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. 2022 Oct 2;90(1):62–87. doi: 10.1111/prd.12450

TABLE 4.

Dental and periodontal conditions and treatment considerations in illegal drug users (modified from O'Neil Wiley Blackwell 2015 (81)

Used illegal drug Psychiatric signs and symptoms Physical examination findings Dental conditions Periodontal conditions Dental treatment considerations
Cannabis

Euphoria

Hyperactivity

Dissociation

Tachycardia

Paranoia

Delusions

Hallucinations

Poor coordination

Irritated conjunctiva

Xerostomia

Increased risk of caries

Leukoplakia

FRC users exhibit deeper PDs, higher AL score and higher odds of having severe periodontitis than non‐FRC users. Gingivitis; gingival enlargement and possible ulcerative conditions

Avoid local anesthetic with epinephrine

Xerostomia treatment products

Topical fluoride treatment

Avoid treatment at least 24 h from last drug use

Cocaine and crack

Euphoria

Insomnia

Paranoia

Dissociation

Aggressive behavior

Delirium

Restlessness

Nasal septal and palatal necrosis and perforation

Powder in nares

Weigh loss

Dilated pupils

Tachycardia

Skin abscess

Slurred speech

Vomiting

Increased heart rate

Wide QRS complex and QT/QTc prolongation

Xerostomia

Occlusal wear

Generalized caries

Bruxism

Orofacial pain

Graft failure

Alterations of taste perception

Keratinization of oral mucosa

Discoloration of saliva

Involuntary facial movements

NUG

Gingival ulceration and erythema

Painful gingival retraction

Periodontitis

No alterations in microbiota composition and counts

Avoid local anesthetic with epinephrine

Occlusive guards

Topical fluoride treatment

Avoid treatment at least 24 h from last drug use

Methamptemins; ecstasy and MDMA

Euphoria

Dissociation

Panic reactions

Impulsive behavior

Depression

Psychotic episodes

Black rotting teeth

Nasal septal necrosis

Poweder in nares

Mucus discharge from the naris

Jaw clenching

Jaw soreness

Xerostomia

Occlusal wear

Generalized caries

Bruxism

Dehydration

Dilated pupils

Excessive sweating

Tachycardia

Skin abscess

Weigh loss

Burnt fingers

Track marks

Abbreviations: AL, attachment loss; FRC, frequent recreational cannabis; MDMA, 3,4‐Methylenedioxy‐Methamphetamine; NUG, necrotizing ulcerative gingivitis; PD, probing depth.