Oral health of substance-dependent individuals: impact of specific substances

Dental Disorders Reported to the FDA Adverse Event Reporting System in Association with Buprenorphine: An Analysis by Ingredient Composition and Route of Administration

BACKGROUND

Prior research has suggested buprenorphine-containing medications may be associated with an increased risk of dental disorders. However, published data describing adverse dental reactions in buprenorphine users by active ingredient composition and route of administration are limited.

OBJECTIVE

The purpose of this study was to evaluate the influence of formulation on spontaneous reporting of dental disorders among patients treated with buprenorphine.

METHODS

Adverse event reports submitted to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) between 2015 and 2022 were analyzed. Reporting odds ratios (ROR) and 95% confidence intervals (CI) were calculated to measure disproportionality of dental disorder reporting as classified by 39 Medical Dictionary for Regulatory Activities preferred terms.

RESULTS

Compared to pooled reports for all other drugs across FAERS, both buprenorphine monotherapy (ROR 3.09; 95% CI 2.61-3.66) and combination buprenorphine/naloxone (ROR 14.61; 95% CI 13.34-16.01) were associated with positive disproportionality signals. Signals of disproportionate dental disorder reporting were also detected for buprenorphine medicines administered by sublingual (ROR 20.03; 95% CI 18.04-22.24), buccal (ROR 4.46; 95% CI 3.00-6.61) and oral (ROR 7.17; 95% CI 5.03-10.22) routes, but not for other modalities. In considering active ingredient and route together, sublingual buprenorphine monotherapies (ROR 23.55; 95% CI 17.84-31.11) and sublingual buprenorphine/naloxone (ROR 19.47; 95% CI 17.39-21.80) were each associated with disproportionate reporting of dental disorders.

CONCLUSION

Subject to the limitations of spontaneous adverse event data, this study identified significantly disproportionate reporting of dental disorders to FAERS among patients treated with buprenorphine- containing medications, including formulations administered by sublingual, buccal and oral routes. These findings are consistent with prior data and suggest that regular oral care and proper dental hygiene be emphasized for patients undergoing therapy with orally dissolving buprenorphine.

Oral health-care needs among clients receiving alcohol and other drugs treatment-A scoping review

ISSUES

Poor oral health is a significant problem among people who access alcohol and other drugs (AOD) health services, yet little is known about their oral health-care needs and whether any interventions and guidelines are implemented within AOD treatment services.

APPROACH

A scoping review was conducted to identify scientific literature in three focus areas: oral health knowledge, attitudes and practices of clients and clinicians at AOD-related services; oral health guidelines for AOD clinicians; and interventions that describe clinicians promoting oral health among clients.

KEY FINDINGS

Thirty-two reports were identified. Twenty-three studies focused on the oral health knowledge, attitudes and practices of AOD clients, but none of the studies explored perspectives of clinicians. Seven clinical practice guidelines were identified but recommendations varied. Only two interventions in which an AOD clinician promoted oral health were identified.

IMPLICATIONS

Most reports provided insight into the perspectives of clients accessing AOD treatment services. Little evidence demonstrated that clinical practice guidelines were being implemented into practice, or that oral health promotion was part of the tasks of AOD clinicians.

CONCLUSION

This review identified oral health knowledge gaps and perceived poor attitudes that appeared to be reflected in certain oral health practices among clients. This finding indicates a need to educate clients about oral health while receiving AOD treatment. There was an absence of research about the needs for AOD clinicians to advocate for good oral health, and little evidence exists about effective interventions that could enhance integrating oral health care into AOD treatment services.

Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database

BACKGROUND

Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services.

METHODS

This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted.

RESULTS

Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14-10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit.

CONCLUSIONS

Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.

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.

A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system

In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58-0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59-0.95) and cannabis (AOR = 0.78, 95% CI = 0.63-0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42-0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59-0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07-1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05-2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.

Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis

BACKGROUND

The aim of our study was to perform a systematic review of the literature and meta-analysis in order to investigate relationship between drug use and oral health.

METHODS

We searched for studies in English published before July 1, 2019 on PsycINFO, PubMed, SciELO, Scopus, and Web of Science. We assessed the relationship between drug use (methamphetamines, heroin; opiates; crack, cocaine and cannabis as dependent variables) and reported tooth loss, periodontal disease, or decayed, missing, and filled teeth index as an independent variable. The data were analyzed using Stata 12.0 software.

RESULTS

We initially identified 1836 potential articles (with 1100 duplicates) and screened the remaining 736 titles and abstracts, comprising 54 studies. In the next step, we evaluated the full-texts; 44 studies were excluded, accordingly. In total, we included 10 publications in the meta-analysis. Drug type was associated with periodontal disease (OR 1.44; 95% CI 0.8-2.6) and pooled estimates showed that type of drug used increased the odds of the number of decayed, missed and filled teeth (DMFT) (OR 4.11; 95% CI 2.07-8.15) respectively.

CONCLUSIONS

The analytical challenges of segregating the impact of individual drug types on oral health diseases mean that investigations on the direct relationship between oral health status and drug use are limited. Developing programs to improve potential confounding with various substances and addressing the dental health needs of people who use drugs is vital if we are to improve their overall quality of life.

The need for further oral health research surrounding the provision of dental treatment for people with drug dependency

The aim of this article is to highlight the need for further research in providing dental care for people with drug dependency. The association between people who misuse substances and dental disease is widely known occurrence, yet there have been few studies conducted in the UK surrounding this issue due to the nature of the cohort. Further to this, there are a multitude of barriers to accessing/seeking dental care that exist for those with drug dependency. Going forward, there is a need for the development of a new service model where dental care is part of a multidisciplinary team working towards treating people with drug dependency in a holistic way.

[Dental pain among psychoactive substance users in CAPS AD in Vitoria, Vila Velha and Serra, ES, Brazil]

Toothache is a public health problem that causes great inconvenience to psychoactive substances users. The objective was to verify the prevalence of dental pain and its associations among psychoactive substances users from Alcohol and Drug Psychosocial Care Centers (CAPS AD) in Vitoria, Vila Velha and Serra, Espírito Santo, Brazil. A transversal study was conducted with 280 participants between June 2015 and February 2016, using five scripts: one for socio-demographic data and health perception; another for oral health; the Oral Health Impact Profile; the Alcohol Smoking and Substance Involvement Screening Test and the World Health Organization Quality of Life Test. Data were organized in frequency tables and analyzed with the SPSS 20 statistical package. Comparisons were made with Fisher's test and the Odds Ratio (OR) was used to check the strength of the association between the variables. The prevalence of pain in the population studied was 59.3%, and individuals whose quality of life was impacted due to their oral conditions were 2.2 times more likely to report toothache in the last 6 months. The population studied showed a high prevalence of dental pain and the study indicates that dental pain interferes in the quality of life of psychoactive substances users who are treated at CAPS AD services in these three cities.

Oral Health Impact Profile and Associated Variables in Southern Brazilian Drug Users

BACKGROUND

This study investigated the association between sociodemographic, behavioral, oral health, variables of drug consumption, and the short version of the Oral Health Impact Profile (OHIP-14), in Southern Brazilian drug users.

METHODS

In this cross-sectional study, 202 drug users aged 18 or over admitted for treatment at the Institute for Research and Treatment of Alcoholism (Instituto de Pesquisa e Tratamento do Alcoolismo -IPTA) from the municipality of Campo Largo, PR, Brazil, from 2012 to 2014, were involved. They answered a questionnaire and were examined by a calibrated researcher. Data were collected and bivariate (Chi-square test) and multivariate (logistic regression and Wald's test) analyses were performed.

RESULTS

There was statistical difference (P<0.05) in bivariate analysis and the worst impacts were reported by non-whites, those who reported feeling metallic taste in mouth and tooth mobility, which use cigarettes for over 15 yr and consume more than 3 g of crack/day, with DMFT >10, and number of teeth in mouth ≤27. In the multivariate analysis, statistical difference remained, except for ethnicity (P=0.207).

CONCLUSION

Self-perception of oral health was associated with the variables explored, which suggests the need for strategies focused on this population.

Increasing diversion of methadone in Vancouver, Canada, 2005-2015

BACKGROUND AND AIM

Although methadone, an opioid agonist, has been an effective medication used to treat opioid use disorder for over 40years, recent studies have found that methadone was identified in more than a quarter of prescription opioid-related deaths among people who use illicit drugs in Vancouver, Canada. Thus, we sought to longitudinally examine the availability of diverted methadone among people who inject drugs (PWID).

DESIGN AND METHODS

Data were collected from three prospective cohorts of PWID in Vancouver, Canada between December 2005 and May 2015. Multivariable generalized estimating equation logistic regression was used to identify temporal trends in the immediate availability of diverted methadone (defined as the ability to acquire illicit methadone in <10min).

RESULTS

A total of 2092 participants, including 727 (34.8%) women, were included in the present study. In the multivariable analyses after adjusting for a range of potential confounders, later calendar year (adjusted odds ratio [AOR]=1.21 per year; 95% confidence interval [CI]: 1.19-1.23) was independently and positively associated with reporting immediate availability of diverted methadone.

CONCLUSIONS

We observed a significant increase in the reported availability of diverted methadone among PWID over a ten-year follow-up period. Further research is needed to identify strategies to limit methadone diversion and assess the impact of alternative medications that are equally effective but safer, such as buprenorphine/naloxone.

Violence in persons with and without psychosis in the Czech Republic: risk and protective factors

PURPOSE

To prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation.

PATIENTS AND METHODS

This study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months.

RESULTS

The presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060-7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922-12.819), childhood maltreatment (OR =3.15; 95% CI 1.877-5.271), the level of drug use (OR =1.13; 95% CI 1.063-1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000-1.084). Increasing age (OR =0.96; 95% CI 0.942-0.978) and employment (OR =0.30; 95% CI 0.166-0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls.

CONCLUSION

Recent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar.

A qualitative study of patients' knowledge and views of about oral health and acceptability of related intervention in an Australian inpatient alcohol and drug treatment facility

Social factors, health behaviours and the direct effects of substances contribute to the poor oral health and restricted access to dental services experienced by people who are dependent on drugs and/or alcohol. Admission for inpatient withdrawal management provides an opportunity for intervention to promote oral health but to be effective it must be acceptable to patients. To support intervention design, we examined patients' views about oral health, practices and treatment access, and appropriateness of health-promoting intervention in this context. Given paucity of knowledge in the area we employed a qualitative approach, data were collected in semi-structured interviews with inpatients of a public specialist alcohol and drug unit in Australia in September 2014. Analysis employed the framework approach. All 14 participants wanted 'good teeth' but few diligently attended to oral healthcare; most sought assistance only in emergencies. Participants' knowledge of services was limited and practical and affective barriers hindered access. With none recalling attention to oral health during admission, support was strong for incorporation of oral health in inpatient assessments. Participants wanted information about the impact of substances on oral health and oral hygiene practices provided in various formats, and facilitated referral to non-judgemental, affordable treatment. Patients regarded promotion of oral health in the inpatient context as important, relevant and acceptable. Support should respect the different knowledge, practices and motivations for oral health and recovery, of patients. Addressing practical and affective barriers to dental services will require collaboration between drug and alcohol and dental services, and this should be the focus of further research.

Cytopathological Changes Induced by the Crack Use in Oral Mucosa

AIMS

To evaluate cytological alterations, inflammation, and microbial charge of the oral mucosa epithelium in crack users in in terms of the amount and duration of use.

METHODS

Two hundred thirty four crack users (case group) and 120 non-users (control group) participated in this study. Clinically healthy epithelial cells were collected from the posterior mouth floor, using the conventional exfoliative cytology. Some of the aspects evaluated were as follows: Papanicolaou classification, nuclear area (NA), cytoplasmic area (CA), nuclear/cytoplasmic area ratio (NA/CA), inflammation, microbial charge, keratinization, enucleated superficial cells, and binucleation.

RESULTS

The average time of crack consumption was 9.8 years (±7.1) and the average quantity of use was 13.97 g/week (±18.5). The average NA values and NA/CA ratio were increased and CA values were decreased in the case group compared to those in the controls (p < 0.05). Papanicolaou class II, intense inflammation, and intense microbial charge were more prevalent in the case group than in the controls (p < 0.05). There was a significant association between high quantity of smoked crack rocks per week and increased CA values, absence of keratinization, and presence of enucleated superficial cells (p < 0.05).

CONCLUSION

Crack use seemed to induce inflammatory alterations and early indicators of malignant transformation on the oral mucosa epithelium.

Harmful Effect of Beer on Bovine Enamel Microhardness - In Vitro Study

This study aimed to evaluate the effect of beers on the bovine enamel microhardness. Fifty rectangular (1 x 3 x 1 mm–height x width x thickness) enamel specimens were obtained from permanent bovine incisors, and divided into five groups (n = 10) according to the treatment employed: Saliva, Coke, Brahma, Heineken, and Budweiser. Microhardness (Knoop) were obtained before; after 5, 30 and 60 min of immersion in each solution. The data were analyzed using repeated two-way ANOVA and Tukey´s test (p<0.05). Coke decreased the microhardness in all immersion times, and Heineken, showed low values after 60 minutes. Beers tested have low potential to cause enamel erosion when compared to Coke.

Oral health determinants among female addicts in Iran

CONTEXT

Addiction results in a range of health problems especially in the oral cavity.

AIMS

This study assessed the oral health status among women with a history of drug abuse in Tehran, Iran.

SETTINGS AND DESIGN

A cross-sectional study was conducted through structured interviews and clinical examinations of women at three rehabilitation centers in Tehran.

MATERIALS AND METHODS

Data on background characteristics, addiction history, knowledge, attitudes and behaviors, and oral health indices were collected.

STATISTICAL ANALYSIS USED

We used MANOVA test and multiple logistic regression models to analyze the data.

RESULTS

We assessed 95 participants aged 37.88 ± 10.65 years. The most commonly reported drugs used prior to treatment were opiates (77.2%). The mean knowledge and attitude score among the patients was 80.83 ± 12.89 (37.5-100). Less than half of the dentate women reported tooth brushing as "rarely or never" (44.2%). Most of them (81.8%) had never used dental floss and 76.1% were daily smokers. The mean score of dental caries index (decayed, missed and filled teeth) of the participants was 20.2 ± 7.18 and 17 subjects were edentulous (17.9%). Factors such as age, drug type, duration of addiction, time of last dental visit, and frequency of brushing were associated with oral health status among these women.

CONCLUSIONS

Women with a history of drug abuse in our study suffered from poor oral health. Although they had an acceptable level of knowledge and attitude toward oral health, their oral health, and hygiene was poor. These results call for more attention in designing and implementing oral health programs for addicts.

Perfil sociodemográfico e condição bucal de usuários de drogas em dois municípios do Estado do Paraná, Brasil

<title>Resumo</title><sec><title>Introdução</title><p>A pesquisa das condições bucais de usuários de drogas é importante para ser conhecida esta população, cujo crescimento é ascendente no Brasil, a fim de que metas preventivas e atendimento adequado sejam traçados.</p></sec><sec><title>Objetivo</title><p>Identificar o perfil sociodemográfico e a condição bucal desta população, em dois municípios paranaenses.</p></sec><sec><title>Material e método</title><p>Foram coletados, por meio de questionário e de exame físico, dados de 100 indivíduos. Foram obtidos os seguintes valores: índice CPOD, profundidade de sondagem (PS), nível de inserção clínica (NIC), índice gengival (IG), índice de placa (IP) e sangramento à sondagem (SS). Após análise descritiva inicial, empregaram-se os testes t de Student e ANOVA <italic>one-way</italic>.</p></sec><sec><title>Resultado</title><p>A média da idade foi 29,12 anos. As maiores frequências foram: gênero masculino (95,5%), solteiros (69,0%), baixa escolaridade (41%) e maior consumo de drogas lícitas – tabaco (90,9%) e álcool (84,5%) –, seguidas de <italic>crack</italic> (80,9%) e maconha (77,3%). A média do CPOD foi 15,21 (DP=5,84) e quanto maior o tempo de dependência, maior este índice (p<0,05). A média da PS foi 3,55 e do NIC, 3,59. O SS ocorreu em 82,7% dos casos e a inflamação moderada, em 79,5%. Placa detectável e moderado acúmulo de placa foram identificados em 39,5% e 35,3%, respectivamente.</p></sec><sec><title>Conclusão</title><p>Predominaram indivíduos do gênero masculino, jovens, solteiros, com baixa escolaridade e consumidores de drogas lícitas e ilícitas, com condição bucal ruim. Sugere-se mais atenção dos profissionais da área odontológica e dos elaboradores de políticas públicas, com vistas a esta população.</p></sec>

The impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of addicted persons

BACKGROUND

The aim of this cross-sectional study was to evaluate the impact of oral health conditions, socioeconomic status and use of specific substances on quality of life of alcohol and drug addicted persons, receiving care at outpatient treatment facilities in Brazil.

METHODS

A random sample of 262 participants, mean age 37 years, from Psychosocial Care Centers for Alcohol and Drugs (CAPS AD) located in three cities in the state of São Paulo, Brazil, were clinically examined for caries experience (DMFT index) by a calibrated examiner. They were asked to complete a series of questionnaires, including the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), socioeconomic characteristics, and the World Health Organization Quality of Life assessment (WHOQOL), which were considered the outcome variables of the study. Associations between oral health status, socioeconomic characteristics, substance involvement with WHOQOL were investigated by means of the chi-square test and multiple logistic regression analysis with a level of significance α < 0.05.

RESULTS

The mean DMF index of the group was 13.0. Subjects with DMFT >14 (OR = 2.25; CI 95% = 1.30-3.89); low-income (OR = 2.41; CI 95% = 1.22-4.77) and users of cocaine/crack (OR = 2.02; CI 95% = 1.15-3.59) were more likely to have poor general quality of life.

CONCLUSION

This study demonstrated that the general quality of life of addicted persons was associated with caries experience, low income and cocaine/crack use.

Oral health-related quality of life among an Australian sample of people who inject drugs

OBJECTIVES

People who inject drugs (PWID) have poor oral health. However, their oral health-related quality of life (OHRQoL) is unknown. Our study was designed to measure the OHRQoL of PWID.

METHODS

The Oral Health Impact Profile-14 (OHIP-14) was administered to 794 PWID recruited in Australian capital cities as part of the 2013 Illicit Drug Reporting System (IDRS). Three OHIP-14 summary indicators were examined: "Prevalence" (proportion reporting ≥1 item at least "fairly often"), "severity" (mean total OHIP-14 score), and "extent" (number of impacts reported at least "fairly often"). Associations between "prevalence" and "extent" and variables drawn from the health, drug use, and social domains were investigated.

RESULTS

All OHIP-14 summary indicators among IDRS participants were significantly higher than in the general Australian population. In multivariate analysis, the "prevalence" indicator was significantly and positively associated with female gender [adjusted odds ratio (AOR) = 1.75, 95% CI 1.27-2.38], those born in Australia (AOR = 2, 95% CI 1.25-3.23), not completing Year 10 compared with those who had completed Year 12 or a higher qualification (AOR = 1.59, 95% CI 1.03-2.44), and methadone treatment (AOR = 1.61, 95% CI 1.14-2.29). The "extent" indicator was significantly and positively associated with female gender [adjusted incidence rate ratio (AIRR) = 1.56, 95% CI 1.19-2.08], unemployment (AIRR = 1.59, 95% CI 1.01-2.44), and having an injecting career of 10-20 years (AIRR = 1.76, 95% CI 1.03-3.01).

CONCLUSIONS

PWID have poorer OHRQoL than the Australian general population. Poor OHRQoL was particularly common in female PWID and those with longer injecting careers. Interventions to improve the oral health of PWID may improve their OHRQoL.

Oral prevalence and clearance of oncogenic human papilloma virus in a rehabilitation community for substance abusers in Italy: a case of behavioral correction?

BACKGROUND

Human papilloma virus oral infection can be related to several factors including HIV infection, cigarette smoking, marijuana consumption and number of sexual partners. We conducted a study on oral HPV prevalence and clearance among the hosts of the San Patrignano community, a population considered at "high-risk" for HPV due to their previous habits.

METHODS

From March 2007 to September 2010 all subjects were submitted to oropharyngeal brushing and saliva collection at baseline, after 6, 12 and 48 months (for subjects HPV positive at baseline). Samples were analyzed to detect HPV DNA and virus genotypes. The correlation between HPV prevalence and demographic, behavioral or immunological characteristics was assessed.

RESULTS

Among 194 subjects, 30 (15%) were HPV positive with 25 (13%) high-risk (HR)-HPV at baseline brushing. At 12 months HPV infection was cleared in all cases. However at 48 months HPV was newly detected in 33% of subjects. A correlation between time spent in the community and increase in the ratio of "low-risk" (LR) HPV and HR-HPV was observed. HPV infection was not associated with age, gender, HIV status, HCV, alcohol and/or drug exposure, number of years spent in community, sex with drug-addicts and condom use. Only AIDS under antiretroviral treatment was inversely correlated with the risk of infection.

CONCLUSIONS

At 1 year a complete HPV clearance was observed which could be related to adoption of healthier lifestyles of participants. New HPV infections were detected even in the absence of the recognized and declared risky behavioral factors, suggesting a re-expression from a latent infection.

A pilot test of motivational oral health promotion with alcohol-dependent inpatients

OBJECTIVE

Motivational interviewing (MI) is an effective intervention for improving health behavior in a number of domains, and evidence suggests that it may be useful for promoting oral health. The current pilot study was designed to provide initial evidence that, compared with a didactic control intervention, a brief MI-based intervention (BMI) delivered by dental practitioners can yield greater improvements in oral hygiene, health-care utilization, and health outcomes in a population at heightened risk for oral disease.

METHOD

Either the control intervention or BMI, delivered by a dentist or a dental hygienist, was randomly assigned to 60 individuals in inpatient treatment for alcohol-use disorders. Data were obtained by self-report and by examination at baseline and 4-, 12-, and 24-week follow-up assessments.

RESULTS

BMI participants reported significantly more frequent toothbrushing during follow-up than control participants. No other significant effects were found.

CONCLUSION

These findings indicate that a brief intervention using MI methods can be delivered by dental professionals and has potential utility for promoting improved oral hygiene. Additional research to investigate and further develop MI's potential for promoting oral health appears warranted.

Oral health behavior of drug addicts in withdrawal treatment

Background

Oral health behavior (OHB), one major factor contributing to proper oral health status, has been addressed insufficiently in addiction literature. The aim of our study was to investigate OHB and its determinants among drug addicts in withdrawal treatment.

Methods

Through a stratified cluster sampling method, we collected the data from 685 patients in withdrawal treatment in Tehran using self-administered questionnaires on OHB components and conducting interviews about patients’ characteristics and addiction history. The T-test, ANOVA, and a linear regression model served for statistical analysis.

Results

Of the patients, 48% reported brushing their teeth less than once a day, more than 90% used fluoride toothpaste almost or always, and 81% flossed their teeth rarely or never. Eating sugary products twice a day or more was reported by 57% of the patients and 85% of them were current smokers. Poor OHB was associated with male gender, lower education, being addicted mainly to crystalline heroin, starting drug abuse at a younger age, and having a longer history of addiction (p < .05).

Conclusion

Poor OHB was found among the participants in drug withdrawal treatment. Preventive strategies on oral health should be planned and be integrated into other health promotion programs for addicts along with their withdrawal treatment taking into account special groups at higher risk.