Title	Adults Who Are Chronic Crack Cocaine Users May Be at Increased Risk of Developing Periodontal Disease
Clinical Question	In adults, does chronic usage of crack cocaine lead to an increased risk of periodontal disease as measured by clinical attachment loss?
Clinical Bottom Line	The findings from a limited number of cross-sectional studies suggest that adults who are chronic crack cocaine users may be at increased risk of developing periodontal disease.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 27389964 Antoniazzi/2016 106 previous crack cocaine users and 106 individuals who have never been exposed Cross-sectional Key results The prevalence of periodontal disease for non-crack users was 20.8% while for crack users it was 43.4%. This is evidenced by the finding that crack users were more likely to exhibit clinical attachment loss greater than 4 mm. In addition, they were found to be more likely to exhibit bleeding on probing, a higher visible plaque index, and probing depths greater than 3 mm. Crack users had an approximately three-fold greater chance (odds ratio: 3.44; 95% confidence interval: 1.51 to 7.86) of periodontal disease than non-users. 27866365 Cury/2017 160 adult males, some of whom are crack and cocaine abusers Cross-sectional Key results Crack- and cocaine-addicted individuals were found to have significantly higher probing depth (2.84 ± 0.76 mm) compared to non-crack/cocaine abusers (2.55 ± 0.73 mm, p = 0.04). However, there was no significant association between periodontal disease and crack/cocaine dependence (OR = 2.31, 95 % CI = 0.82-6.46, p = 0.11). 27982490 Casarin/2017 74 crack cocaine users and 81 non-crack cocaine users Cross-sectional Key results Crack-addicted individuals had a 1.85 (95% CI: 1.03-3.31), 2.19 (95% CI 1.24-3.88), 2.53 (95% CI 1.27-5.04) and 2.40 (95% CI 1.22-4.75) greater probability of having higher counts (considered ≥75th percentile) for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia and Fusobacterium nucleatum, respectively. However, compared to the non-crack users, there was no significant difference in the prevalence of total counts for each bacterial species.
Evidence Search	("crack cocaine"[MeSH Terms] OR ("crack"[All Fields] AND "cocaine"[All Fields]) OR "crack cocaine"[All Fields]) AND ("periodontitis"[MeSH Terms] OR "periodontitis"[All Fields])
Comments on The Evidence	Validity: Strengths of all three studies include a clear definition of the sample groups. Each study matched subjects in the test and control groups for variables such as gender, tobacco use, and age. Periodontal probing depths in multiple sites were measured. The study protocols were consistently applied to all groups. Weaknesses include the scarcity of comparative studies and the small sample sizes in all three studies. Perspective: The main limitation with this compilation of studies is their cross-sectional design and inconsistency with parameters of periodontal disease. A systematic review or meta-analysis would strengthen and give further credence to the scientific question. While a prospective study like a cohort study or a double-blind randomized control trial would be more ideal, it may raise the ethical question of enrolling participants who knowingly use illegal drugs. The limited studies available suggest an association between crack cocaine use and periodontal disease using different indicators. The first study (Antoniazzi/2016) found that chronic crack cocaine usage leads to greater clinical attachment loss and an increase in probing depths. The second study (Cury/2017) noted a significant increase in probing depths. The third study (Casarin/2017) found that crack cocaine abusers had a higher number of periodontopathogens compared to non-abusers. The Cury study specifically mentioned it did not find a strong relationship between periodontal disease and crack cocaine abuse, yet the Antoniazzi study did find an association. The Casarin study did not look for a specific relationship between the two.
Applicability	Chronic crack cocaine usage is a prevalent problem in society today and has been shown to negatively affect general health status (Falck RS, et al., 2000). As dentists and oral health care specialists, it is critical to understand the consequences chronic crack cocaine usage may have on the oral cavity. Two out of the three studies presented here reported increased periodontal probing depths, and one of those also found a higher prevalence of periodontal disease among users. The third study found higher bacterial counts associated with periodontal disease among crack cocaine users. Other studies (Almeida TC, et al., 2012 and das Gracas Alonso de Oliveira M, et al., 2014) have reported a positive correlation between crack cocaine usage and nuclear changes in oral mucosal cells. These findings suggest that oral health care providers should be aware of all potential negative oral health effects among crack cocaine users. Oral health care providers for these patients should conduct oral cancer screenings, proper oral hygiene instructions, regular follow-up appointments, and maintenance of periodontal health.
Specialty	(Public Health) (Periodontics)
Keywords	Crack, cocaine, periodontal disease, periodontitis
ID#	3195
Date of submission	03/30/2017
E-mail	SETHIS@livemail.uthscsa.edu
Author	Shravik Sethi
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Nuala Porteous, DDS, MPH
Faculty mentor e-mail	porteous@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Brian Ross (San antonio) on 09/23/2022 I am curious if the data gathered has accounted for the variation of self care these patients may have. Or if there is a correlation to other drug use and overlap that may amplify risk for periodontal disease.