Introduction:
Drug abuse or substance abuse occurs due to direct consequences like multiple physical and mental issues. They are respiratory distress (a lung condition causing low oxygen levels due to the buildup of fluid in the lungs), liver cirrhosis (a condition causing liver scarring and liver damage), nephropathies (worsening of kidney functions), cardiac crisis, infectious diseases, such as hepatitis (liver inflammation), AIDS (acquired immunodeficiency syndrome), injury-associated disabilities, mental disorders (depression), and oral health issues.
Oral health complications are amongst the most prevalent comorbidities related to addictions that mainly involve the onset of tooth mobility and subsequent loss of the tooth, chronic periodontal disease (gum infections), mucosal dysplasia (abnormal cell growth within oral cavity lining), xerostomia (dry mouth), parafunctional habits like bruxism (clenching and grinding of teeth) or night grinding, and regressive alterations of teeth or tooth (abrasion, resorption, erosion, and attrition).
How Is Drug or Substance Abuse Classified?
The main categories of illegal drug impact are classified apart from the major detrimental or deleterious habits that impact systemic as well as oral health like,
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Tobacco use.
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Smoking.
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Alcohol drinking.
Tobacco usage mainly constitutes nicotine components as potential carcinogens that interfere with systemic health status and are the leading risk factors for oral and lung cancers. At the same time, alcohol abuse is associated with acid reflux, tooth staining, and a faster build-up of dental plaque resulting in aggravated forms of gingival and periodontal diseases apart from systemically mainly impacting the heart and liver.
Oral health issues associated with drug abuse result from exposure to oral tissues by ingestion or biological interaction of these substances with the normal physiology that the oral cavity possesses. The effect of drugs on brain function also results in addictive behaviors like risk-taking, careless behavior, poor or compromised oral hygiene, and unwanted aggression.
What Is the Impact of Commonly Used Drugs on Oral and Systemic Health?
The impact of commonly used drugs on oral and systemic health is as follows:
1. Opioid Abuse - Although opioids and opiates are not generally considered stimulant drugs, they have the properties of being both a depressant and a stimulant. The side effects of this substance abuse include grinding of teeth, cracked teeth, and damage to the jaw bone (for example, heroin causes sugar or sweet consumption cravings that damage the tooth enamel and root). A higher risk of oral infections that may be fungal or viral is commonly observed in these users.
Opioids act mainly by reducing pain and stimulating pleasure by acting on three main receptors distributed in the brain, peripheral nociceptors, and the spinal cord -mu, kappa, and delta receptors. Thus, as a mechanism of opioid action, tooth sensitivity and associated sensations of the tooth nerve or the dental pulp or root canal are also reduced, which would lead to the user ignoring the pain from cavities or gum disease.
Prescription opioid use, which is legal in most countries even when correctly prescribed by a doctor or dental surgeon, can be severely addictive to a substance abuser. Withdrawal symptoms of severe cravings, sleep issues, and muscle and bone problems are seen in such substance abusers if they are prescribed opiate drugs.
2. Club Drugs and Amphetamine Abuse - Club drugs are derivatives of Amphetamine, like ECSTASY or MDMA (3,4-Methylenedioxymethamphetamine), and cause the users to be addicts of parafunctional habits like,
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Grinding their teeth produces cracks.
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Tooth wear, like abrasions and abstractions.
Xerostomia or dry mouth associated with dehydration can also cause cracked enamel and tooth wear. One of the most commonly abused stimulants is methamphetamine, also known as meth, speed, crack, tweak, or chalk is a white crystalline powder that is available in smokable or injectable forms.
Meth is taken for recreation purposes to create euphoria as well as an aphrodisiac. Orally periodontal disease and rampant dental caries are manifestations commonly seen as “meth mouth.” Systemic manifestations include loss of appetite, hyperactivity, sweating, rapid breathing, and tachycardia (increased heart rate) or bradycardia (slower than normal heart rate).
3. Marijuana - Smoking marijuana is associated with a condition called “Cannabis Stomatitis” characterized by gingival enlargement, erythroplakia (a condition affecting the soft tissue lining of the mouth), and chronic inflammation of the oral mucosa with hyperkeratosis (increased thickness of outer skin layer), and leukoplakia (white patches on gums, tongue, and cheeks) which can lead to malignant oral cancers or throat cancers. The risk and aggressiveness of cannabis-related cancers are incidentally higher in the population below 50 years of age.
According to the American Dental Association, it has been hypothesized that the hydrocarbons present in cannabis are an energy source for dense colonization by the fungal species Candida albicans that cause oral candidiasis. This drug is also known to cause dry mouth or xerostomia, and methamphetamine causes the wearing of tooth enamel because of an imbalance of acids in the mouth. In addition, Cannabinoid hyperemesis can occur, causing frequent bouts of vomiting and the consequent stomach acids that produce oral manifestations like dental caries and rampant tooth decay (rapidly growing caries).
4. Cocaine - It is a highly acidic and potent stimulant that, on contact with the surface of enamel, creates a breakdown of the enamel calcium hydroxyapatite crystals. It is available both in smokable and powdered form. The powdered form of cocaine is the most common of which “crack cocaine” leads to painful mouth sores and infectious ulcers. In the upper palate, oronasal communication can be established by the regular snorting of cocaine along with dentofacial destructive processes like sinonasal tract necrosis with long-term nasal cocaine abuse. Jaw spasms or mouth-related muscle spasms called “buccolingual dyskinesia” are a form of movement disorder caused by the regular consumption of cocaine.
5. Prescription and OTC Drugs - These drugs are the commonly used antihistamines and over-the-counter (OTC) medications that cause regressive tooth alterations. Antihistamines produce dry mouth or xerostomia, and it is the common side effect that leads to gingival inflammation and ulcers (as the saliva is both antimicrobial and contains immunoglobulins or antibodies for oral defense). Prescription asthma medications, oral contraceptives, and immunosuppressant drugs also cause xerostomia. Even frequent use of cough syrups can be detrimental to the tooth enamel containing calcium hydroxyapatite crystals that are affected because of high sugar content.
How Is Drug Abuse, Misuse, or Addiction Treated?
Drug abuse effects on oral health mainly require medical and dental intervention depending on the severity of the condition. Therefore, in addition to treating the emotional and mental health of a drug abuser, taking care of their oral health concerns also needs to be addressed. Substance abuse is mainly treated with medical detox or withdrawal therapies, rehabilitation, and behavioral therapy (psychotherapy) to help patients cope with cravings for drugs. Counseling may be done individually, with family, or in groups. The treatment programs are mainly designed based on the person's condition and the level of care and settings required, such as inpatient, outpatient, or residential programs.
Conclusion:
Drug abuse is always considered an epidemic, and oral health complications are among the most noticeable side effects of drug abuse. Therefore, public awareness of the dangers of these substances and their adverse impact on systemic health, along with timely intervention and support management like behavioral counseling by the dental surgeon or physician, will synergistically impact the oro-systemic management of drug abusers.
