11 Signs of Oral Cavity You Should Not Ignore if You Are a Drug User

Are you a drug user, concerned about your oral health?  Are you unsure about whom to consult?  Here are a few important facts you should know about how drug use can impact your oral cavity

According to the publication “ Addicts and Consumers of Illegal Drugs Worldwide 1990-2021”, published by John Elflein, there are approximately 39.5 million addicts(1). This report also indicates an increase from 180 million in 1990 to 296 million in 2021. United Nations Drug Control and Crime report Cannabis to be the most widely used drug with approximately 219 million users, followed by Amphetamine 36 million, Cocaine 22 million and ecstasy 20 million in 2021. Furthermore, opioids are identified as the drugs causing the greatest harm and fatalities due to overdose (2). Injectable drug use makes the user susceptible to infections like  HIV (12 per cent of users) and hepatitis C (23 per cent of users). Fatality due to liver diseases like hepatitis C accounts for more than half the deaths attributed to the use of drugs. Men are 5 times more likely than women to inject drugs.

The data presented above clearly demonstrates the significant risks posed by drug addiction. Thus, the need for rehabilitation becomes even more crucial, as it not only affects general health but also impacts oral health.

Addiction to Alcohol and various other substances like psychotropic drugs (methamphetamine, marijuana, opioids, cocaine) can affect oral health both directly and indirectly. 

1. Reduced Salivary secretion One of the direct effects is saliva secretion. The function of saliva is to cleanse, and moisturize the oral cavity, prevent infections and enable the lubrication of food. Reduced salivary secretion during recreational drug consumption promotes opportunistic infection and also makes swallowing difficult.

1. Burning sensation in the oral cavity Saliva has antibodies which prevent bacterial, viral and fungal infections. Oral candidiasis also known as oral thrust is a common fungal infection of the oral cavity characterized by whitish scrapable coating on the mucosa with a burning sensation. 
2. Crumbling of teeth Tooth decay in drug users is very specific to the smooth surface of the tooth or close to the gum. This often appears as blackened teeth, rotting or crumbling of the tooth. This is typically due to reduced salivary flow.  A study in the United States found that people who used methamphetamine were four times more likely to have untreated dental decay. In methamphetamine users increased sugar intake and poor oral hygiene contribute to tooth decay.
3. Swollen and reddish gums Poor oral hygiene and neglect of daily routine contribute to plaque deposition, infection, and inflammation. The symptoms include swelling, pain, redness, mobility of the affected tooth and pus drainage. 
4. Shaking tooth If proper oral hygiene is not maintained and intervention is not done to the existing infections then it will result in tooth loss.  Missing tooth affects the diet of the user so the lost tooth should be replaced. 
5. Night Grinding The use of hallucinogens like ecstasy and LSD causes clenching and grinding during sleep. This condition is also called Bruxism- Persistent grinding and chewing cause pain in the associated muscles and the joints of the jaw. The tooth undergoes wear and attrition exposing the nerve endings. 
6. Sensitivity of tooth Attrition and wear of the teeth cause exposure of the nerve endings causing sensitivity to hot and cold food stuffs.
7. Pain in the Jaw Joints and Muscles Persistent clenching and grinding of the jaw causes pain in the ears, temple and cheeks. The muscles involved in the movement of the jaw are overused and undergo tear. This causes moderate to severe pain in the joints and the muscles.
8. Burns and erosion Psychoactive drugs like Cocaine reduce the supply of blood to the oral mucosa which causes ulcers and necrosis of the oral tissue. These tissues may also get perforated forming an oronasal communication on chronic use.
9. Bad Breath Poor oral hygiene and negligence of the existing problem in the oral cavity results in bad breath.
10. Oral cancers There is also an increased risk of oral cancer among people who have a drug dependence, which can also affect the quality of life of the individuals.

Acknowledging and addressing drug dependence is crucial for overcoming these associated problems. Here are a few oral care recommendations to be followed along during the rehabilitation phase of the treatment of drug dependence.

• Brush your teeth twice daily, morning and before bed, spend about two minutes each time. Make sure to brush both your gum line and each tooth.

•  It is recommended to use a small-headed, medium-textured toothbrush that is replaced frequently. 
• Before brushing, consider using interdental cleaning methods such as dental floss, interdental brushes.
• After brushing, avoid rinsing your mouth with excessive water as it washes away the fluoride. Instead, spit out the excess toothpaste. 
• If you use a fluoride mouth rinse, do not use it immediately after brushing as it will wash away the more concentrated fluoride from your toothpaste.
• Consult a dentist to determine if you need a fluoride varnish or high-concentration fluoride toothpaste, especially if you are at high risk of dental caries.
• To reduce the negative effects of added sugar, limit your consumption of foods and drinks with added sugar and leave a couple of hours or more between consuming them. Added sugars refer to sugars, syrups, or honey added by the manufacturer, cook, or consumer.
• If you have evidence of tooth wear, seek dental advice. Avoid frequent intake of acidic foods or drinks, and limit acidic drinks to mealtimes. Additionally, limit fruit drinks to no more than one per day. 
• Refrain from brushing immediately after consuming acidic food or drinks, as the acid temporarily weakens the teeth. Avoid brushing immediately after vomiting as well.
• If you are taking methadone solution, consider using a straw to reduce direct contact with your teeth and gums. Use water to wash down any remaining solution in your mouth, and brush your teeth after taking methadone. However, if you have recently consumed acidic foods or drinks, it is recommended to wait at least half an hour before brushing.
• Consult a dentist in case of ulcer, perforation, colour change in the oral mucosa or burning sensation.

The above recommendations are not a substitute for professional interventions. Dental and oral health is an important consideration during rehabilitation after drug dependence.