Addiction and Periodontal Disease: A Comprehensive Study

Addiction, a condition that involves compulsive use of substances is closely related to periodontal disease, an infection that affects the soft tissue surrounding the teeth. 

Substance abuse and periodontal disease are linked due to several factors such as the abrasive nature of chemicals in drugs such as meth, as well as poor oral hygiene associated with addicts.  According to a 2013 article by Saini, G. K., “Drug addiction and periodontal diseases”, published by the Journal of Indian Society of Periodontology, substance abuse not only affects neurological functions but also takes a toll on various organs and systems throughout the body, including the oral cavity.

Addiction-linked periodontal disease presents with symptoms such as meth mouth, gum recession, gingival inflammation, and periodontal pocket formation.

Treatment strategies for substance abuse-related periodontal disease include behavioral interventions (addiction counseling, motivational interviewing), addressing co-occurring mental health, comprehensive oral examination, scaling and root planing, and antibiotic therapy.

What is Periodontal Disease?

Periodontal disease refers to infections of the structures around the teeth, including the gums, periodontal ligament, and alveolar bone. It ranges from mild gingivitis, characterized by inflamed and bleeding gums, to severe periodontitis, which can result in tooth loss and systemic health complications. Despite its prevalence and potential severity, periodontal disease often goes unnoticed in its early stages, earning it the name “the silent disease.”

How Does Addiction Impact Oral Health?

Addiction affects oral health due to the abrasive nature of compounds in drugs, and poor oral health observed by substance abusers.

Substance abuse and periodontal disease are linked by factors such as the abrasive nature of chemicals in drugs such as meth, as well as poor oral hygiene associated with addicts.

The 2013 article by Saini demonstrates that substance abuse affects oral health in many ways including causing dental caries, gum disease, oral infections, oral cancer, and boca torcida, commonly known as twisted mouth. These issues stem from multiple factors, such as poor oral hygiene, dietary choices, decreased saliva production, and direct chemical damage from substances like tobacco and methamphetamine.

The Link Between Addiction and Periodontal Disease

Substance abuse aggravates existing periodontal issues or increases the risk of developing them. Conversely, periodontal disease may serve as a risk factor for substance abuse initiation or escalation. Several substances have been implicated in worsening periodontal health, including tobacco, alcohol, and illicit drugs.

1. Tobacco Use and Periodontal Disease: Tobacco use, whether through smoking or chewing, is one of the most significant risk factors for periodontal disease. The chemicals in tobacco products interfere with the body’s immune response, making smokers more susceptible to gum infections. Nicotine constricts blood vessels, reducing oxygen and nutrient delivery to oral tissues, further compromising gum health. Additionally, tobacco use hampers wound healing, prolonging the recovery process after periodontal treatment.

2. Alcohol Consumption and Periodontal Disease: Excessive alcohol consumption has been linked to periodontal disease through various mechanisms. According to the 2017 article by Inenaga, K., Ono, et al, “Thirst Sensation And Oral Dryness Following Alcohol Intake”, published in the Japanese Dental Science Review journal, alcohol dry out the mouth, a condition known as xerostomia. This decreases saliva production and impairs its protective functions against bacteria. In addition, alcohol abuse often coincides with poor oral hygiene practices and unhealthy lifestyle choices, exacerbating gum inflammation and disease progression. Chronic alcoholism can also compromise the immune system, rendering individuals more susceptible to oral infections.

3. Illicit Drugs and Periodontal Disease: Illicit drugs like methamphetamine, cocaine, and heroin pose significant threats to oral health. Methamphetamine, in particular, is notorious for its devastating effects on teeth and gums, earning it the name “meth mouth.” According to a 2021 study by Lee, H. H., “Understanding the Basis of METH Mouth Using a Rodent Model of Methamphetamine Injection, Sugar Consumption, and Streptococcus mutans Infection” the drug reduces saliva in the mouth which contributes to severe tooth decay, gum recession, and periodontal disease. Cocaine and meth use leads to bruxism (teeth grinding), which accelerates gum damage and worsens tooth wear. Injecting drugs also increases the risk of oral infections and abscesses which compromises oral health.

4. Psychosocial Factors: Beyond the biological aspects, psychosocial factors also play a role in the relationship between addiction and periodontal disease. Individuals struggling with addiction may neglect their oral hygiene due to preoccupation with obtaining and using substances, leading to plaque buildup and gum disease. Moreover, addiction is often accompanied by socioeconomic challenges, including limited access to dental care and financial constraints, further exacerbating oral health disparities.

What Are The Signs and Symptoms of Substance Abuse-related Periodontal Disease?

Signs and symptoms of addiction-linked periodontal disease include gingival inflammation, gum recession, periodontal pocket formation, bad breath, and changes in tooth structure.

Gingival Inflammation

According to a 2022 study by Quaranta, A., et al, “Illegal Drugs And Periodontal Conditions”, published in the Periodontol 2000 journal, people who abuse substances such as marijuana often present with oral problems such as gingival inflammation. 

In addition, abusing substances such as methamphetamine and cocaine leads to dry mouth (xerostomia) due to reduced salivary flow. The dry environment promotes bacterial growth, accumulating plaque, and gingival inflammation. Inflamed gums appear red, swollen, and tender, and bleed easily during brushing or flossing.

Gum Recession

Prolonged substance abuse contributes to gum recession, where the gums pull away from the teeth, exposing the tooth roots. Receding gums not only compromise the aesthetic appearance of the smile but also increase tooth sensitivity and susceptibility to decay. Recession often results from the destruction of periodontal tissues caused by the inflammatory response triggered by substance abuse.

Periodontal Pocket Formation

As periodontal disease progresses, pockets or spaces form between the gums and teeth. These pockets harbor bacteria and plaque, further aggravating the inflammatory process. In individuals abusing substances, periodontal pocket formation occurs more rapidly and extensively due to compromised immune function and poor oral hygiene practices associated with substance abuse.

Delayed Wound Healing

Substance abuse can impair the body’s ability to heal, including the healing of oral wounds and periodontal tissues. Delayed wound healing in the oral cavity prolongs the inflammatory response associated with periodontal disease and hinders the effectiveness of periodontal treatments such as scaling and root planing.

Bone Loss

According to a 2019 study by Sanjita D, et al, “Drug Abuse And Its Ramifications On Skeletal System’” published in the International Journal of Bone Marrow Research, drug addiction is a risk factor for developing bone loss. Chronic substance abuse accelerates the breakdown of alveolar bone, the bone that supports the teeth. Alveolar bone loss is a hallmark of advanced periodontal disease and leads to tooth mobility and eventual tooth loss. The destructive effects of substance abuse on bone health exacerbate the progression of periodontal disease and compromise the long-term stability of the dentition.

Halitosis (Bad Breath)

Substance abuse-related periodontal disease often presents with persistent bad breath or halitosis. The accumulation of bacteria and food particles in periodontal pockets, combined with dry mouth resulting from substance abuse, creates an ideal environment for the proliferation of odor-causing bacteria. Halitosis has significant social implications and contributes to feelings of embarrassment and self-consciousness in affected individuals.

Changes in Tooth Structure

Some substances, such as methamphetamine, cause significant changes in tooth structure, a condition commonly referred to as “meth mouth.” The 2021 article by Lee, “ demonstrated that using meth alters tooth structure. These changes include severe tooth decay, erosion of enamel, and tooth fracture. Methamphetamine abuse also exacerbates periodontal disease by impairing blood flow to the gums and increasing the risk of oral infections.

Increased Risk of Oral Cancer

Certain substances, such as tobacco and alcohol, are well-established risk factors for oral cancer. Chronic substance abuse significantly elevates the risk of developing oral cancer, which can manifest as abnormal growths or lesions in the oral cavity. These lesions may initially resemble benign conditions but can progress to malignancy if left untreated.

Which Treatment Options Exist For Addiction and Periodontal Disease? 

Treatment strategies for substance abuse-related periodontal disease include behavioral interventions (addiction counseling, motivational interviewing), addressing co-occurring mental problems, establishing support systems, comprehensive oral examination, scaling and root planing, and antibiotic therapy.

Behavioral Interventions

1. Substance Abuse Counseling: Integrating substance abuse counseling into dental care can help address the underlying issues driving addictive behavior and promote long-term recovery. This may involve individual therapy, group counseling, or referral to specialized addiction treatment programs.

2. Motivational Interviewing: Dentists and dental hygienists can use motivational interviewing techniques to help patients explore their motivations for improving oral health, set achievable goals, and develop strategies for overcoming barriers to change.

3. Collaboration with Healthcare Providers: Collaboration between dental professionals, primary care physicians, and addiction specialists is essential to ensure coordinated care and address the complex medical and psychosocial needs of patients with substance abuse disorders.

4. Addressing Co-occurring Disorders: Many individuals with substance abuse disorders also suffer from co-occurring mental health conditions such as depression, anxiety, or trauma. Integrating mental health screening and treatment into dental care can improve outcomes and reduce the risk of relapse.

Dental Treatment

1. Comprehensive Oral Examination: A thorough assessment of the patient’s oral health, including periodontal probing, X-rays, and evaluation of risk factors, is essential to develop an appropriate treatment plan.

2. Scaling and Root Planing (Deep Cleaning): This non-surgical procedure involves removing plaque and tartar deposits from below the gum line and smoothing the tooth roots to facilitate healing and prevent further bacterial accumulation.

Medication

In cases of advanced periodontitis, antibiotics may be prescribed to control bacterial infection and reduce inflammation. However, caution must be exercised in prescribing antibiotics to individuals with substance abuse disorders to minimize the risk of misuse or interactions with other medications.

Apart from antibiotics, a 2020 review by Cuberos, M., et al, “Dental Management Of Patients With Substance Use Disorder”, published in the Clinical Dentistry Reviewed journal shows that prescribing silver diamine fluoride (SDF) helps in treating and controlling dental caries.

Surgical Intervention

In severe cases of periodontal disease where non-surgical treatments are inadequate, surgical procedures such as flap surgery, bone grafting, or tissue regeneration may be necessary to repair damaged tissues and restore periodontal health.

Ongoing Support System

1. Education and Support: Providing educational materials and resources on the link between substance abuse and oral health, as well as practical tips for maintaining good oral hygiene empower patients to take control of their dental health and make positive lifestyle changes.

2. Ongoing Maintenance: Regular follow-up visits for professional cleaning, periodontal maintenance, and reinforcement of oral hygiene practices are crucial to prevent disease recurrence and monitor the patient’s progress.

What is The Number One Cause of Periodontal Disease?

According to the article “ Periodontal (Gum) Disease”, from the National Institute of Dental And Craniofacial Research, periodontal disease mainly occurs due to poor oral hygiene. This causes the formation and accumulation of plaque on the teeth.

What Illicit Drugs Cause Teeth Decay?

Drugs that cause teeth decay include heroin, meth, alcohol, and tobacco. People using heroin often crave sweet food and it can also cause tooth decay. Heroin causes dry mouth and teeth grinding. Methamphetamine or meth has abrasive compounds that break down the protective outer layer of the teeth causing discoloration and decay. Additionally, meth addicts crave high-sugar foods which contribute to cavities, discoloration, and decay. According to the article “Teeth And Drug Use”, from Better Health Channel, alcohol causes teeth erosion while tobacco causes gum infections.

What is The Latest Treatment For Periodontal Disease?

Laser treatment is an emerging treatment of periodontal disease. According to a 2023 article “  Successful Treatments For Periodontal Disease”, from Colgate, lasers have revolutionized dentistry with minimally invasive and precise treatment techniques. The laser method is widely applied in periodontal surgery for the removal of diseased tissues, disinfection of the periodontology, and promotion of a regeneration process.

How Long Does It Take For Smoking to Damage Gums?

Smoking is capable of damaging your gum in as little as a week or take months before the damage is evident. According to the article “ Smoking, Gum Disease, and Tooth Loss”, by the Centers for Disease Control and Prevention, smoking weakens the body’s immune system, making it hard for it to fight off gum infections.

Is Nicotine Gum Safe To Use?

Yes, nicotine gum is safe to use. According to the article “How to Use Nicotine Gum”, from the Centers for Disease Control and Prevention, nicotine gum is among the seven medications approved by the FDA to help people quit smoking. These include lozenge, nicotine patch, gum, oral inhalers, nasal spray, bupropion SR, and varenicline.