School of Dentistry, University of Sydney, Sydney, New South Wales, Australia.
Smile Specialists Suite, Newcastle, New South Wales, Australia.
Periodontol 2000. 2022 Oct;90(1):62-87. doi: 10.1111/prd.12450.
In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.
近年来，牙科和牙周病学的实践变得复杂，出现了若干风险因素，包括治疗越来越多的物质使用障碍患者。本综述介绍了当前文献中非法药物使用对牙周状况的影响及其作为风险因素或指标的可能作用的最新情况。描述了可能对牙周健康和状况产生影响的主要非法药物，包括其作用、临床表现、风险以及对口腔健康和牙周组织的总体影响。对来自流行病学研究的数据进行了分析和总结。以综合的方法报告了使用非法药物的牙周病患者的临床管理，包括非法药物使用者的检测、筛查、访谈和咨询、转介治疗以及牙科和牙周管理。关于非法物质使用对牙周状况的影响，有中等质量的证据表明，长期定期使用大麻是牙周病的一个风险因素，表现为牙周附着丧失、深牙周袋、退缩和牙龈肿大。有限的证据还表明，可卡因的使用会导致一系列牙龈状况，主要表现为化学诱导性创伤性病变（可卡因应用于牙龈）或坏死性溃疡性病变。关于其他药物使用对牙周健康影响的数据有限。有证据表明，长期定期使用大麻是牙周病的一个风险因素，而可卡因的使用会导致一系列牙周状况。在牙周病学家和其他牙科临床医生的日常临床实践中，经常会遇到使用非法物质的患者进行牙科治疗。当临床医生遇到这些患者时，必须妥善管理他们的成瘾问题，同时考虑到它对全面牙科治疗的影响。需要进一步的研究和临床观察，以获得可靠和明确的信息。
