Oral health assessment for users of marijuana and cocaine/crack substances

Abstract: The objective of this study was to assess the oral health status of users of illicit drugs such as marijuana and cocaine/crack and compare it with individuals not using these chemical substances. Questionnaires were applied to 35 illicit drugs users to gather information on demographic status, general health, and use of drugs. Then, a clinical assessment of the oral health condition was performed to collect data on decayed, missing and filled teeth (DMFT) index, salivary flow rate (SFR), and mucosal lesions. The control group was composed of 35 non-illicit drug users. In the experimental group, 91.43% were males, 80% were smokers, and 42.85% were alcoholics. Cocaine was the most common drug used (77.15%), followed by marijuana (68.6%), and crack (51.4%). The average DMFT index was 9.8 and the SFR was reduced in 60% of subjects. Mucosal alterations were detected, but no potentially malignant disorders or oral cancer were diagnosed. Compared to control group, significantly higher values for gender (40%, p = 0.0001), smoking (22.86%) and heavy drinking (5.7%) habits (p = 0.0001), SFR (31.4%; p = 0.0308), and oral lesions (p = 0.0488) were found for the experimental group, although significantly higher values were found in the control group for DMFT index (p = 0.0148). It can be concluded that the use of illicit drugs contributed to an increased prevalence of oral mucosa lesions. In addition, a decline on SFR and a reduced DMFT index was observed for illicit drug users.

Caries experience and salivary aspects in individuals with fragile X syndrome

Abstract Fragile X syndrome (FXS) is the most common cause of hereditary mental retardation, but studies on the oral health condition of these patients are rare. The aim of this study was to determine the experience of dental caries in individuals with FXS, by examining the saliva profile, oral hygiene, socioeconomic characteristics and use of controlled drugs in these patients. Dental health was estimated using the decayed, missing and filled teeth index (DMF-T) and sialometry, and the pH value and buffering capacity of the saliva, colony forming units of S. mutans (CFU/mL), visible biofilm index, and socioeconomic status were all examined. The sample, comprising 23 individuals, had an average age of 17.3 ± 5.6 years, a DMF-T index of 5.5, a diminished salivary flow (78.3%), and a low (73.9%) saliva buffering capacity. Most (52.2%) individuals presented with a high abundance (CFU/mL) of S. mutans. The experience of caries was correlated with salivary parameters, poor oral hygiene, lower socioeconomic status and an increased count of S. mutans in saliva.

Association between crack cocaine use and reduced salivary flow

Abstract Crack cocaine use appears to have an impact on oral conditions. However, changes in the salivary flow among crack users have not been fully clarified. The aim of this study was to compare stimulated salivary flow and the occurrence of hyposalivation between crack users and non-users. A cross-sectional study was conducted involving 40 crack users and 40 controls matched for sex, age, and smoking habits. Interviews were conducted to acquire data on the perception of dry mouth (xerostomia) and drug use. Stimulated salivary flow was determined using the spitting method. A significant reduction in stimulated salivary flow was found among crack users in comparison to non-users (1.02 vs. 1.59 ml/min). A total of 42.5% and 15% of crack users had very low and low stimulated salivary flow, respectively. Moreover, 65% of users reported xerostomia in comparison to 37.5% non-users (p < 0.012). No significant association was found between xerostomia and hyposalivation (p = 0.384). A multivariate analysis revealed that individuals older than 26 years of age, those with a low household income, and crack users (prevalence ratio: 2.59) had a significant association with the occurrence of hyposalivation. A significant association was found between the use of crack and reduced salivary flow. The use of crack was associated with the occurrence of hyposalivation in the multivariate analysis.

Drugs or disease: evaluating salivary function in RA patients

Abstract Oral complications of RA may include temporomandibular joint disorders, mucosa alterations and symptoms of dry mouth. The aim of this study was to evaluate the salivary gland function of subjects with rheumatoid arthritis (RA) comparing it to healthy controls. Subjects with other systemic conditions known to affect salivary functions were excluded. A questionnaire was applied for the evaluation of xerostomia. Resting and chewing-stimulated salivary flow rates (SFR) were obtained under standard conditions. There were 145 subjects included of the study (104 RA and 38 controls). About 66.7% of the RA subjects and 2.4% in control group presented xerostomia. The median resting SFR were 0.24 ml/min for RA subjects and 0.40 mL/min for controls (p = 0.04). The median stimulated SFR were 1.31 mL/min for RA subjects and 1.52 ml/min for controls (p = 0.33). No significant differences were found between resting and stimulated SFR of RA subjects not using xerogenic medications and controls. There was significantly higher number of subjects presenting hyposalivation in the RA group than among controls, even when subjects using xerogenic medications were eliminated from the analysis. In conclusion, hyposalivation and xerostomia were more frequent among RA subjects not using xerogenic medication than among controls, although there were no significant differences in the median SFR between groups.

Oral Clonidine and Midazolam as Premedication in Pediatric Anesthesia- Efficacy and Outcome in Comparison with Oral Promethagine.

Background: In most of the centers of developing country no premedication is used in cases of anesthesia in paediatric population. Many centers use oral promethagine on the night before to ensure good sleep. Th ere is dilemma of using premedication with a fear of losing control over baby. Th ere are controversial results regarding the eff ectiveness of clonidine compared with midazolam as premedication in children. Aim: Th e aim of this study is to evaluate the effi cacy of oral clonidine and midazolam as a premedication and compare to with that of conventional promethagine in pediatric patients. Methods: Th is prospective randomized controlled study was carried out in Combined Military Hospital, Dhaka, among 90 children aged 2 to 7 years of ASA grade I & II scheduled for elective surgery under general anaesthesia during the period of Jan 2012 to Dec 2013. All the children were randomly divided in three groups, 30 children received only syrup promethagine as per body weight (Group-P, n=30) at night. In the study groups, after the syp promethagine at night in addition they were also given oral clonidine 4 μg/kg mixed with honey (Group-C, n=30) and midazolam 0.5 mg/kg mixed with honey (Group-M, n=30) at 60 and 20 min before separation of baby from parents lap respectively. Th e protocol of general anesthesia like induction, intubation, maintenance, reversal and postoperative analgesia was the same for all three groups. Patient’s sedation status, separation anxiety, venipuncture, mask acceptance, anesthetics requirement, salivation, analgesia, post operative nausea vomiting (PONV) and emergence agitation were recorded by an observer blind of the patient’s group. Results: Children characteristics were similar in all three groups. Children who had received clonidine as well as midazolam had more satisfactory sedation upon parent separation and less separation anxiety than promethazine; compared with midazolam & promethazine, clonidine premedication was associated with better mask acceptance; children who had received clonidine had signifi cantly less incidence of salivation and less rescue antisialagogue; children received clonidine were better managed both intra & post operatively and needed less rescue analgesics; children who had received clonidine had signifi cantly less episodes of PONV and also required less rescue antiemetic; incidence of emergence agitation was less in clonidine group in comparison with other two groups. Conclusion: Th e fi ndings of the study suggest that both midazolam and clonidine are safe and eff ective as anaesthetic premedication in paediatric population. It can be concluded that oral midazolam premedication is eff ective as far as sedation is concern but considering multifarious anesthetic function oral clonidine is much superior premedicant. However, the risks of heart rate and blood pressure decreases, and the prolonged onset of sedation associated with clonidine should be considered. We recommend further multi-centre studies with larger samples to validate fi ndings of our study.

Effect of hyposalivation on mastication and mandibular movements during speech

The aim of this study was to evaluate whether patients with hyposalivation present damaged mastication or mandibular movements during speech. Forty subjects composed 2 groups: control and hyposalivation. Masticatory performance was assessed with a silicon-based artificial material and a 10-sieve method. Mandibular movements during speech were observed with a 3D jaw-tracking device. Data were analyzed with Student's t-test or the Mann-Whitney method (P < 0.05). The masticatory performance (mm) of control and hyposalivation were 4.40 ± 0.62 and 4.74 ± 1.34, respectively. Outcomes for speech movements (mm) were as follows: maximum vertical opening amplitude (10.8 ± 4.2; 9.9 ± 2.7) and displacements to the right (1.0 ± 0.8; 0.5 ± 0.6), left (1.8 ± 1.4; 2.3 ± 1.2), or anterior-posterior (2.8 ± 1.1; 2.9 ± 1.0) for control and hyposalivation, respectively. No statistical difference was found between groups for any variable. The results indicated that hyposalivation did not affect masticatory performance or mandibular movements during speech.

Effects of milk curd on saliva secretion in healthy volunteer compared to baseline, 2% pilocarpine and equivalent pH adjusted acetic acid solutions.

Background: Dry mouth is a common clinical problem, and different products have been proposed to improve it. In this investigation, the effects of "milk curd" on the amount of saliva secretion were studied. Materials and Methods: A total of 32 patients (aged 20-30) were selected from healthy volunteers. Milk curd concentrations of 0.5, 1, 2 and 4%, and 2% pilocarpine were prepared as drops. The impact of the drugs on the saliva weight was assessed after 1-5 min. To determine the effects of the pH of the milk curd on the amount of saliva secretion, different concentrations of acetic acid were used. Results: At the end of the first minute, the differences between the data for all groups were statistically significant, and the difference between the 2% and 4% milk curd groups was higher than the others (P < 0.0001). The differences in the amount of the saliva secreted at the end of the second minute between the baseline and 4% milk curd groups and between the 0.5% and 4% MC groups were significant (P = 0.006 and P = 0.025, respectively). In total, there was no significant difference between the effect of various pH treatments and the amount of baseline saliva secretion. Conclusion: Milk curd has a significant local impact, and the saliva increase depends on the dose. It seems that this effect is not only related to its acidic taste. As a result, factors other than pH are involved in the effect.

Pilocarpina no tratamento de xerostomia em pacientes submetidos à iodoterapia: estudo piloto / Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study

Xerostomia é uma queixa tardia frequente associada à iodoterapia. Terapias para o tratamento desta morbidade podem proporcionar melhora na qualidade de vida dos pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. OBJETIVOS: Relatar a experiência com o uso da pilocarpina no tratamento de xerostomia em pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. MATERIAL E MÉTODOS: Cinco pacientes preencheram os critérios de inclusão e receberam 5mg de pilocarpina, 3 vezes ao dia, por uma semana. Os efeitos colaterais do medicamento e a resposta subjetiva à queixa de xerostomia após o tratamento foram avaliados. DESENHO DO ESTUDO: Trata-se de um estudo prospectivo, não-randomizado. RESULTADOS: Sudorese foi o efeito colateral mais comum com o uso da pilocarpina, seguido por cansaço e dor de cabeça. Dois pacientes relataram alívio da xerostomia com o uso da medicação, mas somente um paciente foi capaz de tolerar os efeitos colaterais. CONCLUSÕES: Pilocarpina parece aliviar os sintomas de xerostomia em pacientes submetidos à iodoterapia, já que o medicamento é capaz de estimular o fluxo salivar. No entanto, os efeitos colaterais observados inviabilizam seu uso por recusa por parte dos pacientes em continuar a terapia por períodos mais longos.

Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. CONCLUSIONS: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation.

Manejo do paciente com hipossalivação / Management of hyposalivation patients

Inúmeras alterações sistêmicas, assim como uso de medicamentos poderão levar a um quadro de hipossalivação. Por sua vez, a redução do fluxo salivar propicia desconforto e aumenta a susceptibilidade a processos infecciosos. Para diminuir a morbidade causada pela hipossalivação propõe-se o uso de substitutos salivares e técnicas para o aumento do fluxo salivar, cuja indicação irá depender do fator etiológico e da gravidade da hipossalivação.

Many systemic conditions or impairments as the use of drugs may cause hyposalivation. When saliva is reduced, discomfort and infectious processes may occur as consequences. Salivary substitutes and some techniques for increasing salivary flow rates may be used in order to reduce morbidity from hyposalivation. The type of treatment will rely on the etiologic factors and severity of hyposalivation.

Avaliação do fluxo salivar em pacientes químico - Dependentes em recuperação / Avaliation of salivary secretion in drugs - Dependent Patients in recuperation

Esse estudo teve como objetivos comparar o fluxo salivar em pacientes químico-dependentes em recuperação com indivíduos que não fazem uso de drogas ou medicamentos e verificar a associação entre fluxo salivar e tempo de internação. Foi realizado exame do fluxo salivar em 48 indivíduos de ambos os sexos, 24 internados numa clinica privada de psiquiatria e dependência química no Município do Rio de Janeiro (Grupo 1) e outros 24 indivíduos, dentre pacientes e acompanhantes, abordados na sala de espera na FO-UFRJ e que se declararam não usuários de drogas ou medicamentos (Grupo 2). Analisando-se os resultados deste estudo, observou-se nos indivíduos do Grupo 1, com fluxo salivar maior ou igual a 0,7 ml/min, que a média do tempo de internação foi de 5,18 semanas, enquanto que, nos indivíduos com fluxo salivar menor que 0,7 ml/min foi de 18,14 semanas, indicando que o baixo fluxo salivar pode ser uma conseqüência do tempo de internação e do processo de recuperação. Concluimos que a interrupção do uso de drogas leva à normalidade da secreção do fluxo salivar. Entretanto, nos indivíduos com maior tempo de medicação, durante o tempo de internação, apresentavam fluxo salivar reduzido, possivelmente devido à utilização prolongada de medicamentos no processo de recuperação.

The study aim was to compare the salivary secretion in drug-dependent patients in recuperation to patients whose didn't use drugs or medications and verified the association between salivary and the time interned using medications. Salivary secretion of 48 patients, both sexies were examined, 24 interned in a privated clinic of psychiatry and drug-dependents in Rio de Janeiro city (Group 1) and 24 people (patients and companions) were in reception of odontology university of UFRJ. They declared not use any kind of drugs (Group 2). Results were analysed in this study and observed in Group 1, patients with salivary secretion less than 0,7 ml/min were interned 18,14 weeks, evidencing the hiposalivation is associated to time of patients been interned to time of recuperation. Drugs interruption give to patients normal salivary secretion, however the prolonged time interned suggested a decrease salivary secretion draw on a prolonged use of medications by recuperation treatment.

Fluxo salivar e uso de drogas psicoativas em idosos / Salivary flow and psychoactive drug consumption in elderly people

OBJETIVO: Analisar a associação de fluxo salivar baixo e o uso de drogas psicoativas entre idosos. MÉTODOS: Estudo transversal com 267 idosos de 60 a 74 anos, residentes em um bairro na cidade de Londrina/PR. Foram excluídos os idosos com alto grau de dependência funcional e os restritos ao leito. O fluxo salivar abaixo de 0,44 ml/min (primeiro tercil) foi analisado como variável dependente, e o uso contínuo de drogas psicoativas (antidepressivos, anticonvulsivantes, sedativos, antipsicóticos, hipnóticos ou ansiolíticos) foi considerado como variável independente. A análise multivariada foi realizada considerando a interferência do sexo, da idade e do tabagismo. RESULTADOS: A maioria dos idosos estudados foi do sexo feminino (80,5 por cento), com uma média de idade de 66,5 anos. O uso de drogas psicoativas foi observado em 31 idosos (11,6 por cento). O fluxo salivar médio foi de 0,76 ml/min, sendo que nos usuários de drogas psicoativas foi de 0,67 ml/min. Na análise multivariada, a utilização de drogas psicoativas estava associada ao fluxo salivar <0,44 ml/min, independentemente do sexo, da idade e do tabagismo (p= 0,04). CONCLUSÃO: Os resultados mostram que, neste grupo de idosos independentes e não institucionalizados, há uma associação entre o uso de drogas psicoativas e o baixo fluxo salivar. Estas conclusões fortalecem a necessidade do uso racional destas drogas, principalmente em indivíduos idosos.

OBJECTIVE: To analyze the association between low saliva flow rates and the use of psychoactive drugs among the elderly. METHODS: A cross-sectional study was carried out with 267 elderly people from 60 to 74 years of age who lived in a borough of the city of Londrina, Paraná State, Brazil. Individuals with high functional dependence or restricted to bed were excluded. Saliva flow rate was the dependent variable with values under the first tercile being considered as low flow rates (less than 0.44 ml/min). The continuous use of psychoactive drugs (antidepressant, antiepileptic, sedative, antipsychotic, hypnotic or sedative-hypnotic drugs) was the independent variable. Multivariate analysis was performed taking into account gender, age and smoking status. RESULTS: The majority of the elderly were women (80.5 percent), with a mean age of 66.5 years. Use of psychoactive drugs was observed among 31 elderly (11.6 percent). Mean saliva flow rate was 0.76 ml/min, lower among users of psychoactive drugs (0.67 ml/min). In the multivariate analysis, use of psychoactive drugs was associated with low saliva flow rates (<0.44 ml/min), independent of gender, age or smoking. CONCLUSION: Results show that there is an association between use of psychoactive drugs and low saliva flow rates in this group of independent and non-institutionalized elderly. These conclusions stress the need of a rational use of these drugs, particularly among the elderly.

Pentoxifylline therapy: a new adjunct in the treatment of oral submucous fibrosis.

OBJECTIVE: This study was designed to determine the effect of pentoxifylline (Trental) on the clinical and pathologic course of oral submucous fibrosis. This drug is a methylxanthine derivative that has vasodilating properties and was envisaged to increase mucosal vascularity. STUDY DESIGN: This investigation was conducted as a randomized clinical trial incorporating a control group (Standard drug group SDG, multivitamin, and local heat therapy) in comparison to pentoxifylline test cases (Experimental drug group EDG, 400mg 3 times daily, as coated, sustained release tablets). The stipulated treatment period was 7 months and a total of 29 cases of advanced fibrosis (14 test subjects and 15 age and sex matched diseased controls) were included in this study and 100% compliance was reported at the end ofthe test period. RESULTS: Mild gastric irritation that could be managed by diet protocols was the only untoward symptom reported during this trial. Review of the patients and controls was done at an interval of 30 days and subjective and objective measurements were recorded. The follow up data at each visit with respect to each other and to base-line values was calibrated using a nonparametric test of Mann-Whitney (Kruskal-Wallis test). Significant comparisons with regard to improvement were recorded as objective criteria of mouth opening (t=11.285, p= 0.000), tongue protrusion (t= 3.898, p = 0.002), and relief from perioral fibrotic bands (p = 0.0001554). Subjective symptoms of intolerance to spices (p = 0.0063218), burning sensation of mouth (p = 0.0005797), tinnitus (p=0.000042), difficulty in swallowing (p=0.0000714). and difficulty in speech (p=0.0000020) were also recorded significant improvement at the end of the trial period. CONCLUSION: This pilot investigation points to the effectiveness of pentoxifylline as an adjunct therapy in the routine management of oral submucous fibrosis.

Effect of habitual arecanut chewing on resting whole mouth salivary flow rate and pH.

BACKGROUND: Resting whole mouth salivary flow rate (SFR) and pH play a significant role in pathogenesis of various oral diseases and conditions. AIM: To observe the effect of habitual use of arecanut and various arecanut containing products (AN) on SFR and pH. DESIGN: Cross sectional. SETTING: Outpatient Department of Dental College. PARTICIPANTS: AN chewers and non-chewers attending Dental college. MEASUREMENTS: SFR and pH. VARIABLES: Type, frequency, duration and exposure time of AN, Smoking and Alcohol habit. MATERIALS AND METHODS: Subjects study was divided into chewers (n=110) and non- chewers (n=50). The SFR (expressed in mL/10min) and pH measured. RESULTS: The difference between the mean SFR for chewers and non-chewers was not statistically significant. The difference between mean pH of chewers and non-chewers was statistically significant. (P=0.02). Difference in pH was statistically significant among the different types of AN chewers (P=0.024). With chewing raw AN, an increase in frequency and exposure time increased SFR and pH respectively. In processed AN chewers, increase in duration and frequency of consumption increased SFR and decreased pH respectively. For chewers with betel quid with tobacco, increase in duration was significantly associated with decrease in salivary pH. CONCLUSION: SFR and pH are altered in AN chewers, rendering the oral mucosa vulnerable to the toxic effects of AN.

Dose response of sulphur mustard: behavioral and toxic signs in rats.

The present study elucidates the behavioral and toxic signs in rats following dermal application of sulphur mustard (SM). Graded doses of SM (0.10, 0.25, 0.50, 0.75 and 1.0 LD50) were topically applied to male Wister rats. The body weight as well as behavioral/toxic signs and symptoms were recorded at 1, 2, 3, and 4th day after application of SM. Sulphur mustard consistently decreased body weights of rats in a dose and time dependent manner with maximum decrease on 3rd day post treatment. Sedation and diarrhea were significant in response to doses of SM intoxication in rats. It is concluded that the body weight, sedation and diarrhea may be used as a reliable parameter in evaluating SM intoxication. It is also suggested that hydration and hypertonic saline must be used as a rescue agent within 1-3 days after exposure to SM.

Reduction of secretory responses of salivary glands to cholinergic and adrenergic silogogues in rats in early stages of diabetes mellitus

A dry mouth caused by decreased salivary secretion is a common complication in human diabetes mellitus. Diabetes was induced in rats using two different pancreatic Beta-cells toxins, streptozotocin [STZ] and alloxan. Two weeks after induction of diabetes, pilocarpine-, isoproterenol-, and phenylephrine-induced salivary secretion were estimated and compared to control normal rats. Diabetic rats showed significant decrease in the total volume of crude saliva in response to pilocarpine and isoproterenol but not to phenylephrine. Correction of the diabetic condition by giving insulin subcutaneously resulted in significant improvement of salivary glands response to sialogogues. Taken together, these results suggest that salivary glands dysfunction that occurs early in diabetes is probably due to metabolic deterioration in the acinar cells due to insulin insufficiency, rather than due to developing autonomic neuropathy that may affect salivary glands function in long-term diabetes

Evaluation of antimuscarinic activity in human volunteers: a teaching aid in clinical pharmacology.

The antimuscarinic activity of oxyphenonium bromide, diphenhydramine hydrochloride and astemizole were evaluated in six volunteers. The parameters used were salivary secretion, heart rate and pupillary size. The results indicated that the changes in heart rate and pupillary size and measurements were not convenient parameters for class room demonstration. However, salivary secretion and dryness of mouth were found to be reliable parameters for measurement. It was concluded that simple procedures like evaluation of antimuscarinic activity could be introduced as teaching aids in clinical pharmacology for undergraduate students.