Sunitinib

Oral health effects

• MRONJ / mucosal sensitivity / dysgeusia

  Antiangiogenic kinase inhibitors are linked to MRONJ, mucosal sensitivity, and taste changes.

  Clinical management: MRONJ precautions; symptomatic mucosal care; coordinate with oncology.

• Delayed wound healing after surgery or extractions

  The label warns of impaired wound healing and advises withholding sunitinib for at least 3 weeks 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.

• Bleeding tendency (including gingival bleeding)

  Hemorrhagic events occurred in 30% of patients in the pooled safety population (label); trial bleeding events specifically include gingival bleeding and epistaxis.

  Clinical management: Expect more gingival bleeding during probing and scaling; check recent platelet counts before invasive procedures, use local hemostatic measures, and report spontaneous gum bleeding to the oncology team.

• Dry mouth and sore tongue (xerostomia, glossodynia)

  In a label trial, dry mouth occurred in 13% (vs 7% placebo), oral pain in 14% and glossodynia in 11% of sunitinib-treated patients.

  Clinical management: Recommend saliva substitutes, water sipping, alcohol-free bland rinses and high-fluoride toothpaste; avoid spicy/acidic foods when the tongue is sore.