Dental Care: Oral health of drug abusers   |01 October 2021

Dr Bibhakar Ranjan

In the following interview, Dr Bibhakar Ranjan talks to us about the effects of drugs/substances on oral health, and shares his opinion on how good oral health care can be delivered to patients who are on the path of recovery.

Dr Ranjan has been working as the principal dentist at Dr. Murthy’s Family Medical & Dental Klinik at Anse Aux Pins for more than two years. He has diverse experience in general dentistry for more than eight years.

Seychelles NATION: Why is oral health in drug abusers an important and relevant topic in 2021?

Dr Ranjan: In the past years, different government agencies, national and foreign media have spoken about drug abuse in the Seychelles, and how it is affecting the economy and workforce of an island country whose population is just around 95,000. According to government data, there were 5000 drug abusers in the year 2020 – that is around 10% of our total national workforce. 

There are some other aspects of drug abuse that not many look into. I recently came across a patient who is on the path of recovery, currently put on methadone treatment. After treating the patient, I understood how difficult the recovery process is for this fragile targeted group of patients.

All the drug abusers go through physical, psychological and oral changes which have severe long-term effects. Many a time, these patients turn up to their general physicians or dental surgeons at a very late stage of the disease that is difficult to treat.

Photo source: www.pexels.com

Seychelles NATION: What are the commonly used drugs/substances which can lead to poor oral health?

Dr Ranjan: There are different kinds of substances or drugs people abuse and get addicted to for a long period.

* Tobacco - Cigarettes, E-cigarettes, Cigars, Hookah

* Alcohol - Whiskey, Beer, Wine

* Prescription Drugs - Sleeping pills, Opioid based analgesics

* Contraband Drugs - Party Drugs, Cocaine, Ecstasy

* Natural Opiates - Morphine & Codeine

* Synthetic Opiates - Heroin 

* Amphetamines - Benzedrine, Adderall, Dexedrine

Seychelles NATION: Would you like to tell us about the effects of particular drugs on oral health?

Dr Ranjan: According to the World Health Organisation’s (WHO) recent studies, there are 1.3 billion tobacco users who are mostly from developing and underdeveloped countries. Every year around 8 million people die because of the direct use of tobacco. 

Nicotine is an extremely addictive chemical found in cigarettes, cigars and chewing tobacco. Smoking cigarettes can cause heart diseases, respiratory diseases and oral cancers. Smoking cigarettes brings certain changes in the mouth such as:

1.  Xerostomia (Dry Mouth) – Xerostomia is a condition where the patient often finds their mouth dry. Because of excessive smoking, salivary gland function diminishes and releases less saliva in the mouth. Saliva has an important role to play in the mouth and due to less saliva in smokers, they often have cavities, fungal infections and enamel erosions.
2.  Dental Plaque – In smokers, due to dry mouth and poor oral hygiene, they often develop more plaque and calculus at a faster rate than others. These plaque and calculus if not cleaned on time by professionals often lead to cavities, gingival inflammation & periodontitis.

3. Halitosis (Bad Breath) – Smokers often find themselves having chronic bad breath which is not good for their social and family life.

4. Oral Cancer – Smoking cigarettes and chewing tobacco are often found in 90% of oral cancer patients. Oral cancer can affect the tongue, lips, palate, jaws and throat. 

5.  Smoking Stains – Often smokers report to our clinic with intrinsic & extrinsic brown to black stains on their teeth which are very hard to remove. 

6. Tooth Sensitivity – Due to heavy smoking, patients often go through enamel erosion and enamel cracks, and due to this, they complain of hypersensitivity while drinking hot/cold drinks and food.

7. Oral Submucous Fibrosis – OSMF is an oral precancerous condition characterised by inflammation and progressive fibrosis of submucosal tissue, resulting in marked rigidity and trismus. Smokers often find themselves with less mouth opening which makes it difficult for them to have proper food every day.

Seychelles NATION: Can you explain how alcohol can affect a patient’s oral health?

Dr Ranjan: In Seychelles, we also have chronic alcoholism problems. The alcoholic patient often develops more plaque than non-alcoholics.

Those who drink wine or hard alcohol often complain of sensitivity due to enamel erosion. Alcohol also causes dry mouth and bad breath. Alcoholic patients are often prone to Bruxism (teeth grinding). Often, these patients are not maintaining good oral hygiene; they struggle to maintain a daily brushing routine and they are prone to develop more cavities than the general population.

Seychelles NATION: What are some of the effects of hard drugs on oral health?

Dr Ranjan: Illicit hard drugs include Cocaine, Amphetamines, Hallucinogens, Opiates, Cannabis and other club drugs. Oral health complications with these drugs may result from direct exposure of oral tissues to drugs during smoking or ingestion, and biological interaction of drugs with the normal physiology of the oral cavity. Also, these hard drugs have an adverse effect on brain function which results in risk-taking behaviour, poor oral hygiene and carelessness.

Cannabis – Cannabis smoking is getting quite popular among the youth in Seychelles and in many other countries. Many of these smokers feel it is normal to smoke cannabis, citing different country's regulations regarding cannabis. Cannabis smokers are at higher risk of contracting oral cancers. Xerostomia, Periodontitis, Leukoedema and a higher prevalence of Candida Albicans are found in cannabis users. Cannabis smokers also tend to develop pulpal inflammation during their smoking phase.

Opiates based drugs – Opiate drugs such as morphine, their semi-synthetic derivatives Heroine which is very popular among drug addicts. In opiates, drug users often have tooth loss due to adult periodontitis, smooth surface caries due to salivary hypofunction and bad oral hygiene maintenance. These drug addicts often complain of taste impairment and burning mouth. Other oral conditions related to heroin abusers are Candidosis, mucosal dysplasia and bruxism.

Cocaine – Amphetamines, cocaine and crack cocaine are quite popular in developed countries as it’s a costly drug. These drugs have varied adverse effects on systemic and oral health. Depending on the mode of ingestion of cocaine, cocaine abusers show different oral and facial manifestations. Those who snort cocaine often report nasal septum perforation, change in smell perception, chronic sinusitis and also palatal perforation.

Many times, cocaine abusers apply the cocaine on the gums and tongue to check its quality, and this often leads to gingival recession. Also, cocaine reduces the pH of saliva which leads to enamel erosion. Most cocaine abusers also develop bruxism which causes attrition of the teeth. Cocaine abusers are also at risk of contracting HIV by various means of ingestion of cocaine.

Seychelles NATION: You mentioned that Methadone therapy is also a synthetic opioid to break drug abuse habits. Does this have any oral effects?

Dr Ranjan: Methadone is quite effective in breaking drug abuse habits and has been implemented in many countries to fight drug abuse. On the other hand, it also has several possible oral side effects. The high sugar content of acidic nature along with suppression of salivary secretion results in dental caries and xerostomia. There are sugar-free solutions that may decrease the risk of caries.

Seychelles NATION: How can good oral health care be delivered to patients who are on the path of recovery?

Dr Ranjan: Even after knowing that many of these drug addicts have an oral condition, they are not very keen or motivated to visit a dental clinic unless there's an emergency. I have seen many of these drug addicts have dental anxiety or phobia to be in a dental clinic.

Even in many countries the dental team often has a negative attitude or unwillingness to treat drug addicts. There has also been a lack of communication and collaboration among professionals who are treating drug addicts and dentists and this results in delayed delivery of proper treatment. 

In many countries, the government has implemented a proper educational reform for drug addicts and also for the health workers to overcome stigmatisation and understand the importance of general and oral health care. 

Those who are recovering from drug addiction need regular oral prophylaxis and diet counseling to improve their oral health.

They also need behavioural and psychological counselling, and support from the patient’s family and friends is one important factor which can motivate them to visit their dentist. 

F. P.