Key words: etiology, pathogenesis, drug-induced stomatitis, treatment.
Drug-induced allergic lesions of the mucous membrane of the oral cavity occur quite often at the place of first contact with the allergen. The type of allergic reaction is determined by the properties of the antigen and the antibodies reactivity.
Therefore, the problem of allergic reactions when using diagnostic and medicinal products is very relevant. According to literature data, it occurs in 10–20% of the population: in 3% of cases it is the reason for consulting a doctor, in 5% it is the reason for hospitalization, in 3% it is the reason for intensive therapy, in 12% it leads to a significantly long stay in a hospital, in 1% can be the cause of mortality. According to this indicator toxic-allergic drug-induced reactions take the 5th place after cardiovascular, oncological, bronchopulmonary diseases and injuries. Drug-induced allergy is a pathological reaction to drugs based on immunological mechanisms.[1,2,3]
The reasons for the growth of drug-induced allergies is the uncontrolled usage of self-treatment as a result of the availability of drugs (the possibility of purchasing them without a prescription), the increase in the use of drugs by the population, insufficient or delayed medical information about the side effects of drugs, polypharmacy and polytherapy, environmental pollution with industrial waste, infectious diseases, of a parasitic, viral or other nature, the use of antibiotics, vitamins and other drugs that create the possibility of sensitization for the treatment and feeding of livestock.
The frequency of clinical forms of drug allergy: skin manifestations – 72%, hematological – 11%, visceral – 4%, respiratory – 3%, fever – 7%, drug-induced anaphylactic shock – 3%. [1,2,3]
Clinical symptoms on the mucous membrane of the oral cavity appear a few days after contact with the allergen and are expressed by the following symptoms: redness of the mucous membrane of the oral cavity, itching, burning, dryness, the appearance of erosions, ulcers, necrotic films, pain when eating. Bleeding gums, prolonged soreness when eating, at rest, when talking. Weakness, increased body temperature, headache, bad breath, hypersalivation. Exacerbation is also possible as a result of repeated administration of drugs, use of cosmetics, hygiene products, etc. [4]
The aim of research is to describe a clinical case of drug-induced toxic-allergic stomatitis.
Research methods - clinical dental examination: survey, extraoral and intraoral examination, additional methods.
Clinical case. In September 2023, a 58-year-old female patient came to the clinic with complaints of constant sharp pain in the oral cavity, inability to eat, ulcers on the mucous membrane of the oral cavity, which made it impossible to speak and perform oral hygiene. From the anamnesis, it became known that he has been suffering from rheumatism for the last 5 years. According to the patient, the rheumatologist prescribed therapy, which included a combination of corticosteroids and non-steroid anti-inflammatory drugs ("Medrol" and "Diclofenac" in tablets). "Medrol" (synthetic corticosteroid for systemic use, active substance methylprednisolone). "Diclofenac" (a group of nonsteroidal anti-inflammatory drugs), which also has anti-inflammatory and analgesic properties. In June 2023, the patient independently switched only to "Diclofenac", a cheaper drug. The indicated drug was used in double the dose prescribed by the doctor, and without control, until painful sensations appeared in the oral cavity and stomach. This became the reason for an appeal to a dentist. It is known that "Diclofenac", like all non-steroidal anti-inflammatory drugs, should be taken in accordance with the doctor's recommendations, under the supervision of a doctor and a clinical blood count test. From time to time, the doctor can change the dose of the drug and the duration of the treatment course. It is known that one of the side effects of "Diclofenac" is allergic stomatitis with various manifestations. Probable development of clinical and hematological syndrome-agranulocytosis, disorders of the digestive tract, even ulcers.
The patient did not go to the dentist due to insurmountable fear. Oral hygiene was stopped due to sharp pain in the oral cavity, dental treatment was not carried out during the last 5 years. At home, she rinsed with decoctions of chamomile and sage. But there was no improvement. With the beginning of hostilities, he notes the presence of constant stress, psycho-emotional tension, violation of the regime and balanced nutrition.
Objectively: the general condition is not disturbed. Oily type of skin, excessively moisturized. Regional lymph nodes are not enlarged.
During the intraoral examination, the following were found: halitosis, unsatisfactory oral hygiene (hygienic index=3.0), gingival index was 22% (medium stage of gingivitis), pathological abrasion of teeth, carious lesions of teeth and caries complications (chronic pulpitis, periodontitis).
On the mucous membrane of the oral cavity, there are multiple diffuse areas of redness and swelling, against the background of which there are sharply painful mucosal defects in the form of erosions up to 0.5 cm in diameter and ulcers up to 1.5 cm in diameter, which are covered with necrotic films that are difficult to remove , lining of the back of the tongue (photos 1, 2, 3).
On the basis of the clinical examination and the results of additional examination methods (clinical blood analysis, cytological examination of the material from the affected areas), consultation of a rheumatologist, allergist, and immunologist, a diagnosis was perfomed: severe toxic-allergic drug-induced stomatitis.
The principle of treatment is primarily based on the rapid elimination of the allergen.
The rheumatologist adjusted the treatment of rheumatism. It was prescribed: antihistamine drug Citrine, 1 tab. 2 times a day, enterosgel for the purpose of detoxification - 3 times a day.
Local treatment of the affected areas of oral mucosa included gentle professional hygiene of the oral cavity with antiseptic treatment with 0.5% hydrogen peroxide, 0.06% chlorhexidine bigluconate, after application anesthesia with 20% benzocaine gel. After that, the necrotic plaque was mechanically removed, and a corticosteroid was applied in the form of an ointment.
Recommendations for personal oral hygiene and local treatment at home were given. It was recommended to do an appointement after three days for monitoring of the effectiveness of the treatment and gradual rehabilitation of the oral cavity.
Treatment results. After three days of complex treatment, the patient noted a significant improvement in the condition of the oral cavity mucosa, namely, an almost complete absence of pain, no plaque on the affected areas, and a decrease in the area of mucosal damage.
After 7 days of treatment, the patient has no complaints. An objective examination showed the absence of signs of inflammation of the oral mucosa, a significant reduction in the area of the lesion due to active epithelization of the elements, and their painlessness during palpation. The positive situation in the oral cavity made it possible to recommend the treatment of the hard tissues of the teeth, the periodontium, followed by prosthetics after clinical recovery.
Conclusions. The described clinical case once again confirms the danger of self-medication. The prescribed complex of drugs for local and general use, medical control of the patient's condition, elimination of local aggravating factors, made it possible to obtain positive results in a short period of time.
It should be noted that the description of each clinical case is beneficial for doctors of practical dentistry.
References:
1. Àíäðåé÷èí Ì.À. Êë³í³÷íà ³ìóíîëîã³ÿ òà àëåðãîëîã³ÿ / [Ì.À. Àíäðåé÷èí, Â.Â. ×îï'ÿê, ².ß. Ãîñïîäàðñüêèé]. – Òåðíîï³ëü : "Óêðìåäêíèãà", 2005.
2. Êë³í³÷íà ³ìóíîëîã³ÿ òà àëåðãîëîã³ÿ: íàâ÷. Ïîñ³áíèê /çà ðåä. Î.Ì. Á³ëîâîëà, Ï.Ã. Êðàâ÷óíà, Â.Ä. Áàáàäæàíà – Õ. : «Ãðèô», 2011.
3. Êë³í³÷íà ³ìóíîëîã³ÿ òà àëåðãîëîã³ÿ : ï³äðó÷íèê / [Ã.Ì. Äðàí³ê, Î.Ñ. Ïðèëóöüêèé, Þ.². Áàæîðà òà ³í.]; çà ðåä. Ã.Ì. Äðàí³êà. – Ê.: Çäîðîâ’ÿ, 2006.
4. Íàêàç ¹127/18 â³ä 02.04.2002 «Ïðî îðãàí³çàö³éí³ çàõîäè ïî âïðîâàäæåííþ ñó÷àñíèõ òåõíîëîã³é ä³àãíîñòèêè òà ë³êóâàííÿ àëåðã³÷íèõ çàõâîðþâàíü».
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