|Year : 2014 | Volume
| Issue : 1 | Page : 13-17
Oral health status and treatment needs of substance abusers attending de-addiction centers in Bangalore city
Nithin N Bhaskar1, N Vijayakumar2, Karim Virjee3, V Gopikrishna4
1 Departments of Public Health Dentistry, Bengaluru, Karnataka, India
2 Dr. Syamala Reddy Dental College and Research Institute, Bengaluru, Karnataka, India
3 Oxford Dental College, Bengaluru, Karnataka, India
4 Dayananda Sagar College of Dental Sciences, Bengaluru, Karnataka, India
|Date of Web Publication||18-Aug-2014|
Nithin N Bhaskar
Department of Public Health Dentistry, Dayananda Sagar College of Dental Sciences, Shavigemalleshwara Hills, Kumarswamy Layout, Bangalore 560 078, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Studies in different countries, demonstrated high caries prevalence, poor gingival health, poor motivation and oral hygiene practices with substance abusers. The substances may be natural or synthetic, the use of which has a psychoactive effect and alters or modifies the functions of a living organism. Aim: To assess the oral health status and treatment needs of substance abusers attending de-addiction centers in Bangalore. Materials and Methods: A cross-sectional study was conducted among 426 substance abusers admitted in the wards who were randomly selected from 5 selected de-addiction centers from April 2009 to September 2009. The study population consisted of four groups namely alcohol, nicotine, alcohol + nicotine and other drugs group from the selected de-addiction centers. The oral health status of the patients was determined based on the WHO proforma1997. Descriptive statistics, Pearson's Chi-square test and ANOVA tests were applied. Results: The study population consisted of 426 male subjects in the age group of 16-65 years old with an average of 36.35 years. Alcohol + nicotine group had significantly more temporomandibular joint clicking than other groups (P < 0.05). Ninety-Six oral mucosal lesions were found in the study. Alcohol group had significantly higher mean CPI code 3 (pockets 4-5 mm) than the other groups (P < 0.05). The prevalence of decayed, missing, filled teeth in the study population was 83.33%. The mean DMFT of the study population is 4.15 ± 3.74 standard deviation. The mean DMFT of the Alcohol group was significantly higher than the other combinations group (P < 0.01). Conclusions: The oral health status of substance abusers was poor. There were a large number of oral mucosal lesions noted in them. The dental caries status and periodontal status was the worst in the alcohol group.
Keywords: Community periodontal index, decayed, missing, filled teeth, oral health status, substance abusers
|How to cite this article:|
Bhaskar NN, Vijayakumar N, Virjee K, Gopikrishna V. Oral health status and treatment needs of substance abusers attending de-addiction centers in Bangalore city. J Indian Assoc Public Health Dent 2014;12:13-7
| Introduction|| |
"Substance abuse" is a disorder characterized by repetitive drug use that results in physical, mental, spiritual, social or economic distress and is often associated with medical problems. Drugs commonly abused are narcotics, cannabis, stimulants, hallucinogens, depressants and others drug dependence is a complex and multidimensional problem. All the dependence-producing substances have a hedonic effect. The habit is so insistent that it dominates the lifestyles of the individual and damages his or her quality of life, or the habit itself causes actual harm to the individual or the community. 
Globally, the number of drug abusers in 2007 was 200 million, i.e. 4.8% of the global population.  The prevalence of drug abuse in India for cannabis was 3.2% in 2000, for opiates 0.4% in 2001, for amphetamines 0.02% in 2001 and ecstasy 0.01% in 2004. About 11.35 million people in India are estimated to be addicted to drug. 
The studies demonstrated high caries prevalence, poor gingival health, poor motivation and oral hygiene practices with drug abusers. Drug users also have special needs in relation to receiving dental care. Anecdotally, they are dentally anxious and have low-pain tolerance requiring careful pain relief and a good rapport with the dentist. 
In the past decade, there have been a limited number of studies on dental health status among drugs addicts.  Hence an attempt has been made to assess the oral health status and treatment needs of substance abusers attending de-addiction centers in Bangalore.
To assess the oral health status and treatment needs of substance abusers attending de-addiction centers in Bangalore city.
To assess the various drug groups and the oral health status.
| Materials and Methods|| |
A cross-sectional study was conducted to assess the oral health status and treatment needs of substance abusers in Bangalore city. There are 17 de-addiction centers in Bangalore, out of which 5 were selected randomly using the lottery method. The 5 de-addiction centers were visited from April 2009 to August 2009.
The selected centers were:
- National Institute of Mental Health and Neuro Sciences (NIMHANS) de-addiction center
- Karnataka State Road Transport Corporation de-addiction center
- Shakti de-addiction center
- Spandana Institute of Mental Sciences
- Abhaya Hospital and de-addiction center.
Prior to the start of the study, ethical clearance was obtained from the Institutional Review Board. Necessary permission was obtained from the de-addiction centers and informed consent was obtained. The examiner and the oral examination was standardized and calibrated in the Department of Community Dentistry, Dr. Syamala Reddy Dental College, Bangalore. A pilot study was conducted at the NIMHANS de-addiction center and the sample size was fixed at 390 using the formula n = 4pq/L 2 . The study population consisted of four groups namely alcohol, nicotine, alcohol + nicotine and other drugs group. A total of 426 individuals admitted in the wards of the selected de-addiction centers participated in the study.
The subjects classified as substance abusers according to the International Classification of Diseases 10 and The Diagnostic and Statistical Manual of Mental Disorders IV classification were included.
The data regarding substance abuse and demographic details were obtained using the NIMHANS proforma. The oral health status was determined using WHO Oral Health Assessment Form 1997. The examination was done using available light, mouth mirror and community periodontal index (CPI) probe.
The statistical analysis was performed using Statistical Package for Social Sciences SPSS version 11.5 by SPSS Inc, Chicago, (USA MINITAB version 17 by MINITAB Inc, state college, Pennsylvania, USA). Pearson's Chi-square test and ANOVA statistical tests were applied and the results were drawn.
| Results|| |
The study population consisted of 69 alcohol only abusers, 25 nicotine only abusers, 230 alcohol + nicotine abusers and others were 102, which included multi-drug users.
The subjects were in the age group of 16-65 years with a mean age group of 36.35 years. About 112 subjects (26.3%) showed temporomandibular joint (TMJ) clicking on examination. TMJ tenderness was observed among 6 subjects, and 3 of them showed reduced jaw opening [Table 1]. TMJ clicking was highest in the alcohol + nicotine group with 71 subjects.
|Table 1: Distribution of the study population according to TMJ signs and symptoms |
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A total of 96 oral mucosal lesions was noted in the study. One case of malignant tumor, 54 cases of leukoplakia, 6 cases of ulceration and 34 other conditions including oral sub mucus fibrosis, smokers palate and hyper pigmentation was recorded.
Out of the 426 subjects examined, 2 (0.47%) of the subjects had questionable fluorosis. 12 (2.82%) had very mild fluorosis, 26 (6.10%) mild fluorosis, 26 (6.10%) moderate fluorosis and 5 (1.17%) of the subjects had severe fluorosis [Table 2].
|Table 2: Distribution of the study population according to dental fluorosis |
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The mean number of sextants across CPI scores was more with CPI score 2, indicating that presence of calculus was a common feature among the abusers [Figure 1].
Alcohol group had significantly higher mean CPI code 3 (pockets 4-5 mm) and code4 (pockets 6-mm) than all other groups (P < 0.05) [Table 3].
The mean decayed, missing, filled teeth (DMFT) were 4.15 ± 3.74 and the prevalence of DMFT were 83.33% [Table 4]. Further alcohol group showed more number of DMFT than others with mean DMFT of 5 [Figure 2]. Among the 426 subjects, the treatment needs were as follows: 766 teeth require one surface fillings, 241 teeth required two surface fillings, 19 teeth required pulp care, including root canal treatment, 135 teeth required extractions, 4 teeth required other care, 445 edentulous areas required prosthetic replacement [Table 5].
|Table 3: Difference in CPI codes (mean number of sextants) between drug groups |
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|Table 5: Distribution of the study population according to treatment needs |
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|Figure 2: Distribution of the study population according to mean decayed, missing, filled teeth|
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| Discussion|| |
In India, substance abuse has been a traditional activity with the use of charas and bhang right from ancient times. Alcohol abuse and tobacco use is a very common practice among the monarchs of India. However in the recent decades, an increase in drug abuse in various segments of the society has risen alarmingly. ,,
In the latest reports with regards to Indian context, 11.35 million persons were addicted to drug. Tobacco smoking is an important risk factor in periodontal disease and a major risk factor in oral cancers. The diseases of the mouth in alcohol users include dental caries, traumatized teeth, periodontal diseases, cancer, recurrent oral ulceration, dermatoses and oral carcinomas. The oral health of users of other drugs has received less attention. 
Without baseline data regarding the oral health status of the population of India comparisons between addicts and nonaddicts, is extremely difficult as also within the different group of addicts.
Different studies have used alternative methods such as Community Periodontal Index of Treatment Needs index and Russel's periodontal index to assess periodontal status in their study and hence all data obtained is not comparable.
A study  reported at least one oral mucosal lesion in 49% of the drug abusers. The current study reported 96 lesions constituting 22.5%, which may be due to the association with the increased permeability of basal layers of the mucosa in alcoholics as well as the action of the various metabolites of other drugs such as tobacco and cannabis. A study  reported TMJ clicking in about 40.0% of abusers and the current study, 26.29% of the subjects reported TMJ clicking. The TMJ alterations maybe due to the fact that substance abusers have the tendency to brux at night.
A study  reported CPI code 0 (healthy periodontal tissues) in 8.76% of subjects, code 1 (bleeding on probing) in 8.76% of examined persons, code 2 (calculus) in 72.35%, code 3 (shallow pockets) in 4.15% and code 4 (deep pockets) in 0.92%. This study reported code 1 in 13.6% of examined persons, code 2 in 48.4%, code 3 in 29.1% and code 4 in 8.9%. Several drugs have been reported to lower the salivary pH and promote the accumulation of plaque and calculus and thereby resulting in increased periodontal problems.
Numerous studies have shown mean DMFT in the range of 3.2-16.9 ,,,, whereas the present study showed the mean DMFT of 4.15 which may be due to the fact that many of the other studies included were subjects who used narcotics predominantly, but in the current study the number of nicotine and alcohol users were more. Substance abusers have a tendency to increased dental caries due to xerostomia that is caused by the various drugs that are used by them.
| Conclusion|| |
Oral Health status of the substance abusers in the present study is poor and the oral mucosal lesions are high. Hence appropriate preventive measures like periodic dental health education and checkup as well as regulatory measures should be implemented.
The study group consisted of more number of alcoholics as the abuse of alcohol is more common in India due to the ease of availability and traditional practices. Further study designs should aim at including an equal number of abusers in each substance category so that a comparative assessment of oral health status will be possible.
The current study did not include the oral hygiene practices of the substance abusers hence further studies could aim at including these aspects.
Studies have shown that substance abusers also have difficulty in accessing dental care, so in this regard we must take measures to provide dental treatment to this special group.
| Acknowledgments|| |
All the five de-addiction centers for their help and support. A special thanks to Dr. Pratima Murthy, Professor and Head of De-addiction Centre, NIMHANS.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]