Prophylactic Oral Management of a Patient with Tuberous Sclerosis Taking Oral Everolimus

DOI
  • MUSHA Atsushi
    Department of Oral and Maxillofacial Surgery/Plastic Surgery, Gunma University Graduate School of Medicine Gunma Oral Health Center for Special Needs Dentistry
  • FUSE Ayumi
    Gunma Oral Health Center for Special Needs Dentistry
  • SUZUKI Naho
    Gunma Oral Health Center for Special Needs Dentistry
  • FUKUSHIMA Keiko
    Gunma Oral Health Center for Special Needs Dentistry
  • OHKUSHI Keita
    Gunma Oral Health Center for Special Needs Dentistry
  • GOMI Akinori
    Department of Oral and Maxillofacial Surgery/Plastic Surgery, Gunma University Graduate School of Medicine Gunma Oral Health Center for Special Needs Dentistry
  • KURODA Shinsuke
    Gunma Oral Health Center for Special Needs Dentistry
  • TSUJINO Keiichiro
    Gunma Oral Health Center for Special Needs Dentistry Department of Pediatric Dentistry, Tokyo Dental College
  • YOKOO Satoshi
    Department of Oral and Maxillofacial Surgery/Plastic Surgery, Gunma University Graduate School of Medicine
  • ICHINOHE Tatsuya
    Department of Dental Anesthesiology, Tokyo Dental College
  • SHINTANI Seikou
    Department of Pediatric Dentistry, Tokyo Dental College

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Other Title
  • エベロリムスを服用している結節性硬化症患者の口腔管理

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Abstract

<p>Everolimus（Afinitor®）is a mammalian target of rapamycin（mTOR）inhibitor and is effective in the treatment of renal angiomyolipomas associated with tuberous sclerosis. However, it is associated with a high incidence of oral mucositis. Here, we describe the prophylactic oral management of a patient with tuberous sclerosis who was undergoing treatment with oral everolimus.</p><p>The patient was a 20-year-old man with a history of tuberous sclerosis, intellectual disability, epilepsy, and renal angiomyolipomas. His primary care physician, an internist, prescribed oral everolimus（10 mg/day）for management of the renal angiomyolipomas and subsequently referred him to our clinic for a dental examination. There were no abnormal findings in the oral mucosa, although the oral hygiene state was not good. Furthermore, the maxillary left second premolar exhibited buccoversion. Considering the risk of oral mucositis caused by the sharp margins of the tooth, we decided to perform prophylactic extraction of the second premolar, followed by regular maintenance and oral hygiene instruction. The tooth was extracted 6 months later. In the meantime, the patient developed several bouts of mild（grade 1）oral mucositis without any appetite loss, and his symptoms did not require dose reductions or discontinuation of everolimus. After extraction, oral management was regularly performed once a month. Severe mucositis never developed, and the everolimus therapy was unaffected.</p><p>In the present case, we were able to minimize the patient’s oral mucositis, and he could continue everolimus treatment for the renal angiomyolipomas. Our collaboration with his primary care internist and appropriate maintenance of oral hygiene and oral hygiene instruction are likely responsible for the uneventful course of everolimus treatment in this case.</p>

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