ADVANCING PEDIATRIC PULMONOLOGY: COMPREHENSIVE INSIGHTS INTO RESPIRATORY HEALTH IN CHILDREN

Аннотация

Background: Drug-induced oral adverse reactions (ADRs) are frequently encountered in dental practice but are often underrecognized or misdiagnosed due to their clinical resemblance to primary oral diseases. As systemic drug use increases, particularly in aging and polymerizate populations, awareness of these reactions becomes essential for timely diagnosis and effectivemanagement. Objective: This review aims to synthesize current evidence on the range, frequency, causative agents, and clinical implications of drug-induced oral ADRs, with an emphasis on diagnostic relevancefor dental professionals. Methods: A structured literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar for articles published between January 2000 and March 2023. From an initial pool of 20 studies, 8 met the inclusion criteria and were analysed. Data were extracted on the type of oral ADRs, implicated drug classes, clinical presentation, and management strategies. A narrative synthesis was used due to heterogeneity in study design andoutcomereporting. Results: The most frequently reported ADR was xerostomia, commonly induced by antihypertensives, antidepressants, and diuretics. Lichenoid reactions, oral ulcers, and mucositis were frequently associated with NSAIDs, β-blockers, and methotrexate. Gingival enlargement was commonly observed in patients taking calcium channel blockers, phenytoin, or cyclosporine. Medication-related osteonecrosis of the jaw (MRONJ) was reported with bisphosphonates and antiangiogenic agents. Tongue disorders, including glossitis and burning tongue, were reported with nervous system and anti-infective medications. Several studies highlighted underreporting and diagnostic challenges due to lack ofpharmacovigilance in dentistry. Conclusion: A wide range of systemic medications can induce clinically significant oral ADRs. Dental professionals must be vigilant in recognizing these reactions, taking thorough drug histories, and collaborating with medical teams for appropriate interventions. Increased education, reporting practices, and awareness of pharmacogenomic variability are essential forimproving oral healthcare outcomes related to medication use. Keywords:Oral adverse drug reactions,xerostomia, gingival hyperplasia, lichenoid reaction, osteonecrosis ofjaw, drug-induced oral lesions,pharmacovigilance, dental pharmacology. Introduction:-The oral cavity, or buccal cavity, plays a vital role in systemic and local health. It is also a frequent site of adverse drug reactions (ADRs), which can significantly 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM,5202,yaM,5emuloV gro.srehsilbupcimedaca.www affect oral functionality, aesthetics, and patient quality of life. Despite this, oral ADRs are often underdiagnosed or misattributed, especially in polymerizate or systemically ill individuals. Oral ADRs commonly manifest as xerostomia (dry mouth), mucosal ulcerations, gingival overgrowth, pigmentation changes, and osteonecrosis. Prompt identification of drug-related oral presentations is critical forpreventing long-term complications. Xerostomia, one of the most common drug-induced oral conditions, arises from reduced salivary gland function and affects both comfort and oral microbiota. Drugs such as tricyclic antidepressants, opioids, anticholinergics, and illicit substances like methamphetamine, heroin, and cocaine are strongly linked to xerostomia and its sequelae—including rampant caries, oral candidiasis, and halitosis (1). A cross-sectional study by Sakai et al. (2025) found that 58.8% of cancer patients undergoing chemotherapy reported xerostomia, with significant negative impact ondailylife activities (3). Other medications, including angiotensin-converting enzyme (ACE) inhibitors like lisinopril and captopril, have been associated with oral ulcerations, angioedema, and dysgeusia. These symptoms can mimic autoimmune diseases, complicating diagnosis (2). Clarithromycin, terbinafine, and lansoprazole have also been reported to cause oral ulceration, mucosal irritation,and altered tasteperception invarious patient populations(4). More severe adverse events include mucocutaneous syndromes such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), linked to drugs such as phenytoin, methadone, and hormonal agents (3). These conditions are life-threatening and present with widespread oral and mucocutaneous erosions. Recent reviews have highlighted genetic susceptibility—particularly specific HLA haplotypes—as critical risk factors in drug- induced hypersensitivity syndromes (1). Among the most debilitating oral ADRs is medication-related osteonecrosis of the jaw (MRONJ), primarily caused by bisphosphonates like zoledronic acid and pamidronate. These drugs, commonly used in oncology and osteoporosis treatment, compromise bone remodelling and increase the risk of necrosis following minor trauma or dental surgery. A 13-year review by Zhong et al. (2025) based on FAERS data identified