Illicit drug use and oral health

Substance use during pregnancy and childhood dental caries: a Brazilian cohort study

This study aimed to evaluate the association between substance use during pregnancy (SUDP) and dental caries considering the Tooth Development Hypothesis and the Behavioral Hypothesis. This is a Brazilian cohort study conducted on 865 children (12-36 months). Exposure to SUDP was the latent variable and consisted of the use of alcohol, tobacco, and illicit drugs. The dependent variable was the number of dental caries lesions according to the Nyvad criteria. Structural equation modeling was used for analysis, estimating the standardized coefficient (SC) in two models: traditional (1) and with bias-corrected bootstrap estimates (2). The models were adjusted for socioeconomic status (SES), child's age, maternal age, symptoms of minor psychiatric disorders, sugar consumption, feeding, developmental defects of enamel, and gingival bleeding on brushing (GBoB) (α = 5%). SUDP did not affect dental caries. SES (SCmodel1=0.168, p = 0.037; SCmodel2=0.134, p = 0.056), GBoB (SCmodel1=0.407, p < 0.001; SCmodel2=0.297, p < 0.001), child's age (SCmodel1=0.087, p = 0.003; SCmodel2=0.087, p = 0.005), and sugar consumption (SCmodel1=0.167, p = 0.021; SCmodel2=0.167, p = 0.048) had a direct effect on the outcome. Child's age exerted a specific indirect effect mediated by GBoB (SCmodel1=0.048, p = 0.017; SCmodel2=0.048, p = 0.034). SUDP did not increase the risk of dental caries considering the Tooth Development Hypothesis and the Behavioral Hypothesis, suggesting that child-directed oral health care and tooth development may be similar between mothers exposed and not exposed to SUDP.

General dental practitioners' knowledge, attitudes and practice towards psychoactive substance use screening: A systematic review

ISSUES

Dentists can play a key role in screening for psychoactive substances use. This systematic review aimed to identify the knowledge, attitudes and practices of dentists related to screening for use of psychoactive substances and the facilitating factors and barriers.

APPROACH

According to Preferred Reporting Items for Systematic reviews and Meta-Analyses, four databases were searched until July 2024 to identify reports relating to screening for substance use by dentists. Search terms used key words relating to knowledge, attitudes or practices concerning the screening of tobacco, alcohol or any other substance use.

KEY FINDINGS

Twenty reports met the inclusion criteria for this review. In practice, dentists were more likely to identify tobacco use than alcohol or other substance use. Although the screening for tobacco was widely performed by dentists, the proposal of interventions was less frequent. Despite the opinion of many dentists that screening is part of their professional role, particularly tobacco, their knowledge of how to identify and intervene seemed low. Lack of knowledge or training were identified as barriers.

IMPLICATIONS

Identification of these factors should encourage greater diffusion of recommended tools for screening and development of initial and continuing training for dentists. These factors should convince decision-makers to help dentists to identify referral solutions, in particular coordinated care pathways, and to consider the acceptability and feasibility of the screening tools available to dentists.

CONCLUSION

Tobacco use was more frequently identified than was other substances, screening was always more frequent than interventions, and lack of training proved to be the main barriers to screening. Education and training in the screening of psychoactive substance use is a key factor in encouraging improved practices, particularly on intervention following detection and on substances other than tobacco.

Oral lesions and disorders and their prevalence arising from the use of illicit drugs in a prison population

BACKGROUND

The dependence on the illicit drugs has been proven to be harmful to the oral cavity and may lead to a series of abnormal manifestations. The main objective of this study was to observe the effects caused by the consumption of illicit drugs in the oral cavity, in a prison population in the North of Portugal.

METHODS

A cross-sectional observational study was conducted involving 91 male inmates aged 25-75 years (mean age 41.14 ± 8.98), from Paços de Ferreira Prison. The participants were subjected to a medical interview and a clinical examination. Descriptive statistics and the Chi-square test were used to assess the association between the qualitative variables. The level of statistical significance used was α ≤ 0.05.

RESULTS

The consumption of illicit drugs proved to be a common practice (86.8%), where cannabis, heroin and cocaine were the most prevalent (29.1%). Thirty-one inmates were attending the methadone rehabilitation program (34.1%). Most of patients consuming illicit substances, were also smokers (93.7%) (p<.001). Of the 91 participants, 82 (90.1%) presented oral manifestations, with caries lesions being the most prevalent (61.0%) and oral mucosa lesions the least observed (3.7%). Heavy drug consumption was related with rampant caries lesion (p=.011) and chewing difficulty (p=.024) when compared with cannabis consumption.

CONCLUSION

The main oral manifestations found, associated to the consumption of illicit drugs were caries lesions, tooth loss and sensitivity, periodontal diseases, temporomandibular disorders, xerostomia, and bruxism.

Exploring oral health challenges and integration strategies in opioid treatment programs: perspectives from clinicians and clients

Background Despite the paramount importance of oral health, individuals undergoing treatment for opioid use disorder face unique challenges beyond traditional addiction care. This qualitative study explores the challenges Opioid Treatment Program (OTP) clients in Australia encounter when accessing oral health care, aiming to understand the underlying factors and identify effective strategies for integrating oral health into an OTP. Methods Semi-structured interviews were conducted with OTP clients, OTP clinicians and oral health clinicians using tested interview guides. Thematic analysis identified patterns and themes across participants' responses. Results Client behaviour and traits such as inadequate health prioritisation, crisis-driven care and lack of motivation, shaped by a complex social environment, contribute significantly to inconsistent care and neglected oral health. Addiction exacerbates oral health issues as clients prioritise drug use over oral care and financial constraints, resulting in poor oral hygiene and a higher prevalence of dental problems. Psychological barriers such as dental anxiety deter clients from seeking care, while access issues including administrative burdens and system barriers, lost phones and unstable living conditions hinder consistent management of oral health. Stakeholders recommend actionable steps to address OTP clients' challenges, including integrating holistic care, establishing collaborative support systems, improving awareness and education and enhancing accessibility and flexible scheduling. Conclusion This study established a framework for improving OTP clients' oral health through integrated, holistic strategies. By addressing gaps in existing research, it supports the development of public health policies integrating oral health care into OTPs, aiming to foster collaboration, improve access and advance client education for better health outcomes.

Association Between Self-Reported Oral Health and Dental Fear Among Illicit Drug Users in Northern Finland

OBJECTIVES

About 10% of adults in northern Finland have severe dental fear, but there is a lack of detailed knowledge about dental fear among illicit drug users. The aim of the study was to evaluate the prevalence of dental fear and its association with self-reported oral health and health behavior as well as background factors of the customers of substance abuse services living in the region of Oulu, Northern Ostrobothnia, Finland.

MATERIALS AND METHODS

One hundred seventeen volunteers, either active or former illicit drug users, were interviewed face-to-face about their background factors, health and health behaviors, and use of illicit drugs. The Modified Dental Anxiety Scale (MDAS) was used to assess a situation-specific level of dental anxiety. For analyses, Pearson's χ2 test, Fisher's exact test, ANOVA, and logistic regression analysis were performed.

RESULTS

Three out of four participants had at least moderate dental fear (MDAS ≥ 10) and 24% had severe dental fear (MDAS ≥ 19), with the average MDAS being 14.0 (SD 5.7). Participants in drug rehabilitation reported significantly more dental fear than the rest of the participants. Severe dental fear was associated (adjusted) with previous painful experiences OR 10.8 (2.3-52.0) and poor behavior by dental personnel OR 4.1 (1.2-13.9).

CONCLUSIONS

Dental fear is common among illicit drug users, and it is, particularly, associated with previous painful experiences and poor behavior by dental personnel.

Is drug use associated with the presence of periodontitis and oral lesions? A meta-analysis

PURPOSE

This systematic review investigated whether drug use is associated with the presence of oral lesions and periodontitis.

METHODS

A search was performed for studies that analyzed the presence of periodontitis and/or oral lesions in users of crack, cocaine, and/or marijuana in the PubMed, Scopus, and Web of Science databases. Observational studies in English, Spanish, or Portuguese, without limitation of year, age, and sex, were included. Studies that did not evaluate periodontitis and oral lesions according to the eligibility criteria were excluded. Two authors independently performed study selection and data extraction using a standardized form. The risk of bias of studies included in the meta-analysis was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The meta-analysis included studies that investigated the association of drug use with the outcome.

RESULTS

The initial search resulted in 9,279 articles, from which 16 studies with 15,434 participants were included in the review and 8 studies were included in the meta-analysis. Most studies that evaluated periodontitis in drug users and non-users found a positive association in users. Most studies that analyzed oral lesions reported a higher prevalence, association, or risk of oral lesions in drug users than in non-users. A critical evaluation identified a need to improve the control and reporting of confounding factors in studies on this topic. An association was found between periodontitis and the use of crack, cocaine, and/or marijuana (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.04-3.27; P=0.04) and between oral lesions and the use of these drugs (OR, 2.13; 95% CI, 1.58-2.86; P<0.001).

CONCLUSIONS

Drug users are more likely to develop oral lesions and periodontitis than non-users. However, the results should be interpreted with caution, considering the heterogeneity and quality of the studies included in the analysis.

Orally dissolving buprenorphine for opioid use disorder linked to caries

BACKGROUND

Buprenorphine is under scrutiny because of the development of xerostomia and caries. The purpose of this article was to inform dental care professionals about the oral effects of buprenorphine and to increase knowledge and awareness of medication-assisted treatment in the management of opioid use disorder (OUD).

CASE DESCRIPTION

In 2022, the US Food and Drug Administration issued a warning about xerostomia and caries associated with the use of transmucosal (sublingual and buccal formulations) buprenorphine. Dental health care professionals should instruct patients taking buprenorphine on how to prevent these dental issues by means of rinsing with water and swallowing once the drug has been completely dissolved, followed by toothbrushing at least 1 hour after taking the drug. In addition, a fluoride supplement should be prescribed.

PRACTICAL IMPLICATIONS

It is imperative for dentists to recognize buprenorphine as medication-assisted treatment and to recognize a patient as having an OUD. While taking buprenorphine, the patient should have more frequent oral health care appointments, including home care instructions and caries risk assessment to monitor for caries and xerostomia so that treatment, if indicated, could be initiated as soon as possible. In addition, the dentist's role in OUD is to make sure patients follow the treatment recommendations and use the buprenorphine and to not have them discontinue because of potential caries risk.

Nutritional status of people who inject drugs in Coastal Kenya: a cross-sectional study

INTRODUCTION

Despite documentation on injection drug use (IDU) in Kenya, the nutritional status of people who inject drugs (PWIDs) is under-explored. Elsewhere studies report under-nutrition among PWIDs which is attributed to food insecurity; competing priorities between drugs and food supply; chaotic lifestyle; reduced food intake; substance use induced malnutrition due to inflammation and comorbidities.

METHODS

This was a cross-sectional study that sought to assess the nutritional status of PWIDs in Coastal Kenya. We recruited 752 participants of whom 371(49%) were on IDUs and 75 non-IDUs and 306 non-drug users using respondent driven sampling, traditional snowball, makeshift outreach and purposive sampling methods.

RESULTS

More than one half of the participants (56%) had BMI classified as normal while 35% had BMI < 18.5. The proportion with BMI < 18.5 was higher among IDUs (46%) compared to the non-IDUs (33%) and non-drug users (23%) at P < 0.001. Using the mid upper arm circumference (MUAC), 17% were classified as underweight and the proportion was lowest (11%) among non- drugs users compared to 22% among IDUs (P < 0.001). However, the IDUs had lower proportion of overweight (8.1%) compared to 55% among the non- drug users. The proportion with low waist-for-hip ratio was highest among the IDUs (74%) while high waist-for-hip ratio was lowest in the same group of IDUs (11%) at P < 0.001. One half (50%), of the participants had no signs of anaemia, (47%) had mild/moderate anaemia while 21 (2.8%) had severe anaemia. However, IDUs were more likely to be overweight based on waist circumference as a parameter. The IDUs had the highest proportion (54%) of mild to moderate anaemia compared to non-IDUs (37%) and 40% non- drug users (P < 0.001). In the multivariable models, IDUs (aRRR 2.83 (95%CI 1.84‒4.35)) and non-IDUs (aRRR 1.42 (95%CI 1.07‒1.88)) compared to non- drug users were positively associated with BMI < 18.5. Being an IDU was positively associated with mild or moderate anaemia (aRRR 1.65 (95%CI 1.13‒2.41)) while non-IDUs were positively associated with severe anaemia (aRRR 1.69 (95%CI 1.16‒2.48)).

CONCLUSION

A significant proportion of the participants were under-nourished with those injecting drugs bearing the heaviest brunt. Being an IDU was positively associated with the low BMI, MUAC, waist for hip ratio and mild or moderate anaemia but high waist circumference. People who inject drugs have high risk for under-nutrition and should be targeted with appropriate interventions.

Providing better access to oral health care for people receiving substance use treatment: A timely discussion

Substance use disorders are a risk factor for poor oral health which in turn impacts quality of life. Resultant oral problems contribute to chronic illness, premature mortality, social stigma, embarrassment and reduced opportunities for employment and social interaction. Providing dental services to people with substance use disorders is often difficult due to high rates of oral disease, anxiety, behavioural and drug use changes, and lifestyle factors. Previous studies have demonstrated that alcohol and other drug service clients find accessing and navigating oral health services complex and suggest a multidisciplinary care approach to improve outcomes. In this commentary, we describe individual and structural barriers that limit the use of oral health care among people with substance use disorders, alcohol and other drug clinicians' challenges to integrating oral health into their practice and identify key issues for oral health services in delivering care. We draw on our experience to recommend a multidisciplinary approach be used to develop strategies in order to increase access to oral health services at a standard similar to the general population for clients of alcohol and other drug services.

Prevalence and associated factors of self-reported halitosis among institutionalized adolescents: Cross-sectional study

OBJECTIVE

To assess the prevalence and associated factors of self-reported halitosis in institutionalized adolescents in a city in southern Brazil.

METHODS

This cross-sectional study involved male institutionalized adolescents, aged 15-19 years old, at the Socio-Educational Assistance Center in the city of Passo Fundo, Brazil. Data collection was performed by a research team composed of two interviewers, two clinical examiners of oral health and two examiners of salivary flow. A structured questionnaire was applied, which included demographical, socioeconomical, general health behaviour, presence of health problems and oral health self-perception variables. Decayed, Missing, Filled Index was used for the clinical examination. The salivary flow collection was performed using the mechanically stimulated total saliva method, in which only the liquid component was measured.

RESULTS

The prevalence of self-reported halitosis in this sample was 51.5% (n = 35). In the final multivariate analysis, halitosis was significantly associated with the non-white racial group (prevalence ratio [RP]:1.703; 95% confidence interval [95%CI]:1.101-2.634), use of crack (RP:1.857; 95%CI:1.270-2.714) and number of decayed teeth (PR: 1.123; 95%CI:1.008-1.252). The use of alcohol and access to dental care in the last 12 months were not significantly associated with self-reported halitosis.

CONCLUSION

It was concluded that non-white and crack-user youngsters had a high occurrence of self-reported halitosis. Higher rates of dental caries are also associated with halitosis.

Oral health-care needs among clients receiving alcohol and other drugs treatment-A scoping review

ISSUES

Poor oral health is a significant problem among people who access alcohol and other drugs (AOD) health services, yet little is known about their oral health-care needs and whether any interventions and guidelines are implemented within AOD treatment services.

APPROACH

A scoping review was conducted to identify scientific literature in three focus areas: oral health knowledge, attitudes and practices of clients and clinicians at AOD-related services; oral health guidelines for AOD clinicians; and interventions that describe clinicians promoting oral health among clients.

KEY FINDINGS

Thirty-two reports were identified. Twenty-three studies focused on the oral health knowledge, attitudes and practices of AOD clients, but none of the studies explored perspectives of clinicians. Seven clinical practice guidelines were identified but recommendations varied. Only two interventions in which an AOD clinician promoted oral health were identified.

IMPLICATIONS

Most reports provided insight into the perspectives of clients accessing AOD treatment services. Little evidence demonstrated that clinical practice guidelines were being implemented into practice, or that oral health promotion was part of the tasks of AOD clinicians.

CONCLUSION

This review identified oral health knowledge gaps and perceived poor attitudes that appeared to be reflected in certain oral health practices among clients. This finding indicates a need to educate clients about oral health while receiving AOD treatment. There was an absence of research about the needs for AOD clinicians to advocate for good oral health, and little evidence exists about effective interventions that could enhance integrating oral health care into AOD treatment services.

Risk of somatic diseases in patients with eating disorders: the role of comorbid substance use disorders

AIMS

Eating disorders (EDs) and substance use disorders (SUDs) often co-occur, and both involve somatic diseases. So far, no study has considered whether comorbid SUDs may impact somatic disease risk in patients with EDs. Therefore, this study aimed to examine the impact of comorbid SUDs on the risk of 11 somatic disease categories in patients with anorexia nervosa (AN), bulimia nervosa (BN) and unspecified eating disorder (USED) compared to matched controls.

METHODS

A retrospective cohort study was conducted using Danish nationwide registries. The study population included 20 759 patients with EDs and 83 036 controls matched on month and year of birth, sex and ethnicity. Hazard ratios (HRs) were calculated to compare the risk of being diagnosed with a somatic disease (within 11 categories defined by the ICD-10) following first ED diagnosis (index date) between ED patients and controls both with and without SUDs (alcohol, cannabis or hard drugs).

RESULTS

The ED cohort and matched controls were followed for 227 538 and 939 628 person-years, respectively. For ED patients with SUDs, the risk pattern for being diagnosed with different somatic diseases (relative to controls without SUDs) varied according to type of ED and SUD [adjusted HRs ranged from 0.95 (99% CI = 0.57; 1.59) to 4.17 (2.68, 6.47)]. The risk estimates observed among ED patients with SUDs were generally higher than those observed among ED patients without SUDs [adjusted HRs ranged from 1.08 (99% CI = 0.95, 1.22) to 2.56 (2.31, 2.84)]. Abuse of alcohol only had a non-synergistic effect on six disease categories in AN patients and five in BN and USED patients. Abuse of cannabis (with/without alcohol) had a non-synergistic effect on five disease categories in AN and BN patients and two in USED patients. Abuse of hard drugs (with/without alcohol or cannabis) had a non-synergistic effect on nine disease categories in AN patients, eight in BN patients and seven in USED patients.

CONCLUSIONS

The present study documents non-synergistic but not synergistic harmful somatic consequences of SUDs among patients with different EDs, with AN and hard drugs being the most predominant factors. Hence, EDs and SUDs did not interact and result in greater somatic disease risk than that caused by the independent effects. Since EDs and SUDs have independent effects on many somatic diseases, it is important to monitor and treat ED patients for SUD comorbidity to prevent exacerbated physical damage in this vulnerable population.

Cannabis use and the risk of periodontitis: A two-sample Mendelian randomization study

AIM

This study aimed to leverage human genetic data to investigate whether cannabis use causally affects periodontitis.

MATERIALS AND METHODS

Data were obtained from summary statistics of genome-wide association studies of lifetime cannabis use (N = 184,765), cannabis use disorder (17,068 cases; 357,219 controls), and periodontitis (17,353 cases; 28,210 controls). We performed two-sample Mendelian randomization (MR) analysis using 6 genetic variants as instrumental variables for lifetime cannabis use and 11 variants as instruments for cannabis use disorder to estimate associations with periodontitis.

RESULTS

There was no evidence for an association between genetic liability for lifetime cannabis use or cannabis use disorder with periodontitis. The estimates from the primary analyses were supported in multivariable MR analysis, which considered potential pleiotropic pathways and in weak instrument analyses.

CONCLUSIONS

This study provides little evidence to support a detrimental effect of genetic liability for cannabis use on periodontal health.

Facilitators for use of oral healthcare services among people with substance use disorders: a qualitative study in Norway

OBJECTIVE

Opioid maintenance treatment (OMT) patients in Norway are eligible for free oral healthcare services; however, oral health morbidity remains high and the uptake of services among this patient group is low. As knowledge of the reasons for the low uptake of services among OMT patients is insufficient, this study adopted a qualitative approach to explore this from the perspectives of patients and dental healthcare workers (DHWs).

MATERIAL AND METHODS

Through focus group and individual interviews, data were collected from 63 participants: 30 patients receiving OMT and 33 DHWs. Key themes were identified through a thematic analysis.

RESULTS

Teeth were a significant factor in OMT patients' quality of life and recovery. Accompaniment to scheduled dentist appointments was identified as a facilitator by both the patients and the DHWs. The dentist-patient relationship was also seen as an important facilitator of dental treatment; DHWs with previous experience of treating OMT patients were valued by patients because of their high verbal and non-verbal communication.

CONCLUSIONS

Helping OMT patients attend dental appointments, improving the dentist-patient relationship, and expanding stakeholders' knowledge of OMT patients' right to oral healthcare services may increase the uptake and benefits of dental healthcare services among OMT patients. The current support framework within the OMT system has the potential to increase the communication and efficiency of dental healthcare services available to patients undergoing OMT.