SYSTEMIC ISOTRETINOIN AND ORAL HEALTH: SALIVARY, MUCOSAL, AND PERIODONTAL CHANGES AND IMPLICATIONS FOR DENTAL PRACTICE

Systemic isotretinoin is widely used for the treatment of severe acne and is frequently associated with mucocutaneous adverse effects. Oral manifestations may include xerostomia, reduced salivary flow, cheilitis, mucosal discomfort, and changes in periodontal parameters, but their clinical significance for dental practice remains incompletely defined. This narrative review summarizes current evidence on salivary, mucosal, and periodontal changes associated with systemic isotretinoin therapy and discusses their implications for dental care. A structured literature search was conducted primarily in PubMed/MEDLINE and supplemented by Google Scholar, Scopus, and Web of Science. Original clinical studies, systematic reviews, and selected mechanistic studies relevant to isotretinoin-associated oral changes were considered. Reduced salivary flow and xerostomia are the most consistently reported oral effects and appear to be largely transient. Cheilitis and oral dryness are common, whereas burning sensations and mucosal ulcerations are reported less frequently. Reduced salivary secretion and, in some studies, decreased buffering capacity may create conditions potentially favorable to dental caries, although a direct causal relationship has not been established. Periodontal findings are heterogeneous. Some longitudinal studies report transient increases in gingival inflammation, bleeding on probing, plaque accumulation, or probing depth, whereas others show little clinical deterioration. Biomarker and microbiological studies suggest additional effects on inflammatory, extracellular-matrix, and antimicrobial pathways, but their clinical significance remains uncertain. Dental management should therefore focus on recognition of oral dryness and mucosal symptoms, individualized caries prevention, plaque control, and periodontal monitoring. Current evidence does not support isotretinoin as a direct cause of periodontitis or routine postponement of necessary dental procedures solely because of isotretinoin therapy.