Oral Effects

Oral manifestations of substance abuse vary, but abusers tend to have a higher incidence of dental caries and periodontal disease than the general population.10 This may result from neglect more than drugs, but cocaine addicts may apply the drug to gingival tissues, and it may be directly responsible for the oral disease. Cocaine abusers may also exhibit angular cheilitis, oral candidiasis, glossodynia, cervical abrasion, gingival laceration, and severe bruxism. Patients with combined cocaine and alcohol addiction tend to exhibit the most severe oral disease conditions and symptoms, such as severe xerostomia, advanced periodontitis, many decayed teeth, many missing teeth, and severe tooth attrition from bruxism. Oral manifestations of cocaine use include reduced salivary secretions, increased dental caries, abnormal tooth-wear patterns, and acute gingival inflammatory effects.10

Individuals who are opiate-dependent may exhibit dental caries on the labial and buccal cervical one-third of the teeth rather than on the occlusal or interproximal surfaces. These lesions are usually darker, larger, and less painful than routine caries. Allergic thrombocytopenia caused by the quinine in adulterated heroin may appear as ecchymosis (an irregular formed hemorrhagic area) of the oral mucous membranes. Marijuana users tend to have a greater incidence of decayed, missing, and filled teeth, stain, and greater microbial plaque with resulting gingivitis. People who abuse alcohol also exhibit extra oral signs including breath and body odor of alcohol, hand, tongue and eyelid tremors, redness of the forehead, cheeks and nose, and jaundice of the face.10