Iranian J Publ Health, Vol. 42, No. 9, Sep 2013, pp.929-940 Review Article
929 Available at: http://ijph.tums.ac.ir
Oral Health of Drug Abusers: A Review of Health Effects and
Care
Hajar SHEKARCHIZADEH 1,2, *Mohammad R. KHAMI 2,3, Simin Z. MOHEBBI 1,2,
Hamed EKHTIARI 4,5, Jorma I. VIRTANEN 6,7
1. Research Center for Caries Prevention, Community Oral Health Department, School of Dentistry, Tehran University of Medical
Sciences, Tehran, Iran
2. Dept. of Oral Public Health, University of Helsinki, Helsinki, Finland
3. Dental Research Center, Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
4. Translational Neuroscience Program, Institute for Cognitive Science Studies, Iran
5. Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
6. Dept. of Community Dentistry, University of Oulu, Oulu, Finland
7. Dept. of Public Health, University of Helsinki, Helsinki, Finland
*Corresponding Author: Email: mkhami@tums.ac.ir
(Received 22 Mar 2013; accepted 10 July 2013)
Introduction
Drug abuse, one of the world’s most devastating
health problems (1), may also be considered a
prevalent problem, because estimations show that,
for example, in 2009 between 149 and 272 million
15- to 64-year-olds around the world reported us-
ing illegal drugs at least once during one year (2).
Among them, reports are that 11 to 21 million
were injecting drug users, mainly from China, the
Abstract
Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both
clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in
addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug
abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal
dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug
abuse: patients’ need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver
services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts
include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment proto-
cols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving
addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve
access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating ad-
dicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug
addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health
care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barri-
ers, oral health care at various levels including education, prevention, and treatment should be integrated into general
care services for addicts.
Keywords: Oral heath, Oral diseases, Illicit drugs, Substance-related disorders
Shekarchizadeh et al.: Oral Health of Drug Abusers…
Available at: http://ijph.tums.ac.ir 930
USA, and Russia (3). In Iran, based on a report
from 2002, drug abuse has increased at a growth
rate three times as great as population growth rate,
and the annual rise in incidence of injecting drug
abuse has been estimated to be 33% (4).
Drug abuse results in several direct consequences
including multiple physical and mental problems
such as cardiac crisis, respiratory depression, liver
cirrhosis, nephropathy, infectious diseases such as
hepatitis, AIDS, and tuberculosis, injury-associ-
ated disability, mental disorders such as depres-
sion, and oral health problems (5-6). These prob-
lems are partly the result of neglected self-care—a
common behavior among addicts (7). Addicts
usually ignore their health problems and seek
health care only at advanced stages of disease with
severe symptoms; this may complicate the treat-
ment procedure in various ways (8-9). In this re-
gard, these patients may give little priority to their
own oral health by seeking only emergency treat-
ment during the period of drug abuse (8, 10,11).
In addition to direct consequences for addicts
themselves, drug abuse has various indirect conse-
quences for their circle of acquaintances and the
whole society, such as reducing working time, rais-
ing health care costs, violence, crime, and the bur-
den of diseases (1). In Disability-Adjusted Life
Years (DALYs), about 0.8%, and 0.4% of global
deaths in 2000 resulted from drug abuse (12). This
problem has a median relative risk of two for
mortality and its annual cost exceeds 200 billion
US dollars (13). According to a national survey of
disease burden in Iran, illegal drug addiction and
its AIDS- and accident-related consequences
caused more than 800,000 DALYs in 2003. This
survey ranked addiction as the fourth most im-
portant health problem in the country (14).
Among other indirect consequences, drug abuse is
associated with increased risk of social problems
such as crime in the form of drug trafficking, or
theft and prostitution by drug users in order to
finance their addiction. Health problems of drug
abusers indirectly have negative effects on society
via increasing health care costs, needle-sharing
behavior, prostitution, AIDS, and other infectious
diseases which result in additional health dangers
for society (15).
Addiction and oral health
Oral health problems are among the most preva-
lent health problems associated with drug addic-
tion (16). Drug abuse has both direct and indirect
consequences for oral health and can exacerbate
oral problems indirectly through its adverse ef-
fects on the users’ behavior and life style (8, 17).
The importance and seriousness of oral health
problems among drug abusers necessitates making
comprehensive dental care programs available to
them. These programs should be integrated into
general health care services (8, 11, 16, 18). Moreo-
ver, the programs should take advantage of multi-
ple approaches involving education, prevention,
and treatment. However, considering the illegal
nature of drug abuse, either receiving services or
providing them, presents several challenges.
Published data about epidemiology, pathological
time course, clinical presentation, and effective
treatment and preventive strategies regarding oral
health among drug addicts worldwide are lacking
(8, 17, 19,20). This paper briefly reviews oral
health consequences of illicit drug abuse, the role
of dental care in addiction rehabilitation, health
services available for addicts, and barriers against
oral health promotion among these patients. Fi-
nally, we offer possible strategies at various levels
for oral health promotion among addicts which
can serve as a framework for future research and
interventions.
Oral health consequences of illicit drug abuse
Excluding smoking and tobacco use as well as al-
cohol drinking, published evidence on effects of
main categories of illegal drugs on oral health is
growing. These drug categories include opiates,
cannabis, hallucinogens, cocaine- and ampheta-
mine-type stimulants, and various club drugs. Oral
health complications associated with drug abuse
may result from direct exposure of oral tissues to
drugs during smoking or ingestion, biologic inter-
action of drugs with normal physiology of oral
cavity, and effects of drugs on brain function
which result in a spectrum of addictive behaviors
such as risk-taking behavior, poor hygiene, aggres-
sion, and carelessness.
Iranian J Publ Health, Vol. 42, No.9, Sep 2013, pp. 929-940
931 Available at: http://ijph.tums.ac.ir
Oral health problems associated with opiates
Opiate drugs include opium, its psychoactive con-
stituents such as morphine, and its semi-synthetic
derivatives such as heroin (2). Opioid, as a broad-
er term, also includes the synthetic derivatives of
this family such as methadone. In opiate drug us-
ers, tooth loss, tooth extractions (17), and general-
ized tooth decay especially on smooth and cervical
surfaces are common (21). Moreover, salivary
hypofunction among these patients leads to xero-
stomia, burning mouth, taste impairment, eating
difficulties, mucosal infections, and periodontal
diseases (22). Periodontal diseases appear usually
in the form of adult periodontitis, although re-
ports also exist of necrotizing gingivitis (23,24).
Heroin users show poor oral health in terms of
caries and periodontal diseases (25-26). A study on
heroin injectors reported that regardless of their
oral hygiene, these patients suffer from progres-
sive dental caries (27). Covering a wider area than
typical cervical lesions, caries in these patients is
darker and usually limited to buccal and labial sur-
faces. This pattern may be pathognomonic for
heroin abuse (28).
Other oral conditions related to opioid addiction
include bruxism, candidosis, and mucosal dyspla-
sia (22). However, insufficient evidence exists to
support a theory of a higher prevalence of oral
cancer specifically in opioid abusers (29).
Oral health problems associated with cannabis
Cannabis abuse, mainly hashish and marijuana,
leads to increased risk of oral cancer, dry mouth,
and periodontitis (30-32). Onset of periodontitis
among young adults has a dose-response associa-
tion with cannabis abuse regardless of concurrent
tobacco smoking (30). A systematic review by
Versteeg et al. (33) showed oral side-effects of
cannabis to include xerostomia, leukoedema, high
prevalence of Candida albicans but not candidiasis,
and higher DMF scores, and especially their D
component (34). Based on one study, cannabis
does not elevate the risk of caries by itself. The
life-style of cannabis users combined with short-
term decrease in saliva makes them highly suscep-
tible to smooth-surface caries (35). Moreover, in
another study, about half the cannabis users re-
ported pulpitis during the period of cannabis
smoking, a condition that may be attributed to
cannabis as having adverse effects on their vascu-
lature (36).
Oral health problems associated with stimu-
lants
Stimulants including amphetamine, methampheta-
mine, cocaine, and crack-cocaine (2) have signifi-
cant adverse effects on oral and dental health. De-
pending on the main method of drug administra-
tion, cocaine abusers show several oral and facial
manifestations. Cocaine snorting is associated
with nasal septum perforation, changes in sense of
smell, chronic sinusitis, and perforation of the pal-
ate. Oral administration of cocaine may result in
gingival lesions (37). Local application of cocaine
onto the gingiva by addicts to test its quality may
lead to gingival recession (38). Bruxism is a com-
mon complication in cocaine users leading to den-
tal attrition (37). Following its oral or nasal appli-
cation, cocaine powder reduces saliva pH, making
the dentition susceptible to dental erosion (39).
Crack-cocaine smoking produces burns and sores
on the lips, face, and inside of the mouth which
may increase the risk of oral transmission of HIV
(40).
Methamphetamine abusers show bruxism, exces-
sive tooth wear, xerostomia, and rampant caries
(so-called meth mouth) (20, 41-43): a condition
described by patients as "blackened, stained, rot-
ting, crumbling or falling apart" (44). This is a dis-
tinct pattern of caries on buccal and cervical
smooth tooth surfaces and proximal surfaces of
the anterior teeth (41, 45). A direct relationship
between rampant caries and methamphetamine
abuse has, however, not yet been established. A
wide range of behavioral factors in addition to
drugs can contribute to dental caries in these pa-
tients: methamphetamine users face an increased
risk of caries, related to lack of oral hygiene, high
sugar intake, and decreased salivary secretion (20,
42, 46). Following the use of stimulants, patients
report tooth grinding and clenching, both of
which result in tooth wear, tooth sensitivity, and
difficulty in chewing and in jaw opening (8).
Shekarchizadeh et al.: Oral Health of Drug Abusers…
Available at: http://ijph.tums.ac.ir 932
Oral health problems associated with hallucino-
gens
Hallucinogens such as ecstasy and LSD (Lysergic
acid diethylamide) result in several oral oral com-
plications including dry mouth, bruxism, and
problems associated with malnutrition caused by
drug-induced anorexia (32, 47). Chewing, grinding,
and temporomandibular joint (TMJ) tenderness
are frequently reported by ecstasy users (48). Ec-
stasy-induced tooth wear attributed to grinding
and clenching is more common on occlusal sur-
faces of back teeth than on incisal edges. This
problem may be more the result of jaw clenching
than of tooth grinding (49,50). High intake of car-
bonated drinks to overcome the sensation of dry
mouth after drug-taking may lead to dental caries
and erosion (47). Topical use of ecstasy may result
in oral-tissue necrosis and mucosal fenestration
(51).
Oral health problems associated with club
drugs
Club drugs including methylenedioxymethamphe-
tamine (MDMA), ketamine, gamma-hydroxy-
butyrate (GHB), and flunitrazepam are chemical
substances used mainly by young people in recrea-
tional settings such as dance clubs and rave parties
(52). These drugs are associated with several side-
effects, among which oral complications have
been frequently reported. For example, dry mouth
and bruxism following the use of MDMA (ec-
stasy) may aggravate oral conditions and result in
dental caries and tooth wear. Increased risk of
dental erosion among these patients is associated
with consumption of high amounts of acidic sug-
ary drinks in order to relieve xerostomia and de-
hydration following use of this drug at dance par-
ties. Furthermore, mucosal involvements such as
ulcers, vestibular swelling, edema, and necrosis
have been case-reported in ecstasy users (47). Co-
caine, another drug used regularly by young peo-
ple engaged in nightlife, has several orofacial side-
effects such as nasal septum perforation, perfo-
ration of the palate, gingival involvement, erosion,
and excessive tooth wear. These side-effects have
been reported especially with concomitant use of
ecstasy (37).
Indirect effects of drugs on oral health
It is difficult to identify and isolate the root causes of
oral diseases among addicts, since they show a
variety of unhealthy behaviors (17, 46). Poor oral
hygiene, increased sugar intake, and inappropriate
nutrition are examples (17,26,53,54). Furthermore, a
low priority set on oral health associated with a need
to obtain drugs, fear of dentists, dental service
acceptability, needle-phobia, self-medication, and
structural factors in their life style lead to low use of
dental services (8). This multifactorial association
between drug abuse and insufficient oral health is
also complicated by factors such as low
socioeconomic status, limited education, and poor
access to dental services (55). The difficulty of
accessing dental services among drug abusers has
been pointed out by several studies (11, 16, 19, 56).
The cause may be the illegal nature of drug abuse
which results in problems with either delivery of
services or receipt of them.
According to various studies, a high rate of trau-
matic orofacial injuries occurs among drug abus-
ers, ones such as fractured teeth or tooth loss fol-
lowing accidents or fights (8, 17, 57). What has
therefore been suggested is that in all patients with
dental trauma, the possibility of drug abuse should
be considered (58). One study in Iran emphasized
drug abuse as a contributing factor in almost all
kinds of trauma, especially in violent injuries
among young adults: around 27% of trauma pa-
tients in this study showed evidence of drug abuse
(59).
Negative effects of drug addiction treatment
on oral health
Methadone—a synthetic opioid widely used in
management of opiate addiction—has several
possible side-effects on oral health. High sugar
content of an acidic nature, along with
suppression of salivary secretion results in dental
caries, erosion, and xerostomia (60). The status
turns even more severe when patients hold this
sugary syrup in their mouth to increase absorption
time or to regurgitate it for later injection or sale
(11). Sugar-free solutions, however, may reduce
the risk of dental caries (60).
Iranian J Publ Health, Vol. 42, No.9, Sep 2013, pp. 929-940
933 Available at: http://ijph.tums.ac.ir
Some other medications used during drug addic-
tion treatment include antidepressants (tricyclic,
selective serotonin reuptake inhibitors), anti-
psychotics such as phenothiazines for treatment
of schizophrenia, and anti-anxiety drugs such as
diazepam. They have a side-effect of salivary gland
hypofunction and subsequent dry mouth leading
to negative effects on oral health (61-63). In addi-
tion, with regard to the higher prevalence of HIV
among injecting drug users (64), anti-HIV drugs
such as dideoxyinosine and protease inhibitors
may also have the side-effect of dry mouth (63).
Xerogenic patients usually have problems with
chewing, swallowing, tasting, or speaking. They
may develop cracked lips, erythematic mucosa and
sores, tooth decay, and periodontitis. Halitosis is
also a common finding among these patients (62).
The role of oral health care (OHC) in addic-
tion rehabilitation/ Oral health and relapse
During treatment, drug withdrawal may result in
dental pain which interferes with treatment proce-
dure and abstinence, and may lead to relapse (18,
27, 58). In a French case-control study of the im-
pact of illicit drugs on oral health and the use of
drugs for toothache, 52% of intravenous heroin
users and 21% of other illicit drug abusers admit-
ted using drugs as pain-killers (27). A similar find-
ing on use of illicit drugs for toothache emerged
from another study (36). Those quitting opiate use
therefore require special care for pain control, and
this should be integrated into their rehabilitation
program (18, 27, 58). Those addiction treatment
centers which provide OHC seem to be more
successful in promoting both the oral and general
health of their patients (65).
Dental pain relief provided by illegal drugs such as
heroin, cocaine, and methadone may also be one
cause of low dental attendance: many of the pa-
tients self-medicate for toothache even by inject-
ing drugs directly into gingiva or teeth, masking
pain and delaying appropriate treatment (8, 36).
Oral health, destigmatization, and resocialization
Dental care for patients receiving drug rehabilita-
tion treatment can improve their oral health, help
them to recover from drug abuse and to recon-
struct a “non-addict” identity (8). Based on one
study, former drug users were embarrassed about
how their mouths looked, but this did not inter-
fere with their resocialization (66). In another
study of intravenous heroin users, the appearance
of their smile had negative effect on their social
life (27).
Oral health and HIV transmission
Illicit drugs such as methamphetamines may lead
to an increase in risky sexual behaviors resulting in
the spread of infectious diseases such as HIV and
AIDS (67). Transmission of HIV via oral sex;
however, seems to be less frequent, with the oral
cavity being an unusual route of HIV transmission
(68-70). Nonetheless, oral trauma and ulcers may
enhance the risk of HIV transmission (70). For
example, the possibility of oral HIV transmission
may increase via burns and sores on lips, face, and
in the mouth following the smoking of crack-co-
caine (40).
Health services for drug addicts
Various health care systems around the world de-
liver diverse services for addicts in terms of treat-
ment services provided, pharmacotherapy, human
resources, financing methods, and prevention-
and harm-reduction facilities. Treatment services
may also be available in the forms of inpatient or
outpatient medical detoxification, outpatient absti-
nence-oriented treatment, and substitution
maintenance therapy for opioid dependence (71).
Opioid agonist treatment with either methadone
or buprenorphine may be implemented in a vari-
ety of settings such as public general hospitals,
public mental health hospitals, and public treat-
ment centers, plus private treatment centers, pri-
vate practice (psychiatrists), primary health care,
community pharmacies, and prisons. In addition,
the proportion of patients treated in the public
sector, private sector, joint public-private sector
ventures, and NGOs varies substantially among
countries. Policies on prevention methods and
harm-reduction facilities may also vary depending
on the country. These facilities include commu-
nity-based needle-exchange programs, needle-ex-
change programs in prisons, supervised injection
Shekarchizadeh et al.: Oral Health of Drug Abusers…
Available at: http://ijph.tums.ac.ir 934
facilities, outreach services for injecting drug users,
naloxone distribution, community-based bleach
distribution, and in prisons bleach distribution
(71-73).
With 1.2 million problematic drug users living in
the country (74), Iran has confronted a huge drug
abuse problem. Nonetheless, the nation’s treat-
ment procedures are new (75). Treatment for sub-
stance abuse includes inpatient care and intensive
outpatient programs. In spite of the criminal na-
ture of drug abuse, as a psychiatric disorder, in-
treatment drug users in Iran are no longer prose-
cuted. From 1994, the Prevention Deputy of the
Iranian Welfare Organization set up outpatient
centers for treatment of drug users (76). These
centers offer the following services: detoxification,
agonist-maintenance therapy, and individual,
group, and family counseling, as well as relapse
prevention, self-help groups, and psychotherapy
(75). Approximately 1,438 centers across the
country serve 642,516 patients. Among the cen-
ters, 85% belong to the private sector. In Tehran
province are located 262 treatment centers includ-
ing 250 nongovernmental and only 12 govern-
mental centers working with 746 professionals,
including 239 medical doctors, 61 psychiatrists,
138 nurses, 79 social workers, and 229 psycholo-
gists (77). A treatment center serving female drug
users only was established in 2007 in Tehran to
reduce drug-related harm among women (78).
Based on a Rapid Situation Assessment (RSA)
2007 report, most of the drug users had received
outpatient treatment in private centers (74).
In addition to treatment centers, Narcotic Anony-
mous groups and Therapeutic Communities were
established in the country in 1994 and in 2001,
respectively. Furthermore, a number of NGOs
also exist, offering consultation and group therapy
by former drug users (76). In contrast to many
countries in the Middle East and North Africa,
Iran has established maintenance treatment with
methadone for those opioid-dependents who are
in prison as an HIV-prevention package. At pre-
sent, 142 prisons in all 30 provinces of Iran pro-
vide MMT programs for injecting and non-inject-
ing opioid drug users (79).
Despite the seriousness of oral health problems
among addicts and positive effects of dental care
in addiction rehabilitation, these patients’ use of
dental services at a low rate (18, 56). Addiction
literature is also scarce regarding the topic of den-
tal and oral health care (80). A few programs have
been implemented to improve access to dental
care among drug users (11, 18, 56,57), but a dis-
tinct lack of published data explain access to care
(11). In Iran, as in most countries worldwide, cur-
rent health care services for addicts lack OHC
programs.
Barriers against oral health promotion among
drug addicts
Challenges to provision of an evidence-based
picture of the oral health situation
There appear to be some challenges and barriers
to research studies in this field, ones that are vital
in order to provide reliable evidence for further
interventions. It is difficult to access drug addicts
as a target population. In addition to problems
with drug abusers’ cooperation with and compli-
ance in oral health studies, problems with their
long-term follow-up are common (8, 81).
The multifactorial and complex nature of drug
abuse and addictive behaviors and a tendency to-
ward poly-drug abuse among addicts cause diffi-
culties in determining the independent effects of
each group of drugs or each aspect of addictive
behavior on various oral health aspects (17). This
may interfere with acquiring a reliable picture of
oral health situation.
Challenges in providing and implementing
effective treatments/interventions
Despite evidence as to addicts’ oral health prob-
lems, several barriers exist against provision of
preventive and curative interventions. Dental pro-
fessionals usually have negative attitudes toward
and unwillingness to treat addicted dental patients
(82). On the other hand, addicts generally show a
low demand for non-emergency dental care and
put a low priority on their oral health (8, 10-11,
66) In addition to the problems with utilization of
dental services (56, 83), they may have problems
with compliance with treatment procedures and
Iranian J Publ Health, Vol. 42, No.9, Sep 2013, pp. 929-940
935 Available at: http://ijph.tums.ac.ir
fail to accept the suggested treatment plan (8, 45,
56).
Finally, lack of appropriate policies to improve
access to oral health services (16) and poor col-
laboration between dental and general health care
sectors serving drug addicts (23, 56) are other ob-
stacles to effective interventions.
Strategies for oral health promotion among
drug addicts
The following strategies serve as a framework for
future research and interventions (Figure 1).
Investigating oral health conditions in drug
addicts
Evaluating the status of oral health among drug
addicts would be possible by either objective or
subjective methods. Objective evaluation via clini-
cal examination may serve to identify specific pat-
terns of oral conditions related to drugs, to deter-
mine appropriate dental indices in order to inves-
tigate addicts’ oral health, and to identify effects of
addiction treatment protocols on their oral condi-
tion. Subjective evaluation via questionnaire or in-
terview provides information on the self-
perception of participants, including self-perceived
oral health and its association with occurrence and
relapse of addiction, self-perceived barriers against
dentalservice utilization, oral health behavior, and
oral health-related quality of life.
Oral health care interventions for drug addicts
Interventions available to drug addicts mainly in-
clude oral health education and prevention as
first-level care, and delivery of dental services as
second-level care. Examples of the former include
empowering dentists on the one hand, and health
care personnel in drug rehabilitation settings on
the other to provide oral health education and
prevention for addicts and their families, and to
provide educational materials (booklets, posters,
brochures, etc.) regarding prevention of oral prob-
lems. As second-level care: 1) Dental services
should be established in addiction rehabilitation
centers to improve access to dental treatment. 2)
Dentists should be empowered in the following
domains to provide treatment services for addicts:
a. Diagnosis and management of oral prob-
lems in addicts
b. Management of systemic disorders related
to addiction during dental treatments
c. Behavioral and psychological management
of addicts during dental treatments
d. Encouraging dentists’ positive attitude to-
ward addicts
e. Cross-infection control of blood-borne
diseases
Discussion
Generally, OHC for drug abusers causes a huge
challenge for society. Because of the aforemen-
tioned reasons, drug abusers have frequent and
special dental needs and compared to their normal
population counterparts are in greater need of ac-
cess to dental treatments (8, 11, 16, 19, 56, 83).
Thus, it seems necessary to integrate OHC pro-
grams into general health services provided for
drug addicts.
Prevention and treatment of oral diseases among
drug addicts may facilitate their rehabilitation treat-
ment and recovery from drug dependence (8).
Most health care-delivery systems around the world,
however, lack OHC programs for addicts. Several
barriers seem to exist against oral health promotion
among drug addicts at both research and interven-
tion levels. Because of the complexities of such an
extensive team work, a multidisciplinary collabora-
tion is necessary to conduct comprehensive re-
search. Lack of appropriate settings such as specific
dental clinics, and equipment inside drug rehabilita-
tion centers, and lack of valid inventories and as-
sessment protocols to detect common oral compli-
cations among drug users are problems. Addition-
ally, lack of comprehensive knowledge of and in-
terest among dental professionals in the im-
portance and necessity of relevant studies, and a
common worry over possible threats of transmis-
sion of HIV and hepatitis viruses during oral as-
sessment of drug dependents interfere with appro-
priate need assessment.
Shekarchizadeh et al.: Oral Health of Drug Abusers…
Available at: http://ijph.tums.ac.ir 936
Fig. 1: Oral health care strategies for drug addicts
Iranian J Publ Health, Vol. 42, No.9, Sep 2013, pp. 929-940
937 Available at: http://ijph.tums.ac.ir
In addition to the high cost of dental services and
low coverage of dental insurance, concerns among
policy-makers as to the cost-effectiveness of such
interventions, especially in countries with develop-
ping health care systems, may obstruct useful oral
health interventions for addicts.
The relationship between drug abuse and oral
complications provides an opportunity for dental
professionals to detect drug abusers at early stages
and refer them for rehabilitation. This approach
can increase cost-effectiveness of interventions
for drug control (46).
Conclusion
Despite the seriousness of oral health problems
among drug addicts and positive effects of dental
care in addiction rehabilitation, provision of effec-
tive OHC for these patients seems to face chal-
lenges including difficulty to access addicts as a
target population, lack of appropriate settings to
conduct oral health studies, lack of valid invento-
ries and assessment protocols to detect common
orodental pathologies among drug users, poor col-
laboration between dental and general health care
sectors serving drug addicts, lack of appropriate
policies to improve access to dental services by
these patients, lack of comprehensive knowledge
of and interest among dental professionals in
treating addicts, and low demand for non-emer-
gency dental care among these patients.
Regardless of all these barriers, OHC for drug ad-
dicts merits more emphasis in the future and
should be implemented at various levels including
education, preventive interventions, and therapeu-
tic procedures. Moreover, because of the com-
plexities of medical, social, psychological, and be-
havioral conditions of drug abusers, management
of drug addiction as a multi-organ disease needs a
multidisciplinary approach. Current health care
programs for drug addicts usually lack OHC ele-
ments. Published evidence on oral complications
related to drug addiction emphasizes that OHC
programs should be integrated into general care
services already available for drug abusers.
Ethical considerations
Ethical issues (Including plagiarism, Informed
Consent, misconduct, data fabrication and/or fal-
sification, double publication and/or submission,
redundancy, etc.) have been completely observed
by the authors.
Acknowledgement
This study has been supported by Tehran Univer-
sity of Medical Sciences and Health Services
Grant number 12900. The authors declare that
there is no conflict of interest.
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