Dental patients with substance use disorders have more tooth decay and periodontal disease than the general population but are less likely to receive dental care, according to a review of 28 studies from around the world by a team of Australian researchers.
Dentists should expect to encounter these issues, the researchers note, as one in 20 people globally between the ages of 15 and 64 years used substances in 2013, and approximately 10% of them have a substance use disorder.
The effects of drug use vary based on the type of drug. For example, cannabis use is associated with significant xerostomia, increased caries, and possibly increased oral cancers. Amphetamine users show accelerated tooth wear due to bruxism, advanced caries, severe xerostomia, and poor dental status based on age.
Opioid users also show evidence of increased decay and periodontal disease. Cocaine causes periodontal disease as well in addition to attrition from bruxism, and, when it’s applied to the teeth and gums, chemical erosion.
Plus, many patients with substance use disorders use more than one substance at a time, compounding their effects. Alcohol and tobacco consumption, which have their own negative consequences on oral health, typically accompany substance use as well.
The lifestyle that often accompanies problematic drug use also affects oral health through high sugar diets, malnutrition, poor oral hygiene, and lack of regular professional dental care. Plus, dental care can be further compromised by tolerance to painkillers and anesthetics.
In turn, poor oral health has significant consequences on quality of life and general health. In addition to the functional and self-esteem issues that accompany bad teeth, the chronic inflammation and bacteraemia that accompany poor oral health increase the incidence of coronary heart disease, stroke, diabetes, and respiratory disease.
The researchers encourage dentists to screen their patients for substance abuse, note any advanced dental or periodontal disease inconsistent with patient age, and consider referral to medical doctors for management.
Also, when a substance use disorder is suspected, dentists should be aware of issues concerning treatment and consent when the patient is intoxicated and be alert to the possibility of resistance to painkillers.
Furthermore, the researchers say that doctors and clinicians who care for people with substance use disorders should screen for oral diseases and arrange for dental care as needed, consider using sugar-free preparations when prescribing methadone, and warn patients of the oral health risks associated with dry mouth and cravings for sweet foods.
These findings mirror those of increased dental decay and periodontal disease in people with severe mental illness, eating disorders, and people with alcohol use disorders, compared to the general population.
The review, “A Systematic Review and Meta-Analysis of the Association Between Poor Oral Health and Substance Abuse,” involved data on 4,086 patients with substance use disorder and 28,031 controls. It was published by Addiction.