Everolimus

Oral health effects

• Stomatitis (aphthous-like ulcers)

  mTOR inhibitors characteristically cause painful, well-defined aphthous-like oral ulcers, often dose-limiting.

  Clinical management: Prophylactic dexamethasone mouthrinse reduces incidence; topical analgesia; coordinate with oncology.

• Taste change (dysgeusia)

  Dysgeusia was reported in 19–22% of everolimus-treated patients (vs 5–6% placebo) in label trials.

  Clinical management: Reassure; check for oral candidiasis (more likely with steroid mouthwash prophylaxis) and dry mouth, and keep oral hygiene meticulous.

• Oral thrush and infection risk (oral candidiasis)

  Everolimus is immunosuppressive; the label warns of localized and systemic infections including fungal infections (e.g., candidiasis), and oral candidiasis was reported in 2% of patients using a dexamethasone mouthwash for stomatitis prophylaxis.

  Clinical management: Look for pseudomembranous or erythematous candidiasis, especially in patients using steroid mouthwash; refer for antifungal treatment and reinforce denture/oral hygiene.

• Delayed wound healing after surgery or extractions

  The label warns of impaired wound healing and advises withholding everolimus for at least 1 week before elective surgery and until adequate healing afterwards.

  Clinical management: Coordinate elective extractions, periodontal or implant surgery with the oncologist so the drug can be paused per label timing; routine scaling and non-surgical care can generally continue. Note the separate MRONJ risk.