The effects of drugs on the oral mucosa

Kepustakaan
Jones JH & Mason DK (1990) Oral Manifestation of Systemic
Disease, 2
nd
edition
The effects of drugs on the oral mucosa
1. lceration related to local effects,
2. !ller"ic (#y$ersensiti%ity) reaction&
2.1. 'mmediate (ty$e ') reaction,
2.2. !(toaller"y (ty$e '') reaction,
2.). !rt#(s (ty$e ''') reaction,
2.*. Delayed (ty$e '+) reaction,
2.,. -#otosensiti%ity
2... -lasma cell"in"i%itis
). Dr(" er($tion (stomatitis medicamentosa)&
).1. /i0ed dr(" er($tion,
).2. 1ic#enoid er($tion,
).). 2ryt#em m(ltiforme,
).*. 3o0ic e$idermal necrolysis,
).,. Systemic l($(s eryt#ematos(s,
)... 20foliati%e dermatitis and stomatitis,
).4. -em$#i"(s and $em$#i"oid5li6e reactions
*. -i"mentary c#an"es affectin" t#e oral m(cosa and s6in
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Pengaruh obat-obatan terhadap mukosa mulut
D7.'8an Herna8an, Dr"., MS.
3erda$at 9e9era$a %ariasi rea6si sam$in" o9at $ada :arin"an m(6osa, secara
6linis tam$a6 9er($a daera# yan" erythema, hyperkeratosis, pigmentation, stomatitis,
ulceration, visicle ata( bulla. Serin" se6ali "e:ala $ada ron""a m(l(t mer($a6an
manifestasi dari rea6si sel(r(# t(9(#, disertai lesi $ada 6(lit dan 9a"ian t(9(# yan"
lain.
3erda$at 9e9era$a istila# ; Stomatitis medicamentosa, istila# (nt(6 me5
nyata6an 9a#8a drug eruption ter:adi ole# 6arena $em9erian o9at secara sistemi6.
Stomatitis venenata, dimana rea6si yan" tim9(l $ada m(6osa a6i9at $em9erian
o9at5o9atan ata( 9a#an 6imia yan" di9eri6an lo6al $ada ron""a m(l(t.
1. Ulceration related to local effects,
lserasi $ada ron""a m(l(t da$at ter:adi ole# 6arena; $eca#nya 9erca6 yan"
erythematous, $eca#nya vesicle (%esi6(la) ata( bullae (9(la). -enye9a9 drug
induced oral (lceration iala#;
<erostomia, (dryness of t#e mo(t#) M(l(t 6erin" yan" da$at dise9a96an ole#
9e9era$a o9at. da$at menye9a96an :arin"an ron""a m(l(t le9i# $e6a ter#ada$
iritasi. -ada $enderita yan" di9eri antidepresant da$at tim9(l efe6 !ntic#oliner"ic
yan" menye9a96an m(l(t 6erin" yan" men"a6i9at6an (lserasi $ada daera# li"(al
dan 9a"ian ron""a m(l(t yan" lain.
!s$irin dan =#oline salicylate, $ada 6onta6 yan" 9erlan"s(n" lama antara
m(6osa oral dan acetylsalicylic acid (asam salisilat), lesi ini $alin" serin di:(m$ai
$ada ron""a m(l(t. Mer($a6an lesi 9er8arna $(ti# $ada m(6osa "in"i%a dan
9(6al den"an $in""iran yan" tida6 terat(r, m(da# di6el($as dan menin""al6an
daera# yan" (lserasi yan" 9erdara# dan sa6it.
!nti5inflamatory a"ents, Phenylbutazone, oxyphenylbutazone, pyrazolones
monophenylbutazone & ketophenylbutazone menye9a96an (lserasi $ada
ron""a m(l(t.
-ro"(anil, sala# sat( o9at antimalaria yan" da$at menye9a96an (lserasi ron""a
m(l(t yan" terasa sa6it.
2mer$romi(m 9romide, o9at ini menim9(l6an efe6 antic#oliner"ic yan" me5
nye9a96an 0erostomia dan men"a6i9at6an (lserasi $ada lida# dan m(6osa m(l(t.
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-ancreatic e0tracts, (lserati ron""a m(l(t dan an"(lar c#eilitis yan" 9erat da$at
ter:adi $ada $em9erian o9at ini.
'so$renaline, ole# 6arena $en"ar(# $H yan" renda# o9at ini, menye9a96an iritasi
dan iritasi $ada m(6osa ron""a m(l(t dan de6alsifi6asi enamel "i"i.
=ocaine, ole# 6arena $Hnya yan" renda# da$at menye9a96an (lserasi 9ila
di9eri6an secara to$i6al
>entian %iolet, 9anya6 di$er"(na6an (nt(6 $en"o9atan oral candidosis dan oral
ulceration, teta$i :("a mer($a6an o9at yan" $otensial menye9a96an (lserasi.
lserasi da$at tim9(l $ada $em9erian 0,,?51,0? "entian %iolet d(a 6ali se#ari
dalam 2* :am.
2. llergic !hypersensiti"ity# reaction$
!ler"i mer($a6an efe6 mer("i6an yan" $alin" serin" ter:adi $em9erian o9at,
"e:ala m(lai dari yan" rin"an 9er($a skin rash, sam$ai yan" 9erat da$at
menye9a96an 6ematian. 7ea6si aler"i $ada daera# orofacial 9er($a
angioneurotic oedema, urticaria, mucosal erythema, blister, bullae, ulceration dan
stomatitis allergica.
2.1. %mmediate !type %# reaction, rea6si aler"i di se9a96an fa6tor '"2 yan"
9er$en"ar(# $ada $ele$asan histamin, le(6otrien, prostaglandine dan
thromboxane.
Klinis& naphylactic reaction, da$at tim9(l lo6al ata( sistemi6 ter"ant(n"
$ada tem$at 6onta6 anti"ennya. -ada 6(lit da$at menim9(l6an urticaria, 9ila
ter:adi $ada daera# laryn0 da$at menye9a96an oedema dan o9str(6si,
sedan" $ada daera# nasal menye9a96an rhinitis. -en"ar(#nya secara
sistemi6 menye9a96an vasodilatasi yan" men"a6i9at6an #y$otensi dan
shock. !na$#ylactic s#oc6 da$at tim9(l 9e9era$a menit setela# $em9erian
o9at dan da$at se"era menim9(l6an 6ola$s.
O9at $enye9a9; -enisilin, streptomycin, o9at anaesthetic local, or"anic
mercurial, sodium hydrocholate dan demethylchlortetratetracycline.
2.2. utoallergy !type %%# reaction, $ada rea6si ini ter:adi i6atan antara anti"en
dan im(no"lo9(lin ('"> dan '"M) dan disertai adanya rea6si complement di
dalam sel yan" men"a6i9at6an 6er(sa6an sel dan lysis.
O9at $enye9a9; $enisilin dan met#ydo$a.
2.). rthus !type %%%# reaction, 9er#(9(n"an den"an rea6si antara anti"en
den"an '"> dan '"M dan complement.
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Klinis; fever, malaise, nyeri sendi dan urticaria.
O9at $enye9a9; $enisilin, s(l$#onamides, stre$tomycin, t#io(racils,
di$#enyl#ydantoin dan aminosalicylic acid.
2.*. &elayed !type %'# reaction, mer($a6an cell mediated imun response,
yan" mer($a6an contact allergy.
-enye9a9; prothese, amalgam, tooth paste, mouth !ashes, denture fixatives,
periodontal packs, cosmetic, che!ing gums, antiseptic lo"enges, antibiotic,
iodine dan volatile oil. Klinis; cheilitis, angular cheilitis, erythema, burning
sensation dan s!elling.
-era8atan; 1. Men"#ilan"6an $enye9a9 (ini iala# tera$inya, teta$i a$a9ila
6ondisinya $ara# ma6a di$erl(6an tera$i sistemi6), 2. Oedema di9eri
6om$res es, ). lserasi, di9eri ora9ase (9ila $ara# di9eri 6orti6osteroid
to$i6al), ,. nt(6 mence"a# infe6si se6(nder di9eri chlohexidine mouth
!ash.
2.,. Photosensiti"ity, $ada $#otoaller"y radiasi dia9sorsi ole# o9at 6em(dian
di(9a# men:adi aller"en. O9at ata( 9a#an yan" da$at mem9eri rea6si ini
iala#; thia"ide diuretics, hypoglycaemic compound, sulphonamides,
tran#uilli"er, antihistamin dan erythrosin.
Klinis; erythrosin $ada $la@(e disclosin" ta9let, adala# $#otosensitiAer dan
9i9ir yan" ter6ontaminasi den"an eryt#rosin ter6ena sinar mata#ari
menye9a96an cheilitis.
(. &rug eruption !stomatitis medicamentosa#$
7ea6si ini tim9(l setela# $em9erian o9at den"an cara in:e6si, min(m, in#alasi
ata( a9so9si melal(i 6(lit ata( m(6osa. Dr(" er($tion mem9eri6an rea6si
yan" le9i# $ara# 9ila di9andin" den"an contact allergy.
).1. )ixed drug eruption, re6si ini ditandai den"an tim9(lnya lesi 6am9(#an
yan" selal( m(nc(l den"an 9ent(6 dan tem$at yan" sama. Klinis& da$at
tim9(l $ada m(6osa oral ata( 6(lit. -ada m(6osa oral lesinya 9er($a;
(lceration, 9(llae, eryt#emato(s $at#ces, ata( erosi. 3im9(lnya 9isa soliter
ata( m(lti$el. -enye9a9nya 9er#(9(n"an den"an fa6tor aller"y.
-enye9a9; 9ar9it(rat, $aracetamol, $#enacetin, $yraAolone deri%ati%es,
s(l$#onamides dan tetracycline.
).2. *ichenoid eruption, dise9a96an ole# 6arena o9at5o9atan yan" "am9aran
6linisnya miri$ den"an 1ic#en $lan(s dan s(lit di9eda6an 9ai6 secara 6linis
ma($(n #istolo"i. -ada m(6osa ron""a m(l(t "am9aran 6linisnya; 9erca6
9er8arna $(ti#, 9er9ent(6 "aris reti6(ler (!hite striation), $la6 9er8arna $(ti#,
eryt#emato(s $atc#es, erosion ata( (lcerartion den"an 9er9a"ai (6(ran.
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-enye9a9; gold salts, organic arsenicals, #uinine, #uinidine, mepacrine dan
chloro#uine. 3etracycline mo(t# 8as#, $ada 6as(s yan" $ara# di$erl(6an
6orti6osteroid sistemi6. Topical analgesic (nt(6 men"(ran"i rasa sa6it.
-era8atan; men"#ilan"6an $enye9a9nya,
).). +rythem multiforme, iala# $enya6it yan" ditandai den"an lesi yan" tim9(l
$ada 6(lit ata( m(6osa, 9anya6 ter:adi $ada de8asa m(da.
-enye9a9& sulphonamide, phenylbuta"one, oxyphenbuta"one dan
phena"one.
).*. &rug related systemic lupus erythematosus, 1($(s eryt#emato(s iala#
6elainan yan" $enye9a9nya 9el(m di6eta#(i, dimana anti9odi dari sistem
6e6e9alan t(9(# da$at mer(sa6 9e9era$a :arin"an t(9(#nya sendiri.
3erda$at d(a macam 1($(s eryt#ematos(s; syatemin 1($(s 2ryt#emato(s
(S12) dan c(tane(s l($(s eryt#emato(s(s.
-enye9a9; HydralaAine, $rocainamide, met#yldo$a, isoniaAid, t#io(racyl dan
car9amaAe$in.
Klinis; cutaneous rash, articular, pulmonary, cardiac, muscle dan abdominal
symtomp, diikuti dengan demam, berat badan turun, hepatospleenomegaly
dan lymphadenopathy.
(.,. +xfoliati"e dermatitis and stomatitis,
>e:ala ini tim9(l 9e9era$a min""( setela# $em9erian o9at.
Klinis; Keadaan da$at men:adi seri(s dan sem9(# lam9at dalam 9e9era$a
min""(.Kondisi ini ditandai den"an tim9(lnya des6(amasi yan" l(as disertai
den"an eryt#ema yan" dif(se, dan dii6(ti den"an stomatitis (erosi dan
(lserasi yan" l(as).
-enye9a9; cimetidine dan ca$to$ril.
-era8atan ; Hilan"6an $enye9a9, corticosteroid, anti#istamin (nt(6
men"#ilan"6an $r(ritis, 6ontrol oral hygiene dan 6eadaan (m(m.
)... Pemphigus and pemphigoid-like reactions, O9at5o9atan da$at
menim9(l6an "e:ala %esi6el dan 9(la.
-enye9a9; rifam$icin, ca$to$ril.
-era8atan; #enti6an $em9erian o9at dan topical steroid therapy.
.. Pigmentary changes affecting the oral mucosa and skin
-i"mentasi 6(lit dan m(6osa ron""a m(l(t da$at dise9a96an fa6tor endo"en,
yait(; melanin, #aemosiderin, c#romo"en, caroten dan #omo"entisic acid.
-i"mentasi ole# 6arena o9at da$at di$en"ar(#i lan"s(n" ole# o9at5o9atan ata(
dari $enya6it se9el(mnya yan" tim9(l $ada tem$at yan" sama, misalnya o6.
Ja(ndice, -e(tA5Je"#ers syndrome, #emoc#romatosis dan o9at5o9atan.
*.1. /uperfacial discolorations, discoloration $ada m(6osa dan "i"( da$at
dise9a96an ole# o9at. -em9erian gentian violet dan $odine menye9a96an
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$er(9a#an 8arna. %hlohexidine da$at menye9a96an $er(9a#an 8arna $ada
"i"i, lida# 9a"ian dors(m dan $er(9a#an 8arna dari t(m$atan sili6at ata(
6om$osit serta "i"i $als(.
*.2. 0lack 1airy tongue, ditandai den"an 9ertam9a# $an:an"nya $a$ila
filiformis yan" 9er#(9(n"an den"an $ert(m9(#an 9a6teri dan :am(r yan"
mem$rod(6si $i"men dan dise9a96an "an""(an $ert(m9(#an flora ron""a
m(l(t. yan" tim9(l setela# $em9erian penicillin ata( tetracycline, ata( sodium
perborate ata( hydrogen peroxide mouth!ashes.
Klinis & $ert(m9(#an yan" 9erle9i#an dari $a$ila filiformis, da$at menca$ai 1
cm $an:an"nya, yan" da$at menye9a96an rasa 6asar $ada $alat(m dan
menim9(l6an rasa in"in m(nta#.
-era8atan & #enti6an $em9erian o9at5o9atan.
DD. & Har(s di9eda6an den"an simple black tongue (pseudo-black tongue)
dimana ter:adi $er(9a#an 8arna #itam, co6lat dan 6(nin" yan" dise9a96an
9e9era$a $enye9a9 termas(6 o9at. -re$arat 'ron da$at menye9a96an 8arna
#itam, sedan" $er(9a#an 8arna 6(nin" dise9a96an aueromycin mouth!ash.
*.). rsenic dan bromide, Setela# $em9erian yan" lama dari 6ed(a $re$arat
ini 6ed(anya da$at menye9a96an $i"mentasi $ada 6(lit dan m(6osa m(l(t.
O9at yan" men"and(n" rsenic da$at meran"san" melanin pigmentation
sistemi6. Kerac(nan bromide menim9(l6an bro!n pigmentation.
*.*. 0ismuth, Kerac(nan dan $en""(naan o9at yan" men"and(n" bismuth
da$at menim9(l6an $er(9a#an blue-grey pigmentation dari m(6osa ron""a
m(l(t, metallic taste dan gingivostomatitis (miri$ !B>). >e:ala a8alnya iala#
"am9aran bismuth line daera# yan" 9er8arna 9ir( tim9(l $ada interdental
papillae dan marginal gingivae. 2nda$an &ismuth sulphide granules
dise9a96an ole# hydrogen sulphide dalam 9ent(6 6om$le6 antara bismuth
salt dan haemoglobin ata( acid radical yan" lain $ada aliran dara#. >ran(la
9er8arna 9ir( t(a ini terda$at dalam sel endotel dari $em9(l(# dara# 6a$iler
dan :arin"an i6at. -en(m$(6an "ran(la ini ter:adi $ada ter(tama $ada daera#
yan" oral hygienenya :ele6 dimana hydrogen sulphide di$rod(6si ole# 9a6teri.
*.,. 2old, >old salt masi# di$er"(na6an (nt(6 $en"o9atan dan da$at
menim9(l6an gold-induced pigmentation (chrysiasis). -em9erian o9at yan"
men"and(n" gold salt :an"6a $an:an" da$at menim9(l6an blue-gray
pigmentation dari 6(lit yan" ter6ena mata#ari. -er(9a#an 8arna 6e(n"(an
$ada "in"i%a dan 6emera#an dari m(6osa ron""a m(l(t serta metalic taste .
-er(9a#an dise9a96an 6arena $arti6el lo"am ini tert(m$(6 $ada
melanophage $ada dindin" $em9(l(# dara# dan e$idermis.
*... *ead, 'ead pigmentation :aran" ter:adi dan serin" di#(9(n"6an den"an
$e6er:aan. 'ead line, iala# grey pigmentation yan" tim9(l $ada "in"i%a de6at
den"an marginal.
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*.4. 3ercury, (ercury compound dia9sorsi t(9(# den"an cara $enelanan dan
in#alasi dan 6erac(nan mercury mer($a6an 9a#aya dari ind(stry dan 6e5
do6teran "i"i. -en""(naan mercury 9anya6 di$er"(na6an (nt(6 antise$ti6,
$arasitisida dan f(n"isida. -em9erian lo6al yan" 9er(lan"6ali a6an
menim9(l6an grey-bro!n pigmentation ter(tama $ada 6(lit dan mata, a6i9at
$en(m$(6an $arti6el lo"am ini $ada dermis.
-ada m(6osa ron""a m(l(t men(n:(66an greyish pigmentation, "e:ala ini
disertai salivation, stomatitis, gingivitis, metalic taste, dan abdominal pain.
*.C. /il"er, )ilver induced pigmentation (ar"yria) tim9(l setela# $em9erian
:an"6a lama dari $re$arat siver nitrate ata( sliver arsphenamine. Da$at
tim9(l $ada 9a"ian t(9(# yan" ter6ena sinar mata#ari ter(tama tan"an dan
8a:a#. -ada ron""a m(l(t terse9ar $ada m(6osa dan "in"i%a. -ada ron""a
m(l(t da$at tim9(l a6i9at o9at $era8atan sal(ran a6ar "i"i yan" 9ocor a6i9at
$erforasi ata( t(m$atan yan" 6(ran" 9ai6.
*.9. Tetracycline, Disam$in" $er(9a#an 8arna $ada "i"i, $ada $en""(naan
yan" lama (le9i# dari d(a ta#(n) da$at menim9(l6an grey-black coloration
$ada 6(lit yan" ter6ena mata#ari 6arena melanin #y$er$i"mantation.
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