HJAR May/Jun 2022

50 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH DIALOGUE COLUMN ORAL HEALTH THE OPIOID EPIDEMIC began in the late 1990s as healthcare providers prescribed pain medications to their patients, who later became addicted to these medications. This was further exacerbated by the fact that pharmaceutical companies encouraged and reassured healthcare providers their patients would not become addicted to these opioids. In turn, physicians prescribed these medica- tions at increased rates. 1 It is not news how bad the opioid epidemic has become, and, unfortunately, the effects of substance abuse on oral health have not escaped this crisis. Drug addiction is a public health concern, as it touches so many lives in terms of health, economics, lifestyle, psychological behavior, and physiological outcomes. Adverse oral health effects linked to illicit use and mis- use of opioids have been well documented. 2 These oral health effects include caries, peri- odontal disease, bruxism, poor oral hygiene, and overall dental neglect. Substance misuse has both direct and indirect consequences for oral health, plus it adversely affects behavior and lifestyle. As shown in the table, the ADA has published a statement for treating pa- tients with substance use disorder. 3 All oral healthcare providers should be acquainted with this policy. These significant oral health ramifica- tions affect not only a person’s self-esteem and appearance, but also one’s functionality and ability to converse, chew, smile, breathe, and digest food. These daily functions and quality-of-life factors are influenced by the patient’s emotional well-being and personal- ity issues that can result from being addicted. Dental disease increases the incidence of heart disease, stroke, diabetes, and respira- tory disease. Liver cirrhosis, nephropathy, hepatitis, tuberculosis, AIDS, and other sexu- ally transmitted diseases are closely asso- ciated and prevalent in patients with drug addiction. 4 Consequently, some of the most prevalent health problems associated with drug addiction are oral health issues and dentition destruction. 5 Intraorally, there are many signs of pos- sible substance abuse. Rampant decay, xero- stomia, worn teeth, ulcerations, leukoplakia, erythroplakia, and poor oral hygiene are all visible signs in the oral cavity of a drug ad- dict. These physical signs linked with drug misuse are what set them apart from other conditions that patients could have without addiction. Many addicted patients do not seek dental care, unless they are in terrible pain or they are desperate for prescriptions to feed their habit. It is crucial that dentists screen patients for present and past history of drug addiction. 6 According to the National Institute on Drug Abuse, the most misused drugs are cannabis products (marijuana), opioids, CNS stimu- lants (methamphetamines), and CNS de- pressants (barbiturates). 7 Alcohol is the most commonly misused legal drug. 8 Xerostomia is associated with the use of cannabis products, especially smoking can- nabis, which increases the risk of caries. 9 Since salivary flow is decreased, the rate of decay is potentially increased when preven- tionmeasures are not followed. An associated higher intake of cariogenic beverages, less dental visits, and less daily oral hygiene are additionally noted. This is not a one-size- fits-all analogy, as people may follow strict oral hygiene habits. However, oral cancer is an increased risk since cannabis smoking includes a variety of carcinogens. Studies have shown that leukoplakia and erythroplakia have been present intraorally with smoking cannabis, as well as head and neck squamous cell carcinoma. When lesions of this type are not examined, monitored, or biopsied, these potential cancers grow, and the stages of malignancy can excel. Cur- rently, there are 18 states in the nation that have legalized marijuana. 10 In the event other states legalize this substance, these types of illnesses will rise in numbers. Patients with xerostomia often will rinse with mouthwash in an effort to add moisture and comfort. This is a harsh mistake if the mouthwash contains alcohol, which burns the mouth, irritates the oral cavity, and wors- ens the issue of xerostomia. Methamphetamine is a highly addictive and potent CNS stimulant. Overt dental Effects of Substance Use ON ORAL HEALTH