Running head: ORAL AND MENTAL HEALTH IN CONNECTION TO STIMULANT DRUG

USE
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The Relationship between Oral and Mental Health in Connection to Stimulant Drug Use

Kaylee Dreckman and Tori Touchet

Lamar Institute of Technology

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Abstract

There has been a steady increase in stimulant drug use over the past 12 years, mainly due to a

greater use among adolescents (Zuvekas and Vitiello, 2013). A stimulant drug is a substance that

raises levels of physiological or nervous activity throughout the brain and the body. Stimulants

include a wide range of drugs from Adderall for ADHD to crack cocaine. There are prescription

and non prescription stimulant drugs, both in which may be misused.Stimulant drugs may make

people more alert, increase their attention and raise their blood pressure, heart rate and breathing

(NIDA, 2014). As stimulant drug use is on the rise, it is important for the dental professionals to

be aware of different side effects of these drugs that may alter or affect the dental procedure.

Some side effects of stimulant drug use may be increased dental caries, Xerostomia, sever tooth

decay, tooth loss and fractures, acid erosion, and bruxism. A patient who is taking a stimulant

drug may have anxiety, decreased appetite, be nervous or panic. Some long term effects may be

extreme weight loss, muscle deterioration, gastrointestinal problems, chronic exhaustion,

breathing problems, headaches, strokes, and seizures. Long term psychological effects may be

hallucinations, delusions, persistent anxiety, paranoia, and depression (NIDA, 2014). A stimulant

drug users nutrition is also going to be compromised over time. People who become addicted to

these stimulant drugs suffer from physical, physiological, emotional and behavioral problems.

All of these factors have an impact on the health of the periodontium (Saini, Prahbat, and Gupta,

2013).

Keywords: Stimulants, ADHD, oral health, dental procedures

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The Relationship between Oral and Mental Health in Connection to Stimulant Drug Use

What are stimulant drugs? Stimulant drugs are substances that raise levels of

physiological or nervous activity throughout the brain and the body (NIDA, 2016). Stimulant

drugs historically were used to treat asthma and other respiratory problems, obesity, neurological

disorders, and a variety of other ailments. Consequently as their potential for abuse and addiction

became apparent the medical use of stimulant drugs decreased. Today stimulant drugs are used to

treat only a few health conditions. These conditions include ADHD, narcolepsy, and occasionally

depression. Stimulant drugs increase alertness, attention, and energy, as well as elevate blood

pressure, heart rate, and respiration.There are prescription and non prescription stimulant drugs,

both in which may be misused (NIDA, 2014). In the past 10 years there has been an increase in

the prevalence rate of nonprescription stimulant use in adolescents and young adults

(Lakhan&Kirchgessner, 2012).Stimulant drugs can affect oral procedures and the mental state of

the patient. Stimulant drug such as ADHD medications, like Vyvanse,Adderall, or Ritalin and

schedule II narcotic such as methamphetamine, ecstasy, and cocaine can cause several adverse

effects in the oral cavity. Not only will these drugs reduce oral health, they can also affect the

mental state such as increasing anxiety, depression, and psychological issues (NIDA, 2014). 30%

of prescribed Adderall is estimated to be used illegally, not for its prescription use (Hart, 2016).

It is very important for a dental hygienist to be aware if the patient is on stimulant drugs, whether

prescription or non-prescription and the risk the patient may be at taking these stimulant drugs.

This will help the hygienist to properly educate the patient and help them experience a calm

dental visit(Shaikh, Modi, &Munde, 2014).

Attention deficit hyperactivity disorder (ADHD) medications such as Vyvanse, Ritalin,

and Adderall are known as stimulant drugs. These prescription stimulant drugs manage the
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symptoms of ADHD and have many effects on oral and mental health. There are several

potential adverse effects for chronic stimulant use in the oral cavity. For example healthy saliva

plays an important role in the prevention of dental caries. Medications commonly used to treat

ADHD cause a reduction in saliva flow which leads to xerostomia. The reduction in saliva flow

increases the risk for dental caries. Studies have shown a child with ADHD has had nearly 10

times the odds of having a high decayed, missing or filled teeth than children who did not have

ADHD. Bruxism has also been linked to ADHD medications and can cause further problems in

our patients. Bruxism can lead to TMJ issues and damaged teeth. Treating ADHD can be

challenging because not only does it affect oral health it also affects mental health. ADHD

medications can exacerbate anxiety symptoms and irritability (Williams, Kumar, Rosenberg,

2014). As dental professionals we can understand that our patients are already having dental

anxiety along with the stimulant drug anxiety. This anxiety can further increase our patients to

have panic attacks leading to hyperventilation (Story, 2016). ADHD medications can also have

an effect on our appetites leading to anorexia and low blood sugar. Large doses of stimulants can

lead to psychosis, seizures, and cardiovascular events. The most commonly observed

cardiovascular events linked with ADHD stimulant medications are hypertension and tachycardia

(Lakhan&Kirchgessner, 2012).Other stimulant drugs such as methampetamine, cocaine, and

ecstacy also have effects on the oral cavity.

Schedule II narcotics, methamphetamine, cocaine, and ecstasy, are also stimulant drugs

that are important for the dental professionals to beware of. They are considered Schedule II

drugs meaning that they provide positive medicinal effects but also considerable abuse potential

(Lakhan&Kirchgessner, 2012).There are many oral health issues to be aware of because of their

high abuse potential.As health care workers, dental hygienists have the responsibility to be
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educated on the symptoms of schedule II drug use and the precautions to take when treating

these patients. These drugs reach their peak at about 2-3 hours after taken. It is important for the

dental hygienist to be aware of symptoms of a patient on these drugs, because the patient may

need to be rescheduled for a later date if they have taken methamphetamines, cocaine, or ecstasy

due to an increased risk of oral infection because of the immunosuppressive effects (Saini,

Prabhat, & Gupta, 2013). Oral signs of people who have been using these stimulant drugs for a

while may be significant and severe. As a dental hygienist you may be the first person to

recognize the symptoms of drug use. If a person comes in with lots of interproximal caries on

their anterior teeth, you may assume they are using some type of drug, most likely

methamphetamine. There may be an aggressive erosion of enamel leading to destruction of

periodontal tissue. The amount of caries may resemble early childhood caries or radiation caries,

but when it is this severe and lacking the etiology for that then it has to be narrowed down more.

The cause for dental diseases associated with stimulate drugs comes from the nature of the drug

along with lack of dental visits and poor oral hygiene. Other factors that may be present would

be dental decay and tooth fractures due to cravings for high sugar foods and beverages, extreme

Xerostomia reducing the amount of saliva for its buffering ability, and bruxism caused from

clenching and grinding. Dental caries and periodontal disease is more common in stimulant drug

users than the general population. This may be caused from more plaque buildup due to poor oral

hygiene and gingival bleeding will be present.The route of transmission of the drug is also a key

factor in the symptoms observed. If the drug is smoked or snorted the ingredients of the drug

may irritate or burn the oral cavity causing ulcers and infections. The most commonly misused

drug is methamphetamine, and most of these symptoms will be present in a user. The oral health
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of a person is strongly affected by stimulant drug use, but their mental state of health is also

affected as well(Shaikh, Modi, &Munde, 2014, p. 6-8).

It is not only important for a dental hygienist to be aware of a patients oral health, but

aware of their mental state of health too. It is important for they hygienist to be aware of a

patients mental state because of how they may behave in the office. Behavioral side effects of

users my last for hours or even days. They may experience prolonged periods of insomnia and

increased activity and they also may experience undesired effects like bizarre behavior, tremors,

and/or slurred or rapid speech. There are also psychological effects that come along with using

stimulant drugs. The patient may have anxiety, seemed confused, have depression, or become

paranoid very easily.This would cause the patient to be less cooperative at the appointment.

People that are using methamphetamines may also hallucinate. Higher than normal anxiety levels

in a dental office may be problem, because a lot of patients already have a fear of going to the

dentist office (Shaikh, Modi, &Munde, 2014, p. 7). Adverse reactions with stimulants are

possible with many anesthetics used in dentistry resulting in elevated blood pressure and heart

rate. Discuss ADHD medications with patients to determine appointment time. A patient should

consider delaying morning dose until after the dental appointment. Make sure to take vital signs

before and during the procedure when treating someone who is taking stimulant drugs (Frare and

pyBerrios, 2013).

It is very important to recognize if the patient is using stimulant drugs to better assist

them for their oral health and dental visits. Recognizing that the patient is on a stimulant drug

can help the hygienist prepare important patient education topics and taking the proper steps on

making sure the patient is comfortable and calm. Explain to the patient about how xerostomia is

a side effect from stimulant drugs. When the patient does have xerostomia make sure to
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recommend they chew sugar free gum, take sips of water throughout the day, make sure mouth

rinses do not contain alcohol, or over the counter saliva substitutes. Explain to patient how

dental caries can lead to pathological infections, tooth pain, and potentially tooth extraction.
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References

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Abuse, N. I. (n.d.). (2106). What are stimulants?

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Hart, C., Dr. (2016, August 15). Is Adderall the same as Meth?
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