Oral complications caused by dietary supplement

Almasri, Bilal, Ko, Eugene, Tanaka, Takako
University of Pennsylvania School of Dental Medicine, Department of Oral Medicine

Introduction

Dietary and herbal supplements (DHS) continue to grow in popularity throughout the United States. Studies have shown a significant increase in the number of DHS, yet often they are not disclosed to primary care physician. DHS are classified as one form of complement and alternative medicine (CAM) and do not require premarketing approval by the Food and Drug Administration. While DHS have shown some efficacy in managing inflammatory conditions, the actual dose of active ingredients in DHS is often variable or unpredictable, which can cause unexpected reactions particularly when used with other herbs or medications. Reported DHS-related oral complications include xerostomia, numbness, and bullous lesions on mucous membranes.

Methods

Case report: A 33-year-old male patient presented to the Oral Medicine clinic with painful recurrent oral ulcers which started 3 months earlier after using an exercise dietary supplement. Past medical history was significant for obesity, gastroesophageal reflux disease, Jackhammer esophagus, non-alcoholic fatty liver disease, and genital herpes infection. Reported medications included esomeprazole and baclofen. Social history included smoking tobacco and e-cigarette, and substance drug use including marijuana and heroin. Upon interview, it was revealed that he practiced weekly self-starvation for weight control. Intraoral examination revealed multiple ulcers affecting the labial mucosa and tongue, which were consistent with recurrent aphthous stomatitis. Blood tests were administered to rule out malnutrition and any underlying systemic conditions. The patient was instructed to rinse with a dexamethasone solution and return to the office for a follow-up.

Results

At the second visit, 2 months later, intraoral examination revealed non-specific lesions including large white plaques with severe ulceration/erosions affecting almost entire mouth. patient revealed that the new painful lesions might be caused by the use of “maximum” dose of an active hexose correlated compound (AHCC) to boost his immune system in the last 6 weeks. He was instructed to discontinue all DHS immediately and start a course of prednisone. Complete resolution of his oral lesion was confirmed at the subsequent visit one week later: however, the patient failed to return for the further follow-up.

Conclusion

This case illustrates the challenges in managing oral lesions in patients taking DHS.