scalded mouth syndrome
Captopril, enalapril, lisinopril
Taste disturbances
Captopril, enalapril
Angiotensin II receptor blockers
Angioedema Angioedema Dry mouth
Losartan
Diuretics
Unspecified Class effect
EM, SJS, TEN Agranulocytosis
Furosemide, thiazides
Amiloride, furosemide, thiazides Amiloride, furosemide, thiazides
Thrombocytopenia
Drug hypersensitivity syndrome
Furosemide, thiazides
Lichen planus
Bendroflumethiazide Furosemide or spironolactone
Taste disturbances
Amiloride, spironolactone
Direct-acting peripheral vasodilator
Lupus erythematosus
Hydralazine Simvastatin Simvastatin
HMG-CoA reductase inhibitors (statins)
Cheilitis
Lichen planus
Platelet aggregation inhibitors
Angioedema
Aspirin Aspirin Aspirin
Mucosal “burn”
FDE
Potassium channel opener
Aphthae or ulcerations
Nicorandil (Not currently available in the U.S.)
ACE = angiotensin-converting enzyme; EM = erythema multiforme; FDE = fixed drug eruption;
Table 1
SJS = Stevens-Johnson syndrome; TEN = toxic epidermal necrolysis. Source: [46]
Antihypertensive medications, for example, can cause xerosto- mia (Ito et al., 2023; Ramirez et al., 2023), gingival overgrowth, salivary gland swelling or pain, lichenoid reactions, erythema multiforme, taste alteration, and paresthesia (Khalil & Zeltser, 2022). ACE inhibitors, in particular, are commonly implicated in lichenoid reactions and taste alterations; angioedema may also occur. Less frequently, pemphigus vulgaris (blistering and sores on the skin and mucous membranes) has been reported (Ghaedi et al., 2021).
Calcium channel blockers are used to treat hypertension, angina, and some arrhythmias (AHA, 2023). This class of drugs, which includes nifedipine, amlodipine, and verapamil, can cause drug-induced gingival enlargement (Damdoum et al., 2022). The enlargements appear as firm nodules on either buccal or labial aspects and lingual or palatal aspects of the teeth, and they typically begin from the interdental papillae and are usually confined to the attached gingiva, although coronal extension that interferes with oral function is possible (Priyadarshini et al, 2023). Gingival enlargement may also
100
EliteLearning.com/Dental
Powered by FlippingBook