Dental management of oral adverse effects associated with immune checkpoint inhibitors: A review

Cancer immunotherapy, particularly immune checkpoint inhibitors (ICIs) that target programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), has significantly advanced the field of oncology. However, these therapies are associated with immune-related adverse events that can affect various tissues, including the oral cavity. This narrative review consolidates current evidence regarding the immunopathogenesis, clinical presentation, differential diagnosis, and dental management of immunotherapy-related oral adverse effects. Relevant literature was identified through structured searches of the PubMed/MEDLINE, Scopus, and Web of Science databases. Oral manifestations of immunotherapy include xerostomia resulting from salivary gland dysfunction, oral lichenoid reactions, mucositis-like lesions, dysgeusia, dysphagia, periodontal inflammation, and, less commonly, autoimmune blistering disorders. These immune-mediated conditions are heterogeneous and may arise unpredictably during or after treatment. Accurate differential diagnosis is crucial, as these oral findings can mimic other therapy-related or infectious conditions. Management primarily focuses on supportive care and immunomodulatory approaches, including topical corticosteroids, saliva substitutes, and antimicrobial therapy when necessary, with systemic treatment reserved for severe cases. Early recognition and interdisciplinary collaboration are vital to minimize complications and ensure continuity of oncologic treatment. Further studies are required to elucidate the underlying mechanisms and enhance management strategies.