Oral changes in cocaine abusers: an integrative review

Melo, César Antonio Araújo; Guimarães, Hanna Rabech Garcia; Medeiros, Raphael Crhistian Fernandes; Souza, Georgia Costa de Araújo; Santos, Patrícia Bittencourt Dutra dos; Tôrres, Ana Clara Soares Paiva

doi:10.1016/j.bjorl.2021.04.011

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Brazilian Journal of Otorhinolaryngology

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REVIEW ARTICLE • Braz. j. otorhinolaryngol. 88 (4) • Jul-Aug 2022 • https://doi.org/10.1016/j.bjorl.2021.04.011 copy

Oral changes in cocaine abusers: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Cocaine is one of the most often used psychoactive drugs worldwide, being extracted from the leaves of Erytroxylus coca plant. Its abusive use can trigger several consequences for the human body, including the oral cavity.

Objective:

To identify the oral disorders that are most commonly found in individuals who abuse cocaine, in addition to the main diagnostic and treatment methods.

Methods:

An integrative review was carried out on the databases: LILACS, BBO, LIS, MEDLINE, SciELO, Science Direct and PubMed. The following keywords were used: ‟Cocaína”, ‟Boca”, ‟Palato” and ‟Odontologia”, together with their synonyms and variations in English, obtained from DeCS andMeSH. The inclusion criteria were original articles, articles in Portuguese, English and Spanish, studies involving individuals, without restriction related to the year of publication. Animal studies, literature reviews, book chapters, theses and dissertations were excluded.

Results:

In total, 1373 records were identified. Of these, 22 articles were selected to comprise the review. Several oral alterations caused by cocaine abuse were found, primarily perforation of the palate, predisposition to periodontal diseases, temporomandibular disorders, bruxism, damage to oral tissues, dental caries, destructive lesions of the facial midline, xerostomia and ageusia. Among the diagnostic methods used by the professionals, anamnesis, intraoral examinations and head and neck computed tomography were the most frequently mentioned. As for treatment, in patients with palatal perforation, the reconstruction of the affected area or the use of prosthetic obturators is carried out.

Conclusion:

The management of these patients is not an easy task, as many of the users do not even seek professional help. The health professionals must be able to recognize these manifestations and alterations to establish timely and accurate diagnosis and treatment planning. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/).

HIGHLIGHTS

Integrative review aiming to detect oral changes in cocaine abusers.
The main oral changes, methods of diagnosis and treatment were identified.
Good anamnesis and qualified health professionals are necessary.

Portals/databases	Search strategy
LILACS, BBO, LIS e MEDLINE (BVS)	(‟Cocaína” OR ‟Cocaine” OR ‟Transtornos Relacionados ao Uso de Cocaína” OR ‟Cocaine-Related Disorders” AND ‟Odontólogos” OR ‟Dentists” OR ‟Odontologia” OR ‟Dentistry” AND ‟Palato” OR ‟Palate” OR ‟Boca” OR ‟Mouth” OR ‟Maxila” OR ‟Maxilla”)
SciELO	(‟*Cocaína” OR ‟Cocaine” AND ‟Palato” OR ‟Palate” OR ‟Boca” OR ‟Mouth” OR ‟Maxila” OR ‟Maxilla”)
Science Direct	(‟Cocaína” OR ‟Cocaine” OR ‟Transtornos Relacionados ao Uso de Cocaína” OR ‟Cocaine-Related Disorders” AND ‟Odontologia” OR ‟Dentistry” AND ‟Palate” OR ‟Palato”)
PubMed	(‟Cocaine” [MeSH Terms] OR ‟Cocaine-Related Disorders” [MeSH Terms] AND ‟Dentistry” [MeSH Terms] AND ‟Mouth” [MeSH Terms])

Authors/year	Country	N. of patients	Age (years)	Gender	Design	Main oral lesions or alterations	Outcome
Antoniazzi et al. (2017)¹⁹19 Antoniazzi RP, Sari AR, Casarin M, Moraes CMB, Feldens CA. Association between crack cocaine use and reduced salivary flow. Braz Oral Res. 2017;31:e42.	Brazil	80	–	–	Cross-sectional study	Reduction of salivary flow	Significant association between the use of crack-cocaine and reduced salivary flow.
Antoniazzi et al. (2018)¹⁵15 Antoniazzi RP, Lago FB, Jardim LC, Sagrillo MR, Ferrazzo KL, Feldens CA. Impact of crack cocaine use on the occurrence of oral lesions and micronuclei. Int J Oral Maxillofac Surg. 2018;47:888–95.	Brazil	212	–	–	Cross-sectional study	Cell alterations in the oral mucosa (karyolysis, karyorrhexis, ‟broken egg” events and micronuclei)	Crack-cocaine users had a higher incidence of fundamental lesions.
Bains et al. (2005)²⁰20 Bains MK, Hosseini-Ardehali M. Palatal perforations: past and present. Two case reports and a literature review. Br Dent J. 2005;199:267–9.	United Kingdom	2	36 and 70	M	Case report and literature review	Palatal perforation	There is a relationship between palatal perforation and cocaine use.
Onate et al. (2018)²¹21 Barrera OM, Rivera VM, Vela UJ, Barrera MR, Mönckeberg FG. Lesiones destructivas de la línea media facial secundarias al consumo de cocaína. Caso clínico. Rev Med Chil. 2018;146:1070–3.	Chile	1	44	M	Case report	Destructive lesions in the midline	It was possible to diagnose a destructive lesion in the midline induced by cocaine, through the histological findings.
Blanco et al. (2017)²²22 Blanco GF, Madeo MC, Martínez M, Vázquez ME. Case for diagnosis. Palate perforation due to cocaine use. An Bras Dermatol. 2017;92:877–8.	Argentina	1	42	F	Case report	Palatal perforation	Palatal defects create functional difficulties related to speech and swallowing. Prosthetic rehabilitation with an obturator may be necessary to restore the function.
Brusati et al. (2009)²³23 Brusati R, Carota F, Mortini P, Chiapasco M, Biglioli F. A peculiar case of midface reconstruction with four free flaps in a cocaine-addicted patient. J Plast Reconstr Aesthetic Surg. 2009;62:e33–40.	Italy	1	46	F	Case report	Destruction of bone tissue in the facial midline, palate, anterior skull base, frontal bone and left orbital bone.	Extensive destruction of the craniofacial region, where four free flaps in association with the base of the skull and forehead are reconstituted with bone grafts and the use of implants.
Chaiben et al. (2014)²⁴24 Chaiben CL, Fernandes Â, Martins MC, Machado MÂN, Brancher JA, Lima AAS. Disorders of taste function in crack cocaine addicts. Pol Przeglad Otorynolaryngol. 2014;3:32–6.	Brazil	60	21 to 45	F	Experimental study	Loss of taste	The users found it difficult to recognize the salty, sweet and bitter tastes. Overall, the users mistook the salty flavor for sour or bitter taste and 20 (66.6%) were diagnosed with hypogeusia.
Chaparro-González et al. (2018)²⁵25 Chaparro-González NT, Fox-Delgado MA, Pineda-Chaparro RT, Perozo-Ferrer BI, Díaz-Amell AR, Torres V. Manifestaciones bucales y maxilofaciales en pacientes con adicción a las drogas. Odontoestomatologia. 2018;20:24–31.	Venezuela	32	On average 37.7	M and F	Descriptive observational field study	Caries and periodontal disease	The most frequently used drugs were crack, followed by cocaine and marijuana. There is a predominance of caries (87.5%), followed by the presence of signs of periodontal disease.
Cury et al. (2018)²⁶26 Cury PR, Araujo NS, Oliveira MGA, Santos JN. Association between oral mucosal lesions and crack and cocaine addiction in men: a cross-sectional study. Environ Sci Pollut Res. 2018;25:19801–7.	Brazil	161	≥18	M	Cross-sectional observational study	Traumatic ulcer, actinic cheilitis, and fistula associated with retained tooth root	Prevalence of oral mucosa lesions (traumatic ulcer, actinic cheilitis, and fistula associated with retained tooth root) was higher in crack/cocaine addicts and crack/cocaine addiction was significantly associated with the occurrence of oral mucosa lesions.
Cosola et al. (2007)²⁷27 Cosola M, Turco M, Acero J, Navarro-Vila C, Cortelazzi R. Cocaine-related syndrome and palatal reconstruction: report of a series of cases. Int J Oral Maxillofac Surg. 2007;36:721–7.	Italy and Spain	6	29 to 46	M and F	Case series	Palatal perforation	In all described cases, perforation of the nasal septum occurred first, followed by extensive destruction of the nasal and paranasal sinuses, with progression to palatal necrosis.
Dovigi et al. (2015)²⁸28 Dovigi A, Natarajan E. Clinical pathologic conference case 2: Palatal perforation. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:e292–5.	USA	1	41	M	Case Report	Palatal perforation	Midline destructive lesions induced by cocaine are a result of ischemic necrosis triggered by cocaine in a small subset of cocaine users, especially those who are predisposed to producing ANCA.
Hofstede et al. (2010)²⁹29 Hofstede TM, Jacob RF. Diagnostic considerations and prosthetic rehabilitation of a cocaine-induced midline destructive lesion: a clinical report. J Prosthet Dent. 2010;103:1–5.	USA	1	48	M	Case Report	Midline destructive lesions	Palatal defects (erosion of the palate, nasal septum and inferior nasal turbinates) create functional difficulties related to speech and swallowing. Subsequent prosthetic rehabilitation with an obturator may be necessary to restore function in this group of patients.
Maia et al. (2012)³⁰30 Maia CBC, Felix F, Paes V, Azevedo JA, Grangeiro ERN, Riccio JLN, et al. Nasal septum perforation in patient with pyoderma gangrenosum. Int Arch Otorhinolaryngol. 2012;16:278–81.	Brazil	1	27	F	Case Report	Pyoderma Gangrenosum	The association between Pyoderma Gangrenosum and cocaine use is poorly described, since there are only two cases in the literature.
Martinez et al. (2014)³¹31 Crovetto RM, Whyte Orozco J, Cisneros AI, Crovetto de la Torre MA. Lesión necrotizante de la línea media con fístula oronasal causada por inhalación de cocaína. Av Odontoestomatol. 2014;30:63–7.	Spain	1	45	F	Case Report and Literature Review	Destructive lesions of the midline with oronasal fistula	In the presence of necrotic lesions in the midline, with inconclusive nasal biopsies, the associated presence of palatal perforation is more typical of destructive midline lesions induced by cocaine or extranodal lymphoma than Wegener’s granulomatosis.
Rosas et al. (2006)³²32 Rosas MP, Jimenez Santos CI, García González CL. Palatine perforation induced by cocaine. Med Oral Patol Oral Cir Bucal. 2006;11:153–6.	Mexico	1	48	F	Case Report	Palatal perforation	The abusive intranasal cocaine use can induce necrosis and focal ischemia, which causes destruction of the secondary mucosa and the mid-facial bone.
Paradisi et al. (2020)³³33 Paradisi E, Cabrero MC. Perforación de la bóveda palatina por consumo de cocaína: reporte de un caso. Rev Soc Odontol La Plata. 2020;30:9–12.	Argentina	1	37	M	Case Report	Palatal perforation	The lesions present in the oral cavity as a result of medication use are irreversible if there is no control over time.
Pelo et al. (2008)³⁴34 Pelo S, Gasparini G, Di Petrillo A, Tassiello S, Longobardi G, Boniello R. Le Fort I osteotomy and the use of bilateral Bichat bulla adipose flap: an effective new technique for reconstructing oronasal communications due to cocaine abuse. Ann Plast Surg. 2008;60:49–52.	Spain	1	45	M	Case Report	Oronasal communication	Le Fort I osteotomy and the use of the Bichat’s fat pad as a bilateral flap is an effective technique in the correction of small and medium-sized oronasal communications that cannot be resolved with a simple oral mucosa flap.
Candina et al. (2013)³⁵35 Candina HR, Batista AH, Betancourt AM. Periodontopatías en jóvenes y adolescentes adictos a drogas psicoactivas, atendidos en el centro de deshabituación de adolescentes, del municipio Playa. Rev Cuba Investig Biomed. 2013;32:178–85.	Cuba	43	13 to 29	M and F	Cross-sectional observational study	Periodontal diseases	Drug addicts had a high frequency of periodontal diseases, such as mild and moderate gingivitis and gingivitis with pocket formation, without periodontitis.
Shibli et al. (2005)³⁶36 Shibli JA, Marcantonio E, Spolidorio LC, Marcantonio E. Cocaine associated with onlay bone graft failure: a clinical and histologic report. Implant Dent. 2005;14:248–51.	Brazil	1	27	M	Case Report	Unusual onlay bone graft failure	Gingival recession and dental erosion have been associated with the local application of cocaine and its intense vasoconstrictor effect, which is responsible for these effects.
Sordi et al. (2017)³⁷37 Sordi BM, Massochin RC, Camargo AR, Lemos T Munhoz EA. Oral health assessment for users of marijuana and cocaine/crack substances. Braz Oral Res. 2017;31:1–11.	Brazil	35	19 to 56	M and F	Cross-sectional study	Reduction in the salivary flow rate and mucosal lesions, aphthous stomatitis, frictional keratosis, candidiasis, tooth extraction scars and depapillation of the tongue	Illicit drug users, mainly of cocaine (77.15%), showed a reduction in the salivary flow rate and an increase in the number of lesions.
Stahelin et al. (2012)³⁸38 Stahelin L, Cristina S, Souza DM, Neves FS. Lesões destrutivas da linha média induzidas por cocaína com ANCA positivo mimetizando a granulomatose de Wegener. Rev Bras Reumatol. 2012;52:4–7.	Brazil	1	43	F	Case Report	Midline destructive lesions	Although the ANCA test does not clearly differentiate the ANCA found in some patients with MDL from those in patients with WG, localized involvement and biopsy findings not typical of small vessel granulomatous vasculitis should be recognized as characteristics of cocaine-induced lesions.
Tsoukalas et al. (2000)³⁹39 Tsoukalas N, Johnson CD, Engelmeier RL, Delattre VF. The dental management of a patient with a cocaine-induced maxillofacial defect: a case report. Spec Care Dent. 2000;20:139–42.	USA	1	46	F	Case Report	Palatal perforation by three oronasal fistulas	Chronic nasal cocaine users can go to a dental office for routine care. If the dentist suspects cocaine abuse, all comprehensive treatment should be suspended until medical clearance.

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[1] * Corresponding author. E-mail: cesar.a.a.melo@gmail.com (C.A. Melo).