The use of illicit drugs, in particular heroin, can have profound effects on the dentition, causing rampant caries, advanced periodontal disease and exacerbation of mucosal diseases. In surveys of injecting drug users, up to 70%, reporting concern about the state of their mouths, described problems such as 'teeth snapping off', 'teeth falling apart', gum disease and trauma. Methadone and methamphetamines are perceived by some injecting drug users to 'eat away their teeth'.1This may be partly related to the effect these drugs have on salivary flow, dietary changes and the concomitant long-term lack of oral hygiene.

Dentists can therefore be confronted with patients presenting with acute dental pain who are either currently dependent or are recovering from their dependency. It is essential that our attitudes, and those of our staff, do not become barriers to effective management of these patients' pain. Self-reporting of the degree of dental pain must be accepted on face value, as the experience of pain is totally subjective in nature and these patients' pain thresholds may have been significantly affected by long-term drug use. This can result in diagnostic dilemmas with the reported pain appearing out of proportion to the clinical signs.

Most dental pain can be treated clinically with effective local anaesthesia, interventional dental treatment and in the immediate post-treatment phase, by maximising the use of non-opioid analgesia such as paracetamol and non-steroidal anti-inflammatory drugs. If a patient has extreme pain which does not respond appropriately to dental treatment and short-term, non-opioid analgesia, it would be wise to consult with the patient's medical practitioner.


Dr M McCullough

Australian Dental Association