Drug-Induced Oral Manifestations: A Clinical Review at the Intersection of Dentistry and Pharmacy

Document Type : Review Articles

Authors

Ministry of Defense, Saudi Arabia

Abstract

Background: Drug-induced oral manifestations (DIOMs)—including xerostomia, gingival overgrowth, mucositis, candidiasis, dysgeusia, and pigmentary changes—are common sequelae of systemic pharmacotherapy. They impair mastication, swallowing, speech, and taste, reduce adherence to medical regimens, and increase healthcare utilization. Their multifactorial pathobiology spans direct epithelial and salivary toxicity, immune-mediated reactions, microbial dysbiosis, and patient-level susceptibility.

Aim: To synthesize contemporary evidence on the epidemiology, mechanisms, clinical presentation, and management of DIOMs, and to delineate interprofessional roles for dentistry and pharmacy while identifying priority gaps for research and guideline development.

Methods: Narrative clinical review of peer-reviewed literature and recent consensus guidance relevant to DIOMs. Content was organized by (i) major manifestations, (ii) high-risk populations, (iii) interprofessional models of care, and (iv) preventive and therapeutic strategies, with emphasis on practical decision points for clinicians.

Results: Xerostomia is strongly associated with antidepressants, antipsychotics, antihistamines, and antihypertensives; gingival overgrowth clusters with phenytoin, cyclosporine, and calcium-channel blockers via fibroblast proliferation and extracellular matrix accumulation. Mucositis is prominent with antimetabolites and targeted oncology agents; candidiasis arises with antibiotics, corticosteroids, and immunosuppressants, often amplified by salivary hypofunction. Taste alterations are frequent with ACE inhibitors, metronidazole, and anticancer regimens. Elderly polypharmacy, cancer therapy, transplantation, and long-term pediatric antiepileptic or immunosuppressive therapy confer heightened risk. Effective care integrates pre-treatment dental optimization, basic oral care, evidence-based preventives (e.g., benzydamine, cryotherapy, photobiomodulation), antifungals, sialogogues, minimally invasive caries control, surgical gingivectomy when indicated, and medication substitution/deprescribing where feasible.

Conclusion: DIOMs are predictable, preventable, and manageable when dentistry and pharmacy collaborate around structured screening, shared care pathways, and medication stewardship. Standardized definitions, pharmacovigilance, and longitudinal studies are urgently needed to personalize prevention and quantify reversibility.

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Egyptian Journal of Chemistry
Volume 68, Issue 13 - Serial Number 13
(In Loving Memory of Late Professor Doctor”Zeinab M. Nofal” In progress
December 2025
Pages 1207-1219

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History

  • Receive Date: 06 August 2025
  • Revise Date: 28 September 2025
  • Accept Date: 02 October 2025

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