Targeted therapies in medicine: what we can learn about the mouth

Biologic agents are targeted immune modulating agents that have been widely used in the treatment of inflammatory and neoplastic conditions with favorable results. The use of biologic agents in patients with oral diseases is limited mainly to patients suffering from refractory forms of immune-mediated diseases of the oral cavity. Biologic agents were used in all cases as off-label indications. Patient's response varied, but in general biologic agents could be considered as a therapeutic option in patients with no other alternative. Published reports include patients with severe⁄extensive inflammatory oral mucosal disease either as the sole presentation or as a component of more widespread systemic disease. Conditions treated include aphthous ulceration associated with Behcet disease (BD) and Crohn disease, recurrent aphthous stomatitis, lichen planus and blistering oral disease. Agents used include tumour necrosis factor (TNF)-a inhibitors (etanercept, infliximab and adalimumab), the T-cell modulators alefacept and rituximab.