Dental health status in crack/cocaine-addicted men: a cross-sectional study

Exercise Modulates Brain Glucose Utilization Response to Acute Cocaine

Exercise, a proven method of boosting health and wellness, is thought to act as a protective factor against many neurological and psychological diseases. Recent studies on exercise and drug exposure have pinpointed some of the neurological mechanisms that may characterize this protective factor. Using positron emission tomography (PET) imaging techniques and the glucose analog [¹⁸F]-Fluorodeoxyglucose (¹⁸F-FDG), our team sought to identify how chronic aerobic exercise modulates brain glucose metabolism (BGluM) after drug-naïve rats were exposed to an acute dose of cocaine. Using sedentary rats as a control group, we observed significant differences in regional BGluM. Chronic treadmill exercise treatment coupled with acute cocaine exposure induced responses in BGluM activity in the following brain regions: postsubiculum (Post), parasubiculum (PaS), granular and dysgranular insular cortex (GI and DI, respectively), substantia nigra reticular (SNR) and compact part dorsal tier (SNCD), temporal association cortex (TeA), entopenduncular nucleus (EP), and crus 1 of the ansiform lobule (crus 1). Inhibition, characterized by decreased responses due to our exercise, was found in the ventral endopiriform nucleus (VEn). These areas are associated with memory and various motor functions. They also include and share connections with densely dopaminergic areas of the mesolimbic system. In conclusion, these findings suggest that treadmill exercise in rats mediates brain glucose response to an acute dose of cocaine differently as compared to sedentary rats. The modulated brain glucose utilization occurs in brain regions responsible for memory and association, spatial navigation, and motor control as well as corticomesolimbic regions related to reward, emotion, and movement.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

Illicit drug use and oral health

People with drug use disorders (PWDUD) have elevated prevalence of oral diseases, in particular dental caries (tooth decay), periodontal (gum) disease and xerostomia (dry mouth). When left untreated, these oral health conditions may progress and lead to tooth ache, abscesses and tooth loss, and in turn, to poor chewing functioning and digestion, dental aesthetic problems and reduced wellbeing. Illicit drug use may, per se, cause xerostomia, which in turn increases vulnerability for dental caries. However, the other main drivers of oral diseases and their progression-poor oral hygiene, frequent sugar intake and infrequent dental visits-can mainly be ascribed to the irregular lifestyle, poor economy and mental health problems that often accompany illicit drug use. Establishment of good oral health habits is essential in the dental care for PWDUD. Dental treatment is often comprehensive and challenging; because the patients may have extensive treatment needs but also difficulties adhering to preventive measures and dental appointments. An integrated care approach for PWDUD would likely benefit both their oral and general health.

Salivary flow rates and buffer capacity and its relationship with oral health status: a cross-sectional study on crack-cocaine-addicted males

This cross-sectional study evaluated the saliva profile in crack-cocaine-addicted males and its relationship with dental caries, periodontal disease, and oral mucosal lesion (OML) using 148 adult male volunteers (37 addicted; 111 non-addicted) at the School of Dentistry, Federal University of Bahia. Data on decayed, missing and filled teeth (DMFT), periodontal disease and OML were collected from the clinical examination of the participants. Samples were analysed for the salivary flow rate (SFR) of unstimulated and wax-stimulated whole saliva and the saliva buffer capacity. Bivariate and regression analyses were conducted to assess the salivary profile and its association with the oral status of addicted participants (α = 0.05). The mean buffer capacity of stimulated saliva was significantly lower in the addicted participants (pH 5.2 ± 1.7) than in the non-addicted group (pH 5.8 ± 1.3, p = 0.03). In the addicted group, OML was associated with a stimulated SFR < 1.0 mL/min (OR = 11.98, 95% CI = 1.30-27.10, p = 0.04). The DMFT index and periodontal disease were not associated with the salivary profile, but with older age (OR = 7.20, 95% CI = 1.51-31.14, p = 0.01) and lower education levels (OR = 24.00, 95% CI = 1.68-341.00, p = 0.02), respectively. In conclusion, addiction was associated with the lower buffer capacity of stimulated saliva, and OML was associated with lower-stimulated salivary flow rate. Periodontal disease or DMFT was not associated with salivary factors in addicted males. Therapy approaches dealing with saliva status may be important for use with addicted males to reduce OMLs.

Salivary proteome analysis of crack cocaine dependents

OBJECTIVE

Salivary proteomic analysis may help to understand physiopathological changes in crack cocaine dependents. This study aimed to compare the salivary protein profile between crack cocaine dependents and non-drug users.

DESIGN

Nine heavy smokers and alcohol consumers men admitted to rehab due to crack cocaine abuse and nine non-drug users age-matched men were evaluated. Unstimulated whole saliva was collected. Proteomic analysis was performed by mass spectrometer. Data were processed using ProteinLynx GlobalServer software. Results were obtained by searching the Homo sapiens database from the UniProt catalog. The search tool IBI-IMIM was used to identify proteins candidates for biomarkers.

RESULTS

The mean age of crack cocaine and control groups was 36.89 ± 7.78 and 35.78 ± 6.68 years, respectively. 458 salivary proteins were identified in both groups; 305 proteins in the crack cocaine group. Among the 68 proteins presented in both groups, 29 were down-regulated (i.e. "Statherin" and "Transforming growth factor-beta-induced protein ig-h3" were down-regulated at least 10-fold) and 27 up-regulated (i.e. "Negative elongation factor" was up-regulated 19-fold) in the crack cocaine group compared to controls. 90 out of the 458 proteins found in the proteomic analysis were identified as candidates for biomarkers of diseases. Among these, 65 (72.22 %) were detected in the crack cocaine group.

CONCLUSION

Crack cocaine dependents with chronic alcohol and tobacco use have a higher number of proteins in saliva compared to non-drug users. 22.3 % of salivary proteins present in crack cocaine dependents were present in controls; 3.9 % of them were expressed in similar quantity.

Assessing oral health of crack users in Brazil: Perceptions and associated factors, findings from a mixed methods study

This study explores associated factors and perceptions of oral health among crack users recruited in open drug scenes in Brazil. A mixed methods approach was used. The quantitative component analysed findings from a large (N = 7381), population-based survey. The outcomes under analysis were 'self-perception of oral health' and 'self-reporting of problems affecting the mouth, teeth and gingiva (gums)'. The qualitative component comprised a focus group, with 12 individuals recruited from a drug treatment clinic. Lower self-perception of oral health problems vis-à-vis a higher prevalence of problems affecting the mouth, teeth, and gingiva were found in users who had a lower level of education, used substances daily, had worse self-perception of physical health, did not receive health care and regularly used alcohol and/or tobacco. The results show an association between substance use and decline in oral health, as well as the lack of health services focusing on such issues. Oral health services should be emphasised as a gateway to the health system. So far, the putative cross-referral between services and professionals working in oral health and other health professionals working in the field of drug dependence has not been observed.

Cocaine, polysubstance abuse, and oral health outcomes, NHANES 2009 to 2014

BACKGROUND

Cocaine is the second most abused illicit drug in the United States. To date, no study has examined the association between cocaine use and oral health with a nationally representative sample. Our study examined the association between cocaine use-singly and with other substances-and oral health outcomes, including periodontitis and untreated caries, among US adults.

METHODS

Data for 11,753 individuals, aged ≥30 years, who completed a periodontal examination, in the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Descriptive analyses and multivariable binary logistic regression analyses were conducted on weighted data.

RESULTS

Overall, 17% (20.5 million) of US adults aged ≥30 years had ever used cocaine, with higher likelihood seen among males, non-Hispanic whites, and those living in poverty. Current cocaine use prevalence was 2.6% (3.2 million). By number of co-used substances, the odds of having any periodontitis were higher among cocaine users who consumed ≥3 other substances (adjusted OR = 2.47; 95% CI = 1.15 to 5.30) when compared with solely cocaine users. By type of substance co-used, odds of having untreated caries were greater among those reporting cigarettes (adjusted OR = 1.94; 95% CI = 1.21 to 3.11) or methamphetamine (adjusted OR = 5.40; 95% CI = 1.92 to 15.14) usage. Odds of any periodontitis were higher among those reported ancillary cigarette use (adjusted OR = 2.84; 95% CI = 1.60 to 5.04) compared with cocaine-only users.

CONCLUSIONS

In addition to a positive association between periodontal disease, dental caries, and cocaine use, select co-usage elevated the risk of oral disease. Patients should be screened for and counseled regarding substance abuse to facilitate a successful quit.

Association between oral mucosal lesions and crack and cocaine addiction in men: a cross-sectional study

The aim of this cross-sectional study was to evaluate the prevalence of oral mucosal lesions (OMLs) and their association with crack/cocaine addiction in men. Clinical oral examination was performed in 161 adult male patients at the School of Dentistry of the Federal University of Bahia, Brazil. Crack/cocaine addiction was determined from the medical records, and all drug-addicted individuals used both crack and cocaine. All participants (40 crack/cocaine-addicted men and 121 non-addicted men) underwent a systematic evaluation of the lips, labial mucosa, commissures, buccal mucosa and sulcus, gingiva and alveolar ridge, tongue, floor of the mouth, and soft and hard palate by a single examiner. Bivariate and regression analyses were conducted to assess for the presence of OMLs and the association of OMLs with crack/cocaine addiction. OMLs were found in 22 participants with a significantly greater prevalence in the crack/cocaine-addicted group (25 vs. 9.9%; p = 0.01). The most prevalent types of lesions in the addicted group were traumatic ulcer and actinic cheilitis (7.5% for each) followed by fistulae associated with a retained dental root (5%). After adjusting for covariates, crack/cocaine addiction was significantly associated with OMLs (OR = 2.87; 95% CI = 1.08-7.67; p = 0.03). The prevalence of OMLs was higher in crack/cocaine-addicted individuals, and crack/cocaine addiction was significantly associated with OMLs. A public health program aimed at the early diagnosis and treatment of OMLs is vital to improving the oral health status of individuals addicted to crack/cocaine.

Hierarchizing caries risk factors among first-year university students in Nice (France): a cross-sectional study

BACKGROUND

The purpose of this study was to rank the risk factors for dental caries among first-year university students in Nice (France).

METHODS

All first-year students are required to undergo a compulsory preventive medical examination. Among these students, volunteers were offered a dental visit. Information was collected through an interview followed by an oral examination. We assessed the volunteers' oral hygiene habits (daily toothbrushing frequency, type of toothbrush used, frequency of toothbrush replacement, place of toothpaste purchase, and flossing), daily health-related behaviors (number of main daily meals, daily sugary intakes, smoking, alcohol consumption, consumption of cannabis or other drugs), oral-health-related behaviors (self-reported oral health, dental visits during the past year, reason for the last dental consultation, and failure to seek dental care due to financial reasons), and oral health issues (dental crowding, oral hygiene, presence of caries, presence of pit and fissure sealant remnants). The dependent variable was the presence of at least one untreated carious lesion. The data were subjected to univariate analyses to select explanatory variables, and subsequently, a logistic regression was performed.

RESULTS

Six hundred twenty-nine students aged 18.8±1.6 years were enrolled in this study. The sex ratio was 0.72, with a strong predominance of the female gender. Only 59.3% of the students had never experienced dental caries, while 22.4% had already undergone restorative procedures and did not have any carious lesion at the time of the examination, and 11.6% presented with carious lesions and had never been treated by a dentist. Lastly, 6.7% had carious lesions despite evidence of prior restorative procedures. The multivariate analysis revealed the following pejorative risk factors: failure to seek dental care due to financial reasons (OR:3.06, 95% CI: 1.40-6.70), poor oral hygiene revealed during the oral examination (OR:2.59, 95% CI: 1.60-4.20), and poor self-reported oral health (OR:2.43, 95% CI: 1.24-4.77). Conversely, the analysis revealed the following protective factors: preventive visits to the dentist (OR:0.63, 95% CI: 0.41-0.99), the use of an electric toothbrush (OR:0.36, 95% CI: 0.17-0.77), and sealant remnants (OR:0.22, 95% CI: 0.05-0.97).

CONCLUSIONS

The highest-ranking caries risk factor for the study population was the financial barrier.