b. Adverse Reaction to Drug Absorption. Ingestion of certain drugs by
individuals having an idiosyncrasy or intolerance to them may result in the allergic
manifestations referred to as stomatitis medicamentosa. The signs in the mouth vary
from a sensitive erythema (redness) to an ulcerative stomatitis or gingivitis. If
withdrawal of the suspected drug is followed by disappearance of the lesions, it is
evidence of its causal relationships. Therefore, treatment consists of identification and
elimination of the drug causing the lesions.
c. Adverse Reaction to Contact With Drugs. While the lesions of stomatitis
medicamentosa are the result of absorption of drugs, the lesions of stomatitis venenata
are caused by the direct contact with a drug or a material. Causative agents of stomatitis
venenata may be topical medications, dentifrices, or mouthwashes. Intraoral signs may
vary from a sensitive erythema (redness) to an ulceration. Treatment consists of
elimination of the causative agent, local symptomatic care, or use of a mild antibacterial
agent to minimize secondary infection of an ulceration.
1-49. LICHEN PLANUS
Lichen planus (figure 1-12) is a common inflammatory disease that is observed
frequently on oral mucosa. Oral lesions appear on adults as a lacy network of slender
white lines, primarily on the buccal mucosa. Initiating factors may be herpes simplex,
various bacterial and fungal agents, drugs (penicillin and barbiturates), vaccinations, or
radiation and chemotherapy. On the skin, lichen planus is observed as a bilateral
symmetrical area on the flexor muscle surfaces of the wrists and lower leg. Lichen
planus may exist in various oral forms--erosive, vesicular, or hypertrophic (increase in
growth through cell size, not number). The symptoms are treated.
NOTE: The oral buccal mucosa is a common site for lichen planus. The picture shows
the erosive form of lichen planus in which can be seen the typical lacy network
of slender white lines on the mucosal surface.
Figure 1-12. Lichen planus.