Oral Health: A Window To Drug Addiction

By: Victor J. DeNoble, Ph.D. & Kimi F. DeNoble, MS

Research has shown that oral health problems are very common among people who are addicted to drugs.  Many abused drugs produce chronic tooth decay, cracked teeth, gingivitis and other forms of gum disease.  For example, alcohol is high in sugar which contributes to an increase in tooth decay and frequent chronic consumption can de-mineralize tooth enamel.  Stimulants like ecstasy, amphetamines or cocaine cause severe clenching and grinding of teeth, as well as dry mouth when the individual is under the influence of the drug.  Users of stimulants are also known to have a high intake of sugar.  This combination of side effects can cause serious tooth decay.  Methamphetamine prevents saliva from being produced that results in a condition called “meth mouth” which is characterized by discoloration, rotting and broken teeth, as well as  extreme tooth decay.  The chemical composition of methamphetamine includes a wide range of highly toxic chemicals such as lithium, and muriatic and sulfuric acids all of which are highly corrosive.  Tobacco can cause a wide range of oral problems such as delayed wound healing, sinusitis, soft tissue damage and oral cancer.

Because the relationship between substance abuse and oral pathology is well documented, the dental visit can provide the ideal setting for drug abuse identification and intervention.  In addition, having an understanding drug addiction will assist dental professionals in making decisions when medications with potential for abuse are being considered as part of the overall treatment paradigm for these patients.

Years ago, drug addiction was viewed as a character flaw, an inability to control one’s own behavior.  Today, we know that drug addiction is a disease.  Further, it is a self-inflicted disease; no one addicts us, we addict ourselves.  The motive for drug addiction varies from person to person but the decision to use and eventually abuse the drug is still an individual choice.  Drug addiction is not an event that happens all at once.  It’s a biochemical process that takes time and will eventually result in long-term changes in brain function.  These changes are the underlying mechanism for compulsive drug abuse.  The time it takes to complete this biochemical change varies for each drug.  For some drugs like methamphetamine or crack cocaine, the brain changes can occur in one to three weeks. However, with other drugs such as alcohol or tobacco, the process can take several months.  No matter how long or short the process is the first time, re-addiction for all drugs is fast – – sometimes it can occur within a day.  Therefore, once you are addicted to a drug, you are at risk for re-addiction for the rest of your life.  This makes the choice of pain management medication in dental and medical procedures more difficult.

Everyone is born with specific areas of the brain that recognize and respond to addictive drugs; therefore no one is immune from addiction.  In fact, we are all at risk for addiction.  Once an addictive drug enters our blood, it will be transported to the brain and the process of altering brain function begins.  But why do people use addictive drugs?  Simple.  Addictive drugs make us feel good, at least for a brief period of time.  The major neurotransmitter mediating the addictive process is dopamine.  Dopamine has a wide range of functions in the brain, however, the feeling of happiness is mediated in the mesolimbic system. The mesolimbic system is commonly called the “pleasure center”.  When dopamine levels are normal, we feel comfortable.  If they fall, we can be depressed and, if they rise sharply, we can experience euphoria.  All drugs that are addicting change the way dopamine functions in the mesolimbic dopamine system.  The mechanism for dopamine alteration for each addictive drug is different.  These different mechanisms explain why we can be addicted to several drugs at the same time.  Unlike the normal release of dopamine, when drugs are used to activate this system the resulting dopamine response goes far beyond what the system is supposed to produce and the process of addiction begins.

Addictive drugs make us feel good but the feel good feature of these drugs does not lead to health problems.  Aside from the oral manifestations, these drugs have a wide range of pharmacological side effects that have  other health consequences.  For example, cocaine makes us feel good for about 40-60 minutes, however, the side effects of cocaine put the user at risk for potential life threatening conditions for days.  Atrial fibrillation induced by cocaine has been shown to last for up to 3 days whereas cocaine is metabolized and excreted within 24 hours.  Cocaine renders the addict at risk for heart attacks, strokes, kidney failure and pulmonary embolisms.  Each addictive drug has its own constellation of unique side effects that can be further reviewed at the National Institute of Drug Abuse website.

Research has shown that drug addiction results in dental complications many of which will appear before other less visible complications, e.g., organ failure.  Since many Americans visit their dentists more often than they visit their physicians, dental professionals have an increased likelihood of detecting drug abuse and therefore an increased potential for intervention.


Dr. DeNoble has a Doctorate in Experimental Psychology from Adelphi University, NY and two postdoctoral fellowships from NIAAA and NIDA.  He was recruited by Philip Morris to study the behavioral and physiological effects of nicotine on the brain.  He subsequently conducted drug discovery research in CNS diseases for the pharmaceutical industry.  In 1994, after a congressional release from a confidentially agreement with Philip Morris, he testified before Congress and became a key witness in the federal government’s case against the tobacco industry. Currently, he is the Vice President of Hissho, Inc., a scientific and medical communications company.

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