Table 1.

Effects of long-term substance abuse on systemic and oral health

Abused substance	Systemic manifestations	Oral manifestations
Alcohol	Liver toxicity, impairment of immune system	Predisposition to oropharyngeal cancer Predisposition to periodontal disease
Cannabis (marijuana)	Immuno-suppressive effect	Smoked without a filter, it increases inhaled smoke which causes cannabis stomatitis, leukoedema of the buccal mucosa and hyperkeratosis Periodontitis can be present in young adults due to frequent marijuana use
Methamphetamine	Stimulates sympathetic system Highly addictive Mode of ingestion: smoking, snorting, swallowing or injecting	Xerostomia (dry mouth) leads to the loss of protective function of saliva thus resulting in high caries and periodontal disease rates, often referred to as “meth mouth”. More common in individuals who inject the drug rather than those who use it intranasally or through smoking Due to its sympathomimetic effect, it induces clenching and bruxism Osteonecrosis of mandible
Opioids (heroin, opioid prescription pain killers)	Psychoactive drugs that bind to opioid receptors: Mu-opiate receptor is activated which leads to changes in glucose intake and glycemic control	Use leads to salivary hypofunction causing xerostomia, caries, burning mouth and taste impairment The literature reports opioids to induce a preference for sweet foods Duration of drug use, poor oral hygiene and nutritional habits contribute to oral health complications
Cocaine	Inhaled intranasally, smoked form (crack) or rubbed on gingival tissue	Long-term intranasal use can lead to perforations of the hard palate and nasal septum. Recurrent maxillary sinusitis, burns, blisters and sores are often associated with cocaine use Use of the powder form intraorally causes a substantial decrease in saliva pH creating an opportunity for caries-causing bacteria
Tobacco	Long term use increases the risk of cancer and respiratory tract diseases like Chronic Obstructive Pulmonary Disease (COPD) Vaping may predispose otherwise healthy individuals to viral infections like Covid-19	Chronic use increases the risk for periodontitis, staining of teeth It also increases the risk of oro-pharyngeal cancers