**3.1 Minocycline**

Minocycline, a semi-synthetic broad-spectrum antimicrobial agent, is mainly used for the treatment of acne, chronic respiratory diseases, and rheumatoid arthritis. It is lipid soluble and therefore can easily penetrate into body fluids, such as saliva and gingival crevicular fluid, and into various body tissues including bone and soft tissues [66]. Minocycline-induced pigmentation of oral mucous membranes including the buccal mucosa, gingiva, palatal area, lips and tongue has been reported [67–69]. The pathophysiology of minocycline staining is not clearly understood. It has been suggested that either a minocycline-metabolite complex or melanin, iron and calcium-containing granules are the source of the pigment [70]. The pigmentation of oral soft tissues appears as distinctive blue-gray or brown in color and occurs as a result of pigmented black bone visible through the thin overlying mucosa without any actual involvement of the soft tissue itself (**Figure 5**) [71]. The pigmentation appears to be related to the duration of minocycline

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**Figure 6.**

**Figure 5.**

*Adverse Effects of Medications on Periodontal Tissues DOI: http://dx.doi.org/10.5772/intechopen.92166*

**3.2 Oral contraceptives**

Intraoral pigmentation can be managed with lasers [71].

*Discoloration of the gingiva and teeth in a patient on minocycline therapy.*

*Gingival changes in a patient on oral contraceptives.*

therapy or the cumulative dose, and resolves once the drug is discontinued [69, 72].

A higher prevalence of gingival inflammation, loss of attachment and gingival enlargement in woman taking hormone based oral contraceptives [73, 74]. The gingival inflammation seems to be associated to high concentrations of sex hormones present in oral contraceptives (**Figure 6**) [75]. Oral contraceptives (OCs) enhance periodontal breakdown by reducing the resistance to dental plaque and can induce gingival enlargement in otherwise healthy females [76, 77]. Oral contraceptives have pronounced effects on gingival microvasculature and it has been shown that human gingiva contains receptors for progesterone and estrogen. The dosage and duration of intake are the possible factors which influence the effect of oral contraceptives on the periodontal condition. A continued exposure of oral contraceptives for longer duration results in higher risk of periodontal disease development due to increased production of pro-inflammatory cytokines and prostaglandins as a result of elevated levels of the hormones [78, 79]. However, the currently used combined oral contraceptives showed little influence on the periodontal health, possibly related to their lower concentration of progesterone and estrogen compared to the earlier formulations [74, 80]. A critical review supports the conclusion that there is no impact of modern oral contraceptives on the periodontal and gingival tissues.

therapy or the cumulative dose, and resolves once the drug is discontinued [69, 72]. Intraoral pigmentation can be managed with lasers [71].
