Effects of Different Types of Opioid Abuse on Oro-dental Health

Objectives: Although it is said that opioid addiction is associated with poor oro-dental health, there is little research in this area. In particular, there is little work comparing the effects of the different drugs and routes and differentiating direct drug effects from poor oral hygiene due to impulsive careless addictive behaviors. Oral-health problems and dental pains may accelerate addiction progression or may cause treatment failure in abstinence phase due to reduction in pain tolerance and due to causing inappropriate facial appearance, may attenuate re-socialization after treatment period.

Methods: In this cross-sectional study, we assessed 156 male, 17-56 years old (mean=31.2) opioid abusers from treatment waiting list of Iranian National Center for Addiction Study in six different groups according to their type of drug and route of usage: Heroin-injectors, Heroin-smokers, Heroin-sniffers, Opium-smokers, Opium-injectors, Crack-Heroin-smokers (a type of very purified, crystalline, locally-made heroin). After medical and psychiatric interview, included subjects were assessed with plaque index, bleeding index, modified gingival index, pocket depth, and Decay, Missing & Filling surfaces Score (DMFS).

Results: In multivariate analysis after omission of confounder variables, age and positive history of usual usage of brush and paste were two main independent predictive variables for all oral hygiene indices. 92% of subjects report dental pain during their abstinence and withdrawal phase. Opioid abuse duration, positive history of heroin injection and positive history of routine alcohol consumption act as independent variables that correlate with plaque index. Crack-heroin smoking and methamphetamine usage correlate with bleeding index. DMFS is independently correlated with crack-heroin smoking.

Conclusion: Combination of behavioral characteristics and direct and indirect biological effects of opioids and meth amphetamines can affect oro-dental health status. crack-heroin and meth amphetamine abuse as the new emerged drugs of abuse act as direct deteriorating factors on oro-dental tissues in comparison to safer drugs such as opium.