Substance abuse and oral health /orthodontic courses by Indian dental academy

Substance Abuse andSubstance Abuse and
oral healthoral health
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Introduction
 It is the pattern of continued pathological use of a
medication, non-medically indicated drug or
toxin.
 It results in adverse social consequences such as
failure to meet work, family, interpersonal
conflicts.

Definition
According to the American Pscyhiatric
Association, substance abuse is defined as
 Recurrent substance use resulting in failure to
fulfill major role obligations at work.
 Recurrent substance use in situations in
which it is physically hazardous.
 Continued substance use despite having
persistent or recurrent social or interpersonal
problems.

Drugs commonly abused
Cannabinoids
 Hashish
 Marijuana
Depressants
 Barbiturates
 Benzodiazepines
 Methaqualone
Dissociative anasthetics
 Ketamine
 PCP and analogs (phencyclidine)www.indiandentalacademy.com

 LSD (lysergic acid diethylamide)
 Mescaline
 Psilocybin
 Opiods and morphine derivatives
 Codiene
Fentanyl and analogs
 Morphine
 Opium
 Oxycodone Hcl
 Hydrocodiene

Stimulants
 Amphetamine
 Cocaine
 Methamphetamine
 Nicotine
Other compounds
 Anabolic steroids
 Inhalants (gases , propane , nitrous oxide)

Cannabis
 The users of cannabis
were ancient hindus.
 It is called ganjika in
sanskrit.
 It is commonly
known as marijuana.
 The active chemical
compound.
Tetrahydrocannabinol
has psychoactive and
medicinal effects.www.indiandentalacademy.com

Medicinal Use
 Appetite stimulant
 Pain reliever
 Relieve glaucoma
 Treating neurological illness
 Relieve nausea
 Treating multiple sclerosis

Oral Consumption
Cannabis is orally consumed by blending with
ethanol or lipids, the effects of drug take longer
to begin. Dose of oral cannabis is stronger than
equivalent dose of cannabis. It is taken with an
empty stomach. It is also consumed as tea.

Effects of consumption
Cognitive effects
 Psychosis
 Anxiety
 Loss of coordination
 Auditory disturbances
 Hallucinations
Behavioural effects
 Euphoria
 Drowsiness
 Lassitude www.indiandentalacademy.com

Physiological Effects
 Antiemetic
 Dilatation of blood vessels
 Dry mouth
 Lowered blood pressure
 Increased appetite

Methods of Smoking Cannabis
 Spliff or joint
 The bong
 The pipe
 The shotgun
 The one-hitter
 Vapourisation
 Knifing

Lethal dose
The lethal dose of 50% rats tested by inhalation is
42 mg/kg. The LD50 is 1270mg/kg and
730mg/kg for males and females respectively.

Tobacco
Christopher Colombus reported a gift of
strange dry leaves from san salvador.
 These powdered leaves were inhaled by
indians in a Y shaped piece of cone or
pipe called tobago or tobaco, the forked
ends of which were placed in each
nostril.
 The leaves subsequently came to be
known as tobacco. It is derived from the
species of plant of gems nicotiana of
the potato family. It can be smoked,
sucked, chewed, sniffed.

Forms of tobacco available in india
cigarretes, dhumti, gudhaku, hookah, hookli, khaini,
mainpuri tobacco, mawa, mishri, paan, snuff, zarda.
Constituents of tobacco
 Polycyclic aromatic hydrocarbons
causes carcinogenesis
 Nicotine
potential carcinogenic agent
 Phenol
ganglionic stimulations
depression and tumour productionwww.indiandentalacademy.com

 Benzopyrene
tumour promotion and irritation
 Carbon monoxide
produces impaired oxygen transport and
repair
 Formaldehyde and oxides of nitrogen
toxicity to cilias and irritation
 Nitroxamine
potential carcinogenic agent

Smokeless trobacco
 It is called betel nut,
chewed alone or with
betel quid/paan.
 It causes oral
submucous fibrosis.
 It produces wrinkled
changes in oral
mucosa called snuff-
dipper’s pouches.
 It causes high
frequency of oral
cancer.

Smoking tobacco
 Pipe smoking
Cancers of lip
 Reverse smoking
cancers of palate and base of tongue

 Tobacco – vasoconstrictor
 Influences rate at which wound heals.
 Inhibits function of leukocytes.
 Smokers have increased risk of caries.
 Implant failure in tobacco users.

Alcohol
 It is an independent risk factor.
 Synergistic effect of tobacco and alcohol has
been observed.
 It causes pharngeal cancers.
 Killer (1963) showed cancer of floor of mouth is
associated with high alcohol consumption and
heavy smoking.
 Alcohol dehydrates mucosa, increases mucosal
permeability and hence promotes carcinogenesis.

Opiod derivatives
Symptoms
 Addiction
 Drowsiness
 Dry mouth
 Nausea
 Sweating
 Tremors
 Pinpoint pupils
 Increased urination
 Tolerance www.indiandentalacademy.com

Methamphetamine
 Potent central nervous system stimulant.
 Associated with severe oral effects.
 It blocks reuptake of neurotransmitters called
monoamines.
 It can be smoked, snorted, injected or taken
orally.

Oral lesions
Oral cancer
 Oral squamous cell carcinoma is the most
commonest cancer of the oral cavity.
 Chewing, smoking tobacco, human pappiloma
virus and chronic irritation contributes to its
causes.

Clinical features
 Non healing ulcer.
 Irregular mass of red or white patch.
 Site-lateral borders of tongue, floor of mouth,
buccal mucosa.

Oral leukoplakia
 Pre-malignant
condition.
 Causes- tobacco,
alcohol, infections,
trauma.
 Site- cheeks, sides of
tongue, floor of
mouth.
 Appears as a white
patch that cannot be
scrapped off. www.indiandentalacademy.com

Smoker’s palate
 Tobacco related white
lesion occuring in the
palate.
 Seen in pipe or
cigarette smoker.
 White opaque
appearance of the
palatal mucosa
sometimes showing
red dots.

Smoker’s melanosis
 Caused by cigarette
smoking.
 Melanin pigmentation
in the gums and
mucosa.
 Reversible and
improves when
person quits smoking.
 Harmless condition.

Oral submucous fibrosis
 The etiology is chewing areca nut.
 Chronic progressive disease and insidious onset.
 Burning sensation in the mouth, blisters in the
palate, ulceration of oral mucosa, dryness of
mouth.
 Pain in areas where the submucosal fibrotic
bands has developed.
 Difficulty in mouth opening.

Oral lichen planus
 Occurs in the betel
quid chewer’s.
 Lesion consisting of
white, waxy, parallel
striae that do not criss
cross.
 Site- buccal mucosa
and mandibular
groove.

Paan chewer’s lesion
 Occurs in the betel
quid chewer’s.
 Thick brownish black
encrustation on the
buccal mucosa.
 It occurs at the site of
placement of betel
quid.
 When the habit is
discontinued, it
regresses. www.indiandentalacademy.com

Palatal erythema
 Occurs in bidi
smokers.
 Diffused
erythematous hard
palate.
 Associated with
palatal pappilary
hyperplasia.

Central pappilary atrphy of
tongue
 Occurs in the bidi
smokers.
 Median rhomboid
glossitis.
 Localised atrophy of
the tongue pappila.
 Well defined, oval
pink area in the
dorsum of the tongue.

Periodontal diseases
 Smoking creates environment for
periodontal-causing bacteria to
exist and thrive.
 Smoking one pack per day for
10 years will cause about a 10%
loss of bone support.
 Long term studies reveal that
majority of tooth loss in 19 to 40
yrs olds is associated with those smoking
more than 15 cigarettes per day.

• Smokers have an increased severity of ANUG,
deeper peridontal pockets and attachment loss.

Aesthetics
 Staining and discoloration of teeth
 Excessive wear of the teeth
 Halitosis
 Cleft lips and palate in children born to mothers
who smoked during pregnancy.
 Overgrowth of the papilla on the tongue surface,
causing burning sensation and bad breath.
 Calculus formation.

Meth mouth
Methamphetamine
causes
1. Tooth decay
2. Gum diseases
3. Cracks in the teeth
4. Dry mouth
5. Bruxism
6. Clenching
7. Poor diet
8. Poor oral hygiene

Substance abuse treatment
Principles of drug addiction treatment
 No single treatment for all individuals.
 Treatment needs readily available.
 Treatment must attend to multiple problems.
 Need for medical services, rehabilitation, family
therapy.
 Individual or group counselling.
 Medications.
 Medical detoxification.
 Multiple episodes of treatment.

Rehabilitation
 Phase1- Drug Free Withdrawal
 Phase2- Learning Improvement Course
 Phase3- Personal Values and Integrity Course
 Phase4- Changing Conditions in Life Course
 Phase5- Final Program Review

Healthy Oral Life
 Don’t smoke
 Don’t drink alcohol to excess
 Reduce the use of betel quid/paan
 Do not use tobacco in the quid
 Eat more fresh fruits and vegetables
 Ensure oral hygiene is improved

Reference
 HARRISON’S PRINCIPLES OF
INTERNAL MEDICINE,12TH
EDITION.
 SHAFER’S TEXTBOOK OF ORAL
PATHOLOGY, 5TH
EDITION.
 ESSENTIAL’S OF PREVENTIVE AND
COMMUNITY DENTISTRY, 2ND
EDITION
 www.doctorspiller.com

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Substance abuse and oral health /orthodontic courses by Indian dental academy

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