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The Amahuaca are no strangers to state abandonment. They have enjoyed few resources in their efforts to survive disease, poverty and territorial conflict, as missionaries and industries like rubber and logging pushed into their home territory. Today, as the drug trade rips through this isolated frontier, the Amahuaca — along with thousands of other remote Indigenous people — are once again in the throes of invasion. From to , the land used to farm coca climbed by 18 percent, reaching record high levels , according to recent state data. Much of that production now occurs on Indigenous territory. The town of Breu is among the areas affected. Cut off from the rest of Peru with no roads, only river transport, the ramshackle frontier town has become a transit point along the cocaine trade route. Smugglers moving product from the Upper Ucayali River to Brazil and Bolivia pass through Breu, where small quantities of raw cocaine are sold to Indigenous children who often huddle behind the local market smoking it. His appeals to regional authorities have been met with alleged death threats. As the drug trade snakes a path through Ucayali, dozens of Indigenous villagers described the increased presence of colonos, or non-Indigenous settlers, scouting the territory to expand coca cultivation along the border. The conversion of coca leaves into cocaine paste, a process that requires kerosene and other harsh chemicals, is also occurring on native land. Unlike in the VRAEM and other coca-growing hotbeds, there have been minimal eradication efforts along this remote border region, allowing criminal networks to proliferate, experts told Al Jazeera. At least two powerful Brazilian criminal organisations now operate within Peruvian territory, overseeing cocaine production and transportation, often via light aircraft. Indigenous villagers in remote communities throughout the region often report regular sightings of small aircraft flying late in the evening and low to the ground to avoid radar detection. In the secluded border village of Oori, a number of ethnic Asheninka families displaced by decades of armed conflict and drug-related violence have forged a quiet life of subsistence since the early s. But in the past three years, their sense of security has been shattered. Oori sits on the edge of the Murunahua Indigenous Reserve, a 4,sq-km 1,sq-mile protected area that is home to semi-nomadic tribes living in isolation from Peruvian society. Huertas referenced the Chitonahua people, whose clashes with loggers inside the Murunahua reserve in the s were followed by the spread of deadly respiratory diseases that wiped out nearly half of their population. While a group of Chitonahua still resides in isolation within the reserve, the majority today live as refugees along the banks of the Yurua River. Despite mounting threats to the Murunahua reserve, Chitonahua leader Jorge Sandoval dreams of one day returning to his remote home territory. But he has been warned that, after decades of contact with the outside world, his own presence could trigger conflict and the spread of disease among his vulnerable relatives still in isolation. We were all born there. My father and grandfathers are buried there. By Neil Giardino. Published On 25 Jul 25 Jul Sponsored Content.

Illegal drugs and periodontal conditions

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Official websites use. Share sensitive information only on official, secure websites. Email: alessandro. In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. There is a scarcity of data regarding the impact of other drug use on periodontal health. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information. Keywords: amphetamine, cannabis, cocaine, illegal drugs, oral health, periodontology. This review aims to present an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. With an estimated 33 million users, the use of opiates and prescription opioids is less common, but opioids potentiate major harm and health consequences. Precipitating the difficulties in studying the prevalence of illicit drug use, the pattern of usage can be occasional or regular; or, with a combination of both during different timelines, there are also multidrug users who utilize more than one substance concurrently or sequentially. In users who obtain drugs via injection, The impact of drug use regarding health consequences is known to be strong, but the study of its impact is extremely difficult. We aim to ensure that the meaning of each term used in the current paper is clarified. A risk factor for periodontal disease is a characteristic aspect of behavior or an environmental exposure that is associated with periodontitis, 4 but it is important to stress that this does not necessarily define the causality in the association. A risk factor is more appropriately reserved for those factors that have been verified as associated with the disease concerned through longitudinal studies. In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including an increasing number of patients with substance use disorder. Drug use is commonly associated with significant detrimental psychological, nutritional, and social changes, any of which can markedly affect the general and oral health of the individual user. Recurrent chemical use resulting in a failure to fulfill major role obligations at work, school, or home. Continued chemical use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of chemical substances. Addiction is a primary chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, cravings, diminished recognition of significant problems with one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of remission and exacerbation. Use is a pattern of pathologic behavior associated with continued use of a drug or drugs despite persistent social, psychological, or physical problems caused by drug use. Dependence is defined as continued substance use caused by a physical or psychological need for a substance. Tolerance to the effects of the drug and development of characteristic withdrawal symptoms are required. It is considered a state in which an organism functions normally only in the presence of a drug. Tolerance is defined as a need for markedly increased quantities of a drug to achieve the desired results or a condition in which a higher dose of the drug is required to achieve the same effect. Withdrawal is defined as psychological or physiological symptoms developed following discontinuation of the drug use. Cannabis is the most used illicit drug in developed countries, and it is currently legalized in certain nations USA, Canada, Israel, Uruguay, and the Netherlands. Recently, additional countries have been considering cannabis legalization and these include New Zealand and Australia. This drug originates from a mix of shredded flowers, stems seeds, and leaves of the hemp plant Cannabis sativa or Cannabis indica. Because vaporizers are marketed as a safer alternative to smoking tobacco, many subjects view their use as preferable to smoking cigarettes. Most commercially available vaporizers accept only concentrated resins, but some also vaporize plant matter. The easy access to these devices makes them appealing to young people. Cannabis exerts its effects on the body by interaction with specific endogenous receptors, CB 1 and CB 2. These receptors normally modulate neuronal activity by affecting the second messengers and the ion transport systems. CB 1 receptors are found in the cerebral cortex, limbic areas, basal ganglia, cerebellum, and thalamic areas, explaining the mental health effects of cannabis. It is also linked to CB 2 receptors that are found in cells in the immune system, predominantly the macrophages. Moreover, other cannabinoids and a multitude of chemical compounds have been identified and, in fact, as many as metabolites are produced in the body when cannabis is smoked, including numerous potential carcinogens. Cannabis use can result in elevated blood pressure 20 while the user is sitting or supine, but may result in orthostatic hypotension and subsequent dizziness or fainting on standing. In contrast to marijuana, synthetic cannabinoids are not derived from a plant; instead, the compounds are synthesized in a laboratory. The signs and symptoms of cannabis intoxications include euphoria, anxiety, paranoia, impaired judgment and motor coordination, irritated conjunctiva, and increased appetite. Furthermore, behavioral problems such as acute panic attacks and toxic psychosis have been reported. Carbon monoxide, bronchial irritants, tar, and other carcinogens in cannabis smoke may be even higher in content than in tobacco smoke. Chronic smokers of cannabis usually have increased symptoms of bronchitis, including coughing, wheezing, sputum production, and emphysema. The effects of heavy chronic cannabis use have been studied and an increased incidence of bronchial complaints is very similar to that found in tobacco smokers. The observed consequences include rhinopharyngitis, respiratory impairment, 27 and precancerous changes in the respiratory tract and the oral cavity. Although cannabis is not a direct cause of death, the tobacco, which is usually mixed and smoked in adjunct with marijuana, can be, because it can triple the risk of lung cancer and is also related to some forms of oral cancer. A predictable withdrawal pattern has been described for cannabis. It is usually exhibited with a series of symptoms involving behavioral changes, decreased appetite, weight loss, sleep difficulty, abdominal pain, tremor, fever, sweat, and headache. Marijuana has been promoted for certain perceived health benefits, and in some countries its use is legalized. The medical usefulness of the cannabis plant is regarded to arise from its cannabinoid compounds. The combined consumption of cannabis and tobacco, which is common among users, poses challenges for researchers who are interested in identifying the effects of cannabis alone. An important side effect of cannabis is xerostomia; chronic use of cannabis may consequently increase the risk of carries. Darling and Arendorf 32 and Hashibe et al 38 discovered that cannabis smoke is associated with dysplastic changes within the epithelium of the buccal mucosa and the subsequent oral premalignant lesions, including leukoplakia and erythroplakia. However, the concurrent intake of alcohol, tobacco, and possibly other social drugs makes it difficult to be certain if cannabis alone is a risk factor for oral cancer should there be confounding and even synergistic effects. In order to reach a firm conclusion, rigorous clinical trials with robust methods would be required. The deeper inhalation and prolonged contact and absorption time associated with cannabis smoking suggests that it may contribute to the etiology of periodontal disease Figures 1 and 2. Radiographic full status of the patient in Figure 1 showing severe bone loss with multiple angular intrabony defects. As already mentioned, there are many deleterious constituents in cannabis like those of tobacco. The negative impact on periodontal tissues is likely to be related to the combustion products resulting from the burning of these substances rather than from the main active ingredients of the cannabis itself. Despite the fact that a potential genetic susceptibility was discussed, in a recent study no genetic liability for lifetime cannabis use or cannabis use disorder with periodontitis was observed. The National Health and Nutrition Examination Survey uses a complex stratified multistage probability sampling design to select noninstitutionalized civilians to nationally represent the Unites States population of all ages. Periodontitis was examined using continuous and categorical measures. In addition, the mean attachment loss was higher among frequent recreational cannabis users 1. The use of dedicated statistical software revealed that tobacco smoking was the only identified confounder among all other covariates. The bivariate analysis of this sample revealed an odds ratio of 2. On the contrary, no significant associations were observed between cannabis use and severe periodontitis in bivariate models that included exclusively former smokers odds ratio: 0. The results of this study revealed that frequent recreational cannabis users exhibit significantly deeper probing depths, higher attachment loss score, and higher odds of having severe periodontitis than nonfrequent recreational cannabis users. Moreover, frequent recreational cannabis use in the absence of tobacco smoking appeared to have equally adverse effects on periodontal tissues. A large cohort epidemiologic study was conducted by Thomson et al 50 , 52 , 53 and resulted in the publication of three scientific papers that described the possible effects of cannabis smoking as a risk factor for periodontal disease in young adults. This is the only epidemiologic study with longitudinal periodontal data followed through participants aged in their 20s and 30s. Combined attachment loss for each site was calculated by summing up the probing depth and the gingival recession third molars were not included. Membership of the cannabis exposure groups was recorded as follows: there were However, frequent cannabis smokers were also more likely to smoke tobacco as well. Tobacco smoking was measured and its effect as a confounding factor was considered. Half of the cohort , or In , the same authors reexamined the association between cannabis and periodontal disease using statistical hierarchical modeling to: 1 overcome the limitations of the statistical approach used in the previous study trajectory analysis ; and 2 determine the robustness of the earlier inferences. Jamieson et al 49 provided additional insight into cannabis use and periodontal conditions. Probing depth and gingival recession were recorded obtaining the combined attachment loss for each site. The study subjects were also interviewed about petrol sniffing, marijuana, tobacco, and alcohol use. The following additional covariates were collected: age, sex, education, occupation, and location regional or rural. The authors concluded that their results supported previous research indicating the negative impact of the use of marijuana and other substances on periodontal health. However, among nonusers of tobacco, there were only 13 marijuana users, none of whom had periodontal disease, and no statistical assessment was possible. These circumstances do not allow a clear assessment of the impact of cannabis as an independent risk factor for periodontal disease. No attempts were made to assess the length of the exposure to cannabis, or the amount of cannabis used. The statistical logistic regression analyses were adjusted for age, gender, paternal income, paternal education, frequency of toothbrushing, and time since last dental visit. When analyses were adjusted for the effects of all the covariates, all but one odds ratio estimate indicated a negative association between cannabis use and the presence of necrotizing ulcerative gingivitis. It is important to note that the studies from Thomson et al 50 , 52 , 53 obtained clinical, exposure, and disease data in a prospective way, while in the study conducted by Lopez 44 the relationship between exposure and disease was collected simultaneously and is considered less reliable or accurate. Another frequent, interesting clinical observation is the association between chronic use of cannabis and gingival enlargement Figure 3. Cannabidiol is a major nonpsychotropic constituent of cannabis. As indicated above, attention has been focused on its pharmacologic aspects over the past few years because of its anticonvulsive, anxiolytic, antipsychotic, antiemetic, and antiarthritic properties. These include an increase of gingival fibroblast growth and connective tissue matrix production, inflammation, and altered effects on calcium metabolism in a complex epigenetic interactive environment. Dental and periodontal conditions and treatment considerations in illegal drug users modified from O'Neil Wiley Blackwell Stimulants or psychostimulants are a class of psychoactive drugs that induce temporary improvements in mental or physical functions. Cocaine benzoylmethylecgonine is a strong central nervous system stimulant that produces a profound immediate effect by potentiating catecholamines and interfering with the reuptake process of dopamine, a chemical messenger associated with pleasure and movement. It is available in powder or crystal form. Crack cocaine is the crystal, hydrochloride form of cocaine. It comes in solid blocks or crystals varying in color from yellow to pale rose or white and it is usually processed with ammonia or sodium bicarbonate. It is named so because it makes a cracking or popping sound when heated. It is the most potent form in which cocaine appears and the riskiest to health. Cocaine is most often sniffed, with the powder absorbed into the bloodstream via the nasal tissues. It can also be ingested or rubbed into the gums. To promote more rapid absorption of the drug into the body, some users inject it, but this substantially increases the risk of overdose. Inhaling it as smoke or vapor speeds absorption without the health risks as severe as injection. Euphoria, hyperstimulation, reduced fatigue, heightened mental clarity, and arousal are the consequences of the blocking of presynaptic reuptake of serotonine and norepinephrine as the levels of these neurotransmitters increase. With increasing doses of cocaine, these initial signs of central nervous system excitation are rapidly followed by a generalized state of central nervous system depression, a craving for sleep, and frequently result in a decreased respiratory rate with periods of apnea. Cocaine users frequently report that the use of ethanol and cocaine together prolongs the effect. Ventricular arrhythmias and electrocardiogram alterations can occur subsequently. Oral health is compromised in several ways by the snorting, smoking or oral use of cocaine. Several cases of palatal perforations have also been described in the scientific literature. Speech becomes hypernasal and articulation may decrease the effectiveness of their communication. In addition, eating and drinking are difficult because of the oronasal reflux of both solids and liquids. They focused on the hard tissue damage and described that cocaine users are affected by bruxism with involvement of the temporomandibular joint and painful symptoms of the masticatory muscles. In a review on oral health of cocaine effects, Brand et al 76 described a series of orofacial manifestations compatible with cluster headache. Cocaine triggering pain in the premolar zone of the maxilla, followed by spread to the periorbital zone on the same side, has also been reported. Also, the risks of cervical abrasions and caries were found to be higher in cocaine users with a stronger brushing activity. The same authors found cervical caries of incisors and canines in a young patient who rubbed cocaine on the frontal gingivae. The consequence of dissolving hydroxyapatite increases the risk of enamel loss, which gave the tooth a glassy appearance. Levodopa and lithium, which are often mixed with cocaine, may alter taste perception, induce a red discoloration of saliva, or induce involuntary facial movements. Several authors assessed the effects of crack and cocaine on oral mucosa. These studies revealed that crack cocaine smoke increases the rate of cellular proliferation in cells of normal buccal mucosa, inducing clastogenic effects. Higher degrees of keratinization in the floor of the mouth were observed. Because illicit drug use is normally associated with other risk factors identified for oral cancer eg, tobacco and alcohol , crack cocaine users should have frequent preventive oral examinations to allow early diagnosis and treatment. Multiple studies reported the general impact of crack and cocaine on periodontal conditions Table 2. Prevalence of periodontitis among crack nonusers and crack users was Most of those interviewed were aware of the damage that could be done to the nasal septum but felt that nothing would happen to the gingiva. A recent study compared periodontal status between crack cocaine users and nonusers and investigated the association between crack cocaine and periodontitis after adjustments for confounding variables. Prevalence of periodontitis was significantly higher among users than controls, and crack cocaine use was associated with the occurrence of periodontitis after adjustments for confounding variables. Inclusion criteria were a diagnosis of chemical dependency on the drug, having used the drug for at least 1 year, and absence of cognitive impairment. Individuals who had never used crack cocaine were selected for the control group and matched for sex, age, and smoking habit. All erupted teeth except third molars were evaluated with six sites probing for the determination of probing depth, clinical attachment level, and bleeding on probing. Individuals exposed to crack cocaine had a greater prevalence and severity of periodontitis as well as greater degrees of dental plaque and bleeding on probing. After adjustments for other variables, crack cocaine use remained significantly and positively associated with periodontitis. Contrasting results were obtained by Cury et al. Addiction to both crack and cocaine was the exposure, and destructive periodontal disease was the outcome in their study. The route of cocaine administration was intranasal snorting and that of crack was oral smoking. Eventually, 40 out of exposed individuals that were invited to participate were eligible and enrolled. All permanent, fully erupted teeth, excluding the third molars, were probed at six points; combined attachment loss and bleeding on probing were recorded. Demographic and clinical variables were analyzed. No significant difference was found in the prevalence of total counts for each bacterial species analyzed between groups. However, crack users had a greater probability of having higher counts for A. Because the total counts did not differ between crack users and nonusers, the authors hypothesized that the higher occurrence of periodontitis in crack users may be related to other nonbacterial factors. The direct vasoconstrictive effect of cocaine at the sites of application causes a white slough, which can be easily removed, and that shows underlying ulcerations and erythema. Painful and marginal gingival recessions are reported by patients Figure 5. Gingival recession can be exacerbated by aggressive and overzealous brushing. Clinical presentation of a patient with deep narrow recession and bone dehiscence on the lower left central incisor induced by cocaine use. Overall, the association between crack cocaine and periodontitis can be explained by both systemic and local factors. The systemic biologic mechanism seems to be the most plausible explanation as the effect of exposure was maintained after adjustments for clinical variables. In periodontitis, cytokines and growth factors produced by cells in inflamed periodontal tissue can influence osteoclast differentiation and function, providing a link between inflammation and the process of bone destruction. Amphetamine is a central nervous system stimulant that can also be used medically to treat attention deficit hyperactivity disorder, narcolepsy, and obesity in people who failed to lose weight with diets or alternative treatments. Ecstasy is also excreted in other body fluids such as tears, saliva, sweat, and breast milk. This potent psychomotor stimulant is synthesized in a single, straightforward process through the reduction of ephedrine or pseudoepherine. The product is a white, odorless, bitter crystalline powder that can be taken intravenously, intranasally, orally, or smoked. Methamphetamine is alluring because it is cheap, widely available, and produces many desirable effects. Ecstasy is normally sold as tablets, which have different colors, shapes, and logos. Poor nutrition is related to skipping meals and appetite suppression to the point where users are often unhealthily thin and undernourished, with brittle bones, or anorexic and more vulnerable to infections Figure 8. Methamphetamines disrupt metabolic and neuroendocrine regulation, leading to improper calorie consumption and impaired nutrient processing. Indeed, detoxification programs commonly lead to weight gain, as addicts turn to food instead of their drugs of choice. Clinical presentation of a patient MDMA user with cheilitis related to poor nutrition. Sometimes, body coordination may become difficult. The induced neuromuscular stimulation results in muscle rigidity and breakdown of muscle fibers rhabdomyolysis , which in turn may raise the body temperature. The combination of hyperthermia and the warm environment of dance clubs often results in an excessive water intake. However, ecstasy also stimulates the secretion of antidiuretic hormone. This increased water intake with impaired renal excretion will dilute body fluids, causing hyponatremia and cerebral edema with insults and coma. Therefore, consumption of isotonic fluids such as sport drinks instead of water is recommended, as isotonic fluids will help to restore minerals and reduce the risk of developing hyponatremia. Amphetamines and methamphetamine have a variety of effects on oral health. In addition, patients taking amphetamines have an increased risk of gingival enlargement, periodontitis, and mucosal ulceration. Clinical presentation of a patient MDMA user with generalized gingival recessions and abrasions. Ecstasy users have reported that jaw tension, trismus, jaw pain, and tooth grinding were common side effects. Oral examinations were performed to identify the number of remaining teeth, the number of teeth with obvious decay, and the presence of visible plaque. Marginal dietary and oral hygiene behaviors associated with methamphetamine use were likely to increase the caries risk. Methamphetamine users, specifically those who obtained the drug via injections, have a higher level of addiction than those who smoke or inhale methamphetamine, and thus were less likely to practice oral hygiene. Methamphetamine users can also exhibit significant inflammation and destruction of the soft and hard tissues of the mouth. Hasan and Ciancio evaluated the relationship between gingival enlargement and amphetamine ingestion. Forty subjects were included and divided into two groups. The first group consisted of 20 subjects not taking medications, which could promote gingival enlargement cyclosporine, sodium channel blockers , and taking amphetamines. Patients with cardiovascular or hormonal disorders were excluded from the study. Data about the time when the patient started taking the medication, how often the patient took the medication per day, and the medication's dosage were collected. The results demonstrated a relationship between amphetamine usage and increased risk of gingival enlargement. Half of the drug findings in plaque were not detected in femoral blood. These results suggest that plaque offers a prolonged window of detection in comparison with blood and oral fluid, and is a medium for drug retention. In an interview with regular ecstasy users, 2. The extensive edema involved both the upper and lower labial mucosa, bilateral buccal mucosa, dorsum of the tongue, and the bilateral tonsillar regions. The appearance was grayish white without evidence of ulceration or exudation. The patient was treated with corticosteroids, antibiotics, and chlorhexidine mouthwash. According to a recent study by Hegazi et al, overall, 7. Historically, substance use disorders were treated almost exclusively from a tertiary care perspective, as manifestations present clinically, often among only the most acutely and chronically ill. With attention to this gradual clinical reorientation, primary care clinicians including physicians, physician assistants, and nursing practitioners are in a prime position to contribute and optimize the improved health of patients, families, and communities. Dental practitioners are at the center of a very complex, demanding profession that requires, as a minimum, significant skills in dental and surgical procedures, knowledge of medical diagnosis, recognition of concurrent medical and psychiatric disorders, advanced communication and interview skills and advanced knowledge in pharmacology, pharmacotherapy, pain management, drug diversion, and substance use disorder. A multidisciplinary approach would be the most appropriate management in caring for these patients and collaboration should be in alignment across disciplines to enhance ultimate outcomes. It has been suggested that Screening, Brief Intervention and Referral for Treatment should be integrated into dental practice. Screening, Brief Intervention and Referral for Treatment can be carried out through :. Screening that quickly assesses the severity of substance use and identifies the appropriate level of treatment. Brief intervention that focuses on increasing insight and awareness regarding substance use and motivation towards behavioral changes. Referral for treatment that provides those identified as needing more extensive treatment access to specialty care. Quick screening questions can be included in the medical history that is obtained from dental patients. When the dental practitioner suspects a patient uses illicit drugs, they should express their concerns and offer initial counseling and referral for treatment. The provider's ethical and moral obligations is to treat the dental needs of the patient; because of the illustrated dental impact from substance use, the clinician should also offer counseling to assist the patient, as well as provide referrals for a variety of services if requested. Patients should be made aware that all information provided and discussed will remain confidential and that any information will only be shared with the patient's informed consent. Once the patient has disclosed the use of an illegal drug, different behavioral changes counseling techniques can be applied. This approach is respectful to the individual patient's preferences, needs, and values, and ensures that the patient's values guide all clinical decisions. Motivational interviewing is based on an assumption that knowledge is insufficient to bring about behavioral changes. It is much more likely to happen when the need to change is connected to something the individual values. It consists of two phases. During phase one, intrinsic motivation for change is enhanced, whereas in phase two, commitment to change is strengthened. The tone of the motivational interviewing encounter should be nonjudgmental, empathetic, and encouraging. As a counselor, the clinician must establish a nonconfrontational and supportive climate in which patients feel comfortable expressing both the positive and negative aspects of their current behavior. It can be helpful to ask the patient to help set the agenda for the encounter to ensure that they are active and willing participants in the process. This may include deciding what behavior s to talk about including drug use and use and what goals they have for the session or the intervention in general to be achieved. Patients identified as needing more help than brief interventions can be referred for specialty treatment. This approach may include consulting with colleagues or contacting and visiting local treatment centers. Dentists should familiarize themselves with the signs and symptoms of illegal drug intoxication and develop an understanding of the potential effects of these drugs on the patient's overall health. Physical signs or symptoms of substance use include unusual laziness, changes in appetite, unusual body odors, needle marks, or deterioration in the individual's general appearance and cleanliness. Many cocaine users may premedicate themselves before dental appointments to help relieve anxiety associated with the anticipated dental therapy. Also, risk may arise from the use of retraction cords impregnated with epinephrine that may place an individual that has recently used cocaine at an increased cardiovascular risk during dental treatment. The potentiation of cardiovascular effects of epinephrine observed with cocaine is also valid with other stimulants methampthetamines and cannabis. If it is confirmed the patient is indeed an ecstasy user, the dental team should educate the patient and family members in case of minors about the effects of methamphetamine use on overall and oral health. Because meth mouth is a condition with devastating effects on oral conditions, thoughtful considerations about the patient's dental management are necessary. The key to successful dental treatment starts with the cessation of ecstasy. In general, the treatment plans made specifically for addicted patients should be less elaborated than those for nonaddicted patients. The use of salivary stimulants should also be considered rather than saliva substitutes. Intravenous sedation with a benzodiazepine or general sedation should be avoided. In the work carried out by Gantos et al, some additional treatment considerations were proposed, notably the multidisciplinary approach. Destructive oral and psychological changes must be identified and controlled. A thorough risk assessment, caries control, and preventative plan should be established before initiating prosthodontic treatment. Patient motivation, support, and a timely recall schedule are integral for dental health longevity. When the patient is emotionally stable and motivated to proceed with dental treatment, the dental provider should complete a risk assessment, develop a prevention plan, and arrest the active diseases. Scheduling dental appointments for these patients should accommodate their special characteristics. Because of their heightened anxiety, there is often a need for shorter appointments with multiple breaks during the dental appointments. Providing several reminders to ensure attendance, being lenient in rescheduling, and requesting family members to accompany could enhance attendance and provide some stress relief for the patient. A regular reevaluation of the disease control in combination with patient compliance should be the key to developing the final restorative treatment plan. Caries management is a fundamental aspect of disease control, risk assessment, and prognosis of the dental treatment. Fixed dental prostheses present higher patient satisfaction but are more expensive and require maintenance that is more demanding. A full or partial removable dental prosthesis may be a valid treatment option because it provides both esthetics and function without a challenging management. Dental implant is a helpful option, but it must be emphasized that a careful individual evaluation precedes treatment. Pain, one of the most common reasons patients seek medical care, is often undertreated. As for pain management in active or recovering illicit drug users, it is challenging for several reasons. Some of the challenges faced by practitioners include distinguishing between those seeking pain relief and seeking drugs for the euphoric effects; and identifying predictable neuroadaptations such as tolerance and physiologic dependence that can be misinterpreted as drug seeking or relapse behavior. Prescribing around the clock, providing the minimum effective dose of opioids, being aware of tolerance potential, weaning periodically to reassess pain control, and using nonpsychotropic pain medications when possible, are strategies to manage substance use patients. Practitioners should be reminded that while relapse in a recovering individual may occur despite appropriate use of opioids and psychotropic medications required for effective pain management, inadequate pain relief is also a significant risk factor for relapse. In all circumstances, if methadone has been prescribed, it should be maintained and not ceased, and taken into consideration during treatment. The dental treatment of subjects who use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. It is essential to manage their addiction properly in the comprehensive treatment when we encounter such patients. The overall dental management for substance use patients may be complex, and a systematic approach in health care entailing screening, interviews, counseling, and potential referral can prevent the practitioners' accidental negligence on important information in relevance to providing care for substance users. Such information is considered sensitive and difficult to be retrieved, hence caution in enquiring must be stressed. Attention to fine details would prevent malpractice, especially when medications are to be prescribed. The potential risks and complications related to the interaction between local esthetics and other dental products with illegal drugs have been discussed and precautions in administration cannot be further emphasized. When necessary, dental treatment must be postponed for the safety of both patients and clinicians. Careful assessment and multidisciplinary management of illicit drug users can prevent unnecessary tragedy and optimize treatment outcomes. The authors would also like to acknowledge and thank Professor Manlio Quaranta, Rome, Italy, for his enduring support during these years and for being an extraordinary academic guide, mentor, and role model. Illegal drugs and periodontal conditions. Periodontol As a library, NLM provides access to scientific literature. Find articles by Alessandro Quaranta. Find articles by Orlando D'Isidoro. Find articles by Adriano Piattelli. Find articles by Wang Lai Hui. Find articles by Vittoria Perrotti. Issue date Oct. Open in a new tab. Without adjusting for other factors there was an elevated risk of periodontitis in cannabis users Cannabis, tobacco smoking, and petrol use associated with periodontal disease. No attempt of assessing the length of the exposure or the amount of cannabis used. Investigation of the association between crack cocaine and periodontitis after adjustment for confounding variables. Occurrence of periodontitis, visible plaque, and gingival bleeding was significantly higher among crack users, and crack use was associated with occurrence of periodontitis. Yukna 89 Twenty case reports with usual and nonusual oral manifestations selected and ordered by increasing severity No intervention comparisons were performed Periodonatal tissue damage The same pysiologic effects of vasocostriction, epithelial sloughinf, ischemic necrosis and local anesthesia. Oral hygiene trauma may explain the observed lesions Cocaine users may be trading one problem for another when they change the location of drug administration from the nasal site to the gingiva Most of those interviewed were aware of the damage that could be done to the nasal septum but felt that nothing would happen to the gingiva. Periodontal disease was associated with age and dental plaque The population of the present study, in general, was quite young to have moderate to severe periodontal disease. Periodontal pathogens in crack users and nonusers Subgingival bacterial samples collected from 4 sites with the greatest PDs and analyzed using RT PCR No significant difference was found in the prevalence of total counts for each bacterial species analyzed between groups. Crack users had a greater probability of having the higher for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia , and Fusobacterium nucleatum , respectively. There was a statistically significant association between the amphetamine group and gingival enlargement. In the test group there was a significant correlation between medication dosage and the gingival index in patients who had gingival enlargement; moreover, gingival enlargement was statistically significantly associated with the gingival index. Patients taking amphetamines have an increased risk of gingival enlargement. Validity of the data for adult amphetamines users should be assessed in depth. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Shariff Thomson Cannabis use no exposure; some exposure; high exposure and periodontitis also assessed after controlling for tobacco use. Plaque and full mouth bleeding scores were also recorded. Zeng Cannabis use no exposure; some exposure; high exposure and periodontitis also after controlling for tobacco use. Smoking cannabis weekly or daily was associated with higher AL. Meier Jamieson Without adjusting for other factors there was an elevated risk of periodontitis in cannabis users. Cannabis, tobacco smoking, and petrol use associated with periodontal disease. Lopez Cannabis exposure ever use of and regular use and periodontal conditions also assessed after controlling for tobacco use. Association observed between use of cannabis and presence of NUG among nonsmokers. The use of cannabis is not associated with periodontal diseases with the exception of NUG in cannabis smokers nontobacco smokers. Poor coordination Irritated conjunctiva. Xerostomia Increased risk of caries Leukoplakia. Gingivitis; gingival enlargement and possible ulcerative conditions. Xerostomia Occlusal wear Generalized caries Bruxism Orofacial pain Graft failure Alterations of taste perception Keratinization of oral mucosa Discoloration of saliva Involuntary facial movements. NUG Gingival ulceration and erythema Painful gingival retraction Periodontitis No alterations in microbiota composition and counts. Black rotting teeth Nasal septal necrosis Poweder in nares Mucus discharge from the naris Jaw clenching Jaw soreness Xerostomia Occlusal wear Generalized caries Bruxism. Antoniazzi Periodontal status between crack cocaine users and crack cocaine nonusers. Yukna Twenty case reports with usual and nonusual oral manifestations selected and ordered by increasing severity. The same pysiologic effects of vasocostriction, epithelial sloughinf, ischemic necrosis and local anesthesia. Oral hygiene trauma may explain the observed lesions. Cocaine users may be trading one problem for another when they change the location of drug administration from the nasal site to the gingiva. Ramos Cury Periodontal parameters in crack cocaine addicted and not addicted patients. Periodontal disease was associated with age and dental plaque. The population of the present study, in general, was quite young to have moderate to severe periodontal disease. Casarin Periodontal pathogens in crack users and nonusers. Hasan and Ciancio

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