Effects of Systemic and Non-Systemic Drugs on Oral Mucosa: A Prosthodontic Perspective"- A Review.

In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
82
E ec s o Sys emic and Non-Sys emic D ugs on O al Mucosa: A P os hodon ic
Pe spec i e”- A Re iew.
D .B. LakshmanaRao
1
, D .A. Sa h ika
2
, D .D. Kundana eni
3
, D .K. Bhanu P asad
4
.
1. P o & HOD, Dep o P os hodon ics, Leno a Ins i u e o Den al Sciences, Rajahmund y, A.P,
2. S . Lec u e , Dep o P os hodon ics, Leno a Ins i u e o Den al Sciences, Rajahmund y, A.P,
3. S . Lec u e , Dep o P os hodon ics, Leno a Ins i u e o Den al Sciences, Rajahmund y, A.P,
4. S . Lec u e , Dep o P os hodon ics, Leno a Ins i u e o Den al Sciences, Rajahmund y, A.P.
ARTICLE INFO
ABSTRACT
©2025 RS Publicaon
Pape ID: IJPHC-
691EDA9FCBE94
Recei ed: 2025-10-22
Published: 2025-11-21
DOI:
h ps://dx.doi.o g
/10.5281/zenodo.17
670474
Page No: 82-90
The o al mucosa is e y sensi i e o changes caused by many di e en ypes o d ugs, such as
an ihype ensi es, an idiabe ics, an ineoplas ics, co icos e oids, an ibio ics, an i ungals, and
analgesics. These d ug- ela ed al e a ions, like d y mou h, mucosi is, lichenoid esponses,
candidiasis, ulce s, and slow wound healing, ha e a big e ec on he diagnosis, ea men
planning, and p ognosis o emo able p os hodon ic he apy. D ugs used o ea sys emic and
non-sys emic diso de s can change he mucous memb anes o he mou h in ways ha di ec ly
a ec emo able p os hodon ic ea men . To ge good esul s om p os hodon ics, i is impo an
o co ec ly iden i y d ug- ela ed al e a ions and pu in place bo h p e en i e and he apeu ic
ea men s. Comp ehending medica ion-induced mucosal al e a ions and implemen ing sui able
sa egua ds gua an ees inc eased pa ien com o , imp o ed p os hesis e en ion, and diminished
mucosal damage. This e iew ocuses on he mos widely used sys emic and non-sys emic d ugs
on he o al mucosa and lis s he mos impo an he apeu ic p ecau ions o aking ca e o pa ien s
who need de achable p os hodon ic ehabili a ion.
Keywo ds: O al mucosa, Sys emic medica ions, Non-sys emic medica ions, Remo able
p os hodon ics.
Co esponding Au ho : D .B. LakshmanaRao,  Mail: kus[email p o ec ed]
In e naonal Jou nal o Pha maceucal Science
and Heal h Ca e
A ailable online on hp://www. spublicaon.com/ijphc/index.h ml
ISSN 2249 – 5738
Ci e This Pape : LakshmanaRao Ba hala, D . A. Sa h ika, D . D. Kundana eni and D .
K. Bhanu P asad (2025). "Effec s o Sys emic and Non-Sys emic D ugs on O al
Mucosa: A P os hodonc Pe spec e”- A Re iew.". INTERNATIONAL JOURNAL
PHARMACEUTICAL SCIENCE AND HEALTH CARE (IJPHC), ol. 15, no. 6, 2025, pp. 82-
90. DOI: hps://dx.doi.o g/10.5281/zenodo.17670474
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
83
In oduc ion
Medica ions induce al e a ions in he o al mucosa by se e al pa hways, including di ec epi helium
oxici y, immunological modula ion (ei he hype sensi i i y o immunosupp ession), sali a y hypo unc ion,
ascula o angiogenic e ec s, pigmen deposi ion, and modi ica ions o he o al mic obiome. Clinical
mani es a ions encompass xe os omia/a ophy, candidiasis, mucosi is/ulce a ion, lichenoid lesions,
gingi al enla gemen , angioedema, hype pigmen a ion, and mucosal nec osis/slow healing (illus a ions
and p oo p o ided below). (See he main guideline o ea ing mucosi is.) [1,2]
Medica ions aken o a wide ange o sys emic and non-sys emic illnesses can subs an ially a ec he
biological in eg i y and unc ional esilience o he o al mucosa. An ihype ensi es, an icholine gics,
an idiabe ics, immunosupp essan s, chemo he apeu ic agen s, NSAIDs, co icos e oids, an ibio ics, and
psycho opic medica ions o en cause nega i e changes o he mucosa, such as d y mou h, mucosi is,
ulce s, slow healing, candidiasis, hype plasia, and lichenoid eac ions. These changes make de achable
p os hodon ic appliances less com o able, s able, and long-las ing. [1-3]
Majo clinical ca ego ies, ypical d ugs, mechanism & managemen (concise)
1) O al mucosi is / ulce a ion (se e e — chemo he apy, a ge ed he apy, some non-sys emic
d ugs)
D ugs: cy o oxic chemo he apy (5-FU, me ho exa e, doxo ubicin, e c.), head and neck adia ion,
and a ge ed medicines (EGFR inhibi o s, mTOR inhibi o s).
Mechanism: Damage o epi helial cells, an in lamma o y cy okine cascade, and a seconda y
in ec ion.
Clinical ea u es: E y hema → pain ul ulce a ion, dange o sys emic in ec ion, dec eased nu i ion.
Managemen : P e en i e o al ca e, opical analgesia, and p o ocolized suppo i e ea men
acco ding o MASCC/ISOO s anda ds (basic o al ca e, c yo he apy o speci ic agen s, and opical
and sys emic measu es when ad ised). [1,3]
2) Xe os omia / mucosal a ophy (an icholine gic e ec o educed sali a ion)
Medica ions include opioids, diu e ics, an ihype ensi es, an icholine gics, some an idep essan s
(SSRIs, TCAs), and se e al an ipsycho ics.
Mechanism: Dec eased sali a y low leads o d y mucosa, issu ing, bu ning mou h, and loss o
p o ec ing sali a.
Managemen includes ca e ul o al hygiene, sali a s imulan s (i he sali a y glands a e
unc ioning), and con olling he isk o den al ca i ies. [4]
3) O al candidiasis ( ungal o e g ow h)
Medica ions: Inhaled co icos e oids, b oad-spec um an ibio ics, sys emic co icos e oids,
immunosupp essan s (e.g., o au oimmune diso de s).
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
84
E idence: Sys ema ic e iews indica e ha inhaled co icos e oids signi ican ly ele a e he isk
o o opha yngeal candidiasis; he u iliza ion o space s and mou h inse mi iga es his isk.
Managemen : Local an i ungal ea men (nys a in, miconazole o al gel) and p ophylac ic
measu es ( inse, space ). [5,6]
4) Gingi al enla gemen / o e g ow h (seconda y mucosal p oblems)
Pheny oin (an icon ulsan ), calcium-channel blocke s (ni edipine, amlodipine), and cyclospo ine.
Mechanism: Modi ied ib oblas collagen u no e and localized in lamma o y esponse lead o ib ous
hype ophy, cys o ma ion, and subsequen mucosal ulce a ion.
Pheny oin-induced gingi al o e g ow h is ex ensi ely epo ed; i s p e alence a ies signi ican ly and is
a ec ed by o al hygiene and dosage.
Managemen : Enhanced o al hygiene, d ug eplacemen , i possible, pe iodon al ea men , su gical
in e en ion o se e e ins ances. [6, 7]
5) Lichenoid and lichenoid-like eac ions
Medica ions: NSAIDs, ACE inhibi o s, o al hypoglycemics (sul onylu eas), gold sal s,
an imala ials, and o he agen s.
Clinical: Whi e e icula s iae and e osi e lesions ha may esemble o al lichen planus.
Causali y is challenging o es ablish; sys ema ic e alua ions indica e a sca ci y o high-quali y
da a connec ing ce ain medicines o lichenoid lesions. Tempo al co ela ion and wi hd awal
esponses assis in diagnosis. [5,8]
6) Angioedema (o al/ acial mucosal swelling)
ACE inhibi o s a e adi ional medica ions ha may induce b adykinin-media ed angioedema
a ec ing he lips, ongue, and h oa , which can be li e- h ea ening. Nons e oidal an i-
in lamma o y d ugs and o he subs ances may induce his amine-media ed edema.
Clinical and Managemen : Sudden de elopmen o painless edema; ai way e alua ion is
essen ial — discon inue medica ion, p omp medical in e en ion equi ed; a ge ed he apies
a y based on unde lying e iology. Recen e alua ions delinea e incidence, isk de e minan s,
and p e en i e measu es. [3,4]
7) D ug-induced o al hype pigmen a ion
Medica ions: Minocycline, an imala ials (chlo oquine, hyd oxychlo oquine), some an ineoplas ics
(cyclophosphamide), an i e o i als (e.g., zido udine), among se e al o he s.
Mechanism: Accumula ion o d ug o d ug-me aboli e complexes, ac i a ion o melanin syn hesis, o
deposi ion o hemoside in. [9]
E idence: Sys ema ic s udies and case se ies indica e nume ous implica ed agen s and inconsis en
e e sibili y ollowing cessa ion o he agen .
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
85
8) Nico andil and o he ulce -causing d ugs
Nico andil, a asodila o u ilized o angina, is linked o he de elopmen o deep, ch onic pain ul
o al ulce s; addi ionally, o he medica ions, whe he opical o sys emic, may in equen ly induce
se e e ulce a ion o condi ions wi hin he e y hema mul i o me/S e ens-Johnson spec um. [2,4]
9) D ug- ela ed mucosal pigmen a ion o s aining (e.g., minocycline)
Clinical: Blue-g ay o b ownish lesions on he pala e o gingi a; occasionally, osseous colo ing
is isible h ough he mucosa. F equen ly linked o p olonged usage. [6]
P ac ical diagnos ic app oach (sho )
1. His o y: comp ehensi e d ug lis (sys emic and opical/inhaled), ini ia ion and cessa ion da es,
dosage, local ac o s (inhale echnique, den al de ices), immunological s a us.
2. Examina ion: pa e n ( e icula , ulce a i e, pseudomemb anous, pigmen ed), dis ibu ion (pala e
in inhaled s e oid candidiasis; gingi a in pheny oin-induced o e g ow h), ex ao al symp oms
(angioedema).
3. In es iga ions: pe o m swab/cul u e o Candida, conduc biopsy i cance is suspec ed o
unce ain y exis s (lichenoid e sus lichen planus), and conside a d ug wi hd awal ial i clinically
pe missible.
4. Managemen : add ess in ec ion, implemen opical symp oma ic he apy, employ local measu es
(mou hwash, space pos -inhala ion), seek physician o po en ial subs i u ion i ad e se
medica ion eac ion is p obable. [8,9]
Pa e n Typical d ugs Key managemen poin
Mucosi is/ulce a ion
Chemo he apy, EGFR
inhibi o s, adio he apy
Implemen MASCC guideline-based o al ca e and
add ess pain and in ec ion. [2]
Xe os omia An icholine gics, SSRIs,
an ihype ensi es Sali a y eplacemen s, s imulan s, and luo ide.
Candidiasis Inhaled co icos e oids, b oad
an ibio ics
Adminis e an i ungal medica ion; clean he o al
ca i y ollowing inhale usage. [5]
Gingi al
o e g ow h Pheny oin, CCBs, cyclospo ine
Enhance hygiene, e alua e medica ion
modi ica ion, and pu sue pe iodon al o su gical
in e en ion. [1]
Lichenoid lesions NSAIDs, ACEi, sul onylu eas
E alua e he medicine as a po en ial cause; pe o m
a biopsy as necessa y. [2]
Angioedema ACE inhibi o s Adminis e eme gency ai way managemen ;
discon inue ACE inhibi o s. [3]
Pigmen a ion Minocycline, an imala ials,
some chemo he apies
Documen ; equen ly supe icial; may endu e pos -
cessa ion. [6]
Pe sis en ulce s Nico andil D ug wi hd awal is equen ly necessa y.[8]
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
86
Non-sys emic ( opical) medicines:
Inhaled co icos e oids ( opical espi a o y): local candidiasis—mi iga e isk by u ilizing a space
and pe o ming mou h inse.
Topical an isep ics, such as chlo hexidine, may induce mucosal discolo a ion and al e a ions in
as e wi h ex ended usage.
Den al es o a i e me als and con ac s may induce localized lichenoid esponses o alle gic
con ac s oma i is.
Signi ican clinical insigh s
Nume ous d ug-induced o al lesions esemble undamen al o al diso de s (e.g., lichenoid lesions
s lichen planus). A me iculous d ug his o y is necessa y.
Ce ain esponses (ACE-I angioedema, se e e mucosi is, S e ens-Johnson synd ome) may be
li e- h ea ening; discon inue he medica ion and ele a e ca e upon suspicion.
Enhancing local o al hygiene equen ly mi iga es se e i y o a e s seconda y issues (e.g.,
di icul ies om gingi al o e g ow h, candidiasis). [10]
P ecau ions Du ing Remo able P os hodon ic T ea men in Pa ien s wi h
Medica ion-Induced Abused O al Mucosa
Medica ion-induced mucosal al e a ions—such as mucosi is, xe os omia, candidiasis, lichenoid
esponses, pigmen a ion, a ophy, ulce a ion, angioedema, and impai ed healing—necessi a e
adjus men s in he p os hodon ic ea men s a egy o p e en damage, in ec ion, o de e io a ion o
sys emic heal h.
1. Tho ough Medical & D ug His o y (FIRST STEP)
P ecau ions
Acqui e a comp ehensi e lis o sys emic and opical d ugs, including inhale s, sp ays, opical gels, and
he bal agen s.
Inqui e ega ding:
His o y o chemo he apy o adia ion; Adminis a ion o s e oids (sys emic o inhaled);
Immunosupp essan s (cyclospo ine, ac olimus); An ihype ensi es (ACE inhibi o s leading o
angioedema); An icon ulsan s (pheny oin esul ing in gingi al hype ophy); Nico andil (causing
ulce a ion); An idep essan s and an icholine gics (inducing xe os omia)
De e mine mucosal esponses empo ally linked o a medica ion. Consul he physician p io o modi ying
o discon inuing d ugs.
Jus i ica ion: Timely iden i ica ion p e en s s ess o impai ed mucosa and acili a es accu a e diagnosis
o lesions. [1,4]

In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
87
2. E alua e Mucosal S a us Ca e ully Be o e Any Imp ession o Den u e P ocedu es
Look o :
Mucosi is (caused by chemo he apy, adia ion, me ho exa e); Xe os omia-induced a ophy ( esul ing
om an icholine gics, SSRIs, an ihype ensi es); Lichenoid lesions (nons e oidal an i-in lamma o y
d ugs, angio ensin-con e ing enzyme inhibi o s, o al hypoglycemic agen s); Candidiasis (due o inhaled
co icos e oids and an ibio ics); Ulce s (a ibu ed o nico andil and NSAIDs); Gingi al hype plasia
(pheny oin, ni edipine, cyclospo ine); Hype pigmen a ion (an imala ial agen s, an i e o i al medica ions,
minocycline)
Sa e y Measu es
Pos pone ea men un il ac i e mucosal disease is managed, pa icula ly mucosi is, ulce a ion, and
candidiasis.
Fo pa ien s unde going chemo he apy o immunosupp ession, e ain om su ge ies du ing episodes o
neu openia, h ombocy openia, and se e e mucosi is.
Jus i ica ion: Comp omised o al mucosa may de e io a e due o mechanical p essu e o ic ion om
imp essions o ial den u es. [5]
3. Gen le, Low-T auma Imp ession P ocedu es
P ecau ions
U ilize non-i i a ing imp in ma e ials wi h minimal p essu e, such as ligh -body elas ome s. Re ain om
bo de molding in egions exhibi ing ulce s, lichenoid la e-ups, o mucosi is.
Fo pa ien s wi h xe os omia: U ilize sali a subs i u es p io o imp ession aking and employ hyd ophilic
ma e ials.
Jus i ica ion: The mucosa impac ed by medica ion is delica e; p essu e may induce epi helial sloughing
o ulce a ion.[6]
4. Modi y Den u e Design o Mucosal P o ec ion
P ecau ions
Ex ensi e s ess dis ibu ion employing wide co e ing o alle ia e p essu e on delica e mucosa.
Employ so line s (silicone-based) in cases o xe os omia, a ophic mucosa, immunosupp essed
indi iduals, and pos - adia ion mucosa.
Re ain om using ab up bo de s, excessi e ex ensions, and p onounced elie zones on ulce a ed
egions. Fo indi iduals wi h gingi al hype plasia, ensu e p os heses do no make auma ic ouch wi h
he gingi a.
The a ionale is ha so , esilien ma e ials mi iga e unc ional s esses on damaged mucosa. [7,9]
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
88
5. In ec ion Con ol & Managemen o Candidiasis
P ecau ions
Add ess candidiasis p io o den u e ab ica ion: U ilize opical an i ungals (nys a in, miconazole),
implemen a den u e disin ec ion p o ocol, and e ain om wea ing he p os hesis o e nigh .
Moni o pa ien s on s e oids (inhaled/sys emic) o an ibio ics cau iously o ecu ence.
Jus i ica ion: Immunocomp omised o xe os omic indi iduals a e pa icula ly suscep ible o ungal
in ec ions; den u es may se e as ese oi s. [11]
6. Con ol o Xe os omia Be o e Den u e Deli e y
P ecau ions
Ad ise he use o sali a subs i u es, suga - ee lozenges, and egula wa e consump ion.
Achie e a high-gloss inish on he den u e base o minimize ic ion. Re ain om using alcohol-con aining
mou hwashes.
Jus i ica ion: Dehyd a ed mucosa ele a es ic ion and he likelihood o ulce s benea h den u es. [12]
7. Occlusal & Func ional P ecau ions
P ecau ions
Main ain balanced occlusion o mi iga e localized s ess. Re ain om using den u es ha a e excessi ely
igh o cumbe some. Implemen g adual modi ica ions and obse e mucosal ole ance p og essi ely.
Jus i ica ion: O se s he diminished esis ance o mucosa impac ed by pha maceu icals. [13]
8. F equen Recall & Moni o ing
P ecau ions
B ie ecollec ion in e als (e e y 2–4 weeks ini ially).
Ve i y o : No el d ug-induced lesions, candidiasis, auma ic ulce s, and excessi e p essu e ma ks
Enhance cleanliness p o ocols o bo h den u es and he o al ca i y.
Jus i ica ion: Mucosal p oblems igge ed by medica ion may occu swi ly and unp edic ably. [11,12]
9. Special Conside a ions o Chemo he apy, Radio he apy & Immunosupp essi e Medica ions
P ecau ions
No elec i e changes o imp essions o den u es du ing peaks o mucosi is. Re ain om using den u es
du ing acu e episodes o mucosi is.
Fo pa ien s ollowing adia ion he apy:
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
89
Re ain om o e ex ension, p e en ac ylic monome s om con ac ing ulce a ed issue, and apply so
line s gene ously.
Fo pa ien s wi h immunosupp ession: Adhe e o igo ous den u e hygiene measu es and pos pone
in asi e p ocedu es.
The a ionale is because hese pa ien s exhibi inadequa e healing, a heigh ened suscep ibili y o
in ec ion, and signi ican mucosal agili y. [12,13]
10. In e p o essional Collabo a ion
P ecau ions
Engage wi h ea ing oncologis s, physicians, o psychia is s while modi ying den u e plans du ing
chemo he apy. Alleged ha m ul d ug esponses, Se e e ulce a ion due o nico andil o NSAIDs,
angioedema associa ed wi h ACE inhibi o s, and Reques d ug eplacemen alone when clinically
app op ia e. [1,5] P os hodon ic p ecau ions encompass a comp ehensi e medica ion his o y and
mucosal assessmen , p econdi ioning o in lamed issues p io o imp essions, u iliza ion o so line s
and issue condi ione s, pos ponemen o den u e ab ica ion du ing ac i e mucosi is, egula ollow-up
and hygiene ein o cemen , and collabo a ion wi h physicians ega ding d ug-induced mucosal diso de s.
Conclusion:
Fo p os hodon is s, iden i ying medica ion-induced mucosal disease is essen ial o de eloping a sa e
and success ul ea men plan. A comp ehensi e e iew o medical and pha macological his o y, a
de ailed mucosal examina ion, and he iden i ica ion o high- isk medica ion classi ica ions a e c ucial
ini ial s ages. Clinical p ecau ions—including p e-p os he ic issue condi ioning, u iliza ion o issue-
compa ible imp ession ma e ials, applica ion o so line s, main enance o op imal den u e hygiene,
scheduling ea men du ing phases o educed mucosal in lamma ion, and collabo a ion wi h he pa ien 's
physician—mi iga e mucosal auma and enhance p os hesis adap a ion. Fu he conside a ions
encompass he managemen o xe os omia, he p e en ion o oppo unis ic in ec ions, and he
pos ponemen o den u e manu ac u ing du ing ac i e mucosi is o ulce a ion.
A ailo ed, pha macologically in o med s a egy imp o es mucosal heal h, p olongs p os hesis du abili y,
and gua an ees op imal com o o hose needing emo able p os hodon ic ehabili a ion. Combining
medical expe ise wi h p os hodon ic p inciples allows p ac i ione s o p o ide sa e , mo e eliable, and
e idence-based ca e.
Re e ences:
1. Elad S, Cheng KKF, Co ea ME, e al. MASCC/ISOO clinical p ac ice guidelines o he
managemen o mucosi is seconda y o cance he apy. Suppo Ca e Cance . 2020;28(10):4559–
4568.
2. Rubin Tomaszewski M. P edic ion and p e en ion o ACE-inhibi o -induced angioedema.
Hype ens Res. 2024; DOI: 10.1038/s41440-023-01491-9.
In e na ional Jou nal o Pha maceu ical Science and Heal h Ca e Volume 15, Numbe 6, 2025
A ailable online on h p://www. spublica ion.com/ijphc/index.h ml ISSN 2249 – 5738
DOI: 10.5281/zenodo.17670474
O iginal A icle
©2025 RS Publicaon, spublica[email p o ec ed]
90
3. Chacko LN, Bha K, e al. Pheny oin-induced gingi al enla gemen : e iew and clinical
managemen . J Indian Soc Pe iodon ol. 2014;18(3):1–7.
4. Mi a i lles M, e al. Sys ema ic e iew on long- e m ad e se e ec s o inhaled co icos e oids: local
side-e ec s including o al candidiasis. Eu Respi Re . 2021;30:210075.
5. Binmadi NO, Almaz ooa SA. Medica ion-induced o al hype pigmen a ion: a sys ema ic e iew. J
O al Pa hol Med. 2020;49(9):786–796.
6. Fo una G, e al. D ug-induced o al lichenoid eac ions: a eal clinical en i y? A sys ema ic e iew.
J O al Pa hol Med. 2017;46(9):800–807.
7. Healy CM, e al. Pe sis en nico andil induced o al ulce a ion. B Den J. 2004;197(9):561–563.
8. T eis e NS, e al. O al mucosal pigmen a ion seconda y o minocycline he apy. O al Su g O al
Med O al Pa hol O al Radiol Endod. 2004;97(1):69–73.
9. Fa ook FF, e al. An upda e on mechanisms o pheny oin-induced gingi al o e g ow h. Open Den
J. 2019;13:430–438.
10. Hong CHL, e al. Basic o al ca e and mucosi is sys ema ic e iew (MASCC/ISOO g oup). Suppo
Ca e Cance . 2019;27(5):1817–1831.
11. Eps ein JB, Tha ia J, e al. O al complica ions o cance and cance he apy. CA Cance J Clin.
2012;62(6):400-422.
12. Guggenheime J, Moo e PA. Xe os omia: e iology, ecogni ion & ea men . J Am Den Assoc.
2003;134(1):61-69.
13. Lalla RV, Bowen J, e al. MASCC/ISOO mucosi is guidelines summa y. Suppo Ca e Cance .
2014;22:3323-3328.