BACKGROUND:
The
authors used a large community sample of methamphetamine (MA) users to verify
the patterns and severity of dental disease and establish a hierarchy of caries
susceptibility by tooth type and tooth surface.
METHODS:
Using a
stratified sampling approach, 571 MA users received comprehensive oral
examinations and psychosocial assessments. Three calibrated dentists
characterized dental and periodontal disease by using National Health and
Nutrition Examination Survey protocols. The authors also collected data on
substance use history and other attributes linked to dental disease.
RESULTS:
On all
dental outcome measures, MA users evidenced high dental and periodontal
disease, with older (≥ 30 years) and moderate or heavy MA users
disproportionately affected. Women had higher rates of tooth loss and caries,
as well as a greater prevalence of anterior caries. Current cigarette smokers
were more likely to manifest 5 or more anterior surfaces with untreated caries
and 3 or more teeth with root caries. Nearly 3% were edentulous, and a
significant percentage (40%) indicated embarrassment with their dental
appearance.
CONCLUSIONS:
MA
users have high rates of dental and periodontal disease and manifest a
dose-response relationship, with greater levels of MA use associated with
higher rates of dental disease. Women and current cigarette smokers are
affected disproportionately. The intraoral patterns and hierarchy of caries
susceptibility in MA users are distinctive.
PRACTICAL IMPLICATIONS:
The
prevalence and patterns of dental and periodontal disease could be used to
alert dentists to possible covert MA use and to plan treatment. Concerns about
dental appearance have potential as triggers for behavioral interventions.
Below: (A) Clinical manifestation of pseudomembranous candidiasis in an HIV patient; (B) Clinical manifestation of angular cheilitis in an HIV patient
Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.
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