Doxorubicin

Oral health effects

• Oral mucositis

  Anthracyclines commonly cause stomatitis/mucositis.

  Mechanism: Direct cytotoxic injury to rapidly dividing mucosal epithelium.

  Clinical management: Pre-treatment dental clearance, basic oral care protocols, bland rinses, topical analgesia; oncology coordination. Cryotherapy helps with some bolus regimens.

• Infection & bleeding risk (myelosuppression)

  Neutropenia and thrombocytopenia raise the risk of oral infection and bleeding.

  Clinical management: Defer elective invasive care during neutropenic/thrombocytopenic nadirs; coordinate counts with oncology.

• Darkening of the oral mucosa (mucosal hyperpigmentation)

  Hyperpigmentation of the oral mucosa (and skin/nail hyperpigmentation) is listed among postmarketing reactions (label).

  Clinical management: Document new brown/grey pigmentation with photos and note the drug history; it is benign, but biopsy or referral is warranted if pigmentation is focal, irregular or changing and cannot be confidently attributed to the drug.