An Introduction to Substance Use Disorders for Dental Professionals
Oral Implications of Cocaine Use/Abuse

Dental Caries: Cocaine users experience an increased rate of tooth decay for a variety of reasons: the drug contributes to xerostomia, the user does not seek regular professional care or perform regular personal oral care, and they may rub the drug directly onto the gingival tissue resulting in tooth erosion.

Gingival and Periodontal Diseases: Xerostomia and lack of routine oral hygiene care lead to an increased rate of periodontal diseases. Bruxing may also contribute to disease.

Bruxism and TMJ: Clenching and grinding contribute to the destruction of the supporting structures leading to cervical abrasion, occlusal wear and TMJ disorders.

Gingival Lesions: The user may rub the drug on the gingival tissue resulting in gingival lesions.

Nasal and Oropharynx: Regularly snorting cocaine can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which could result in a chronically inflamed, runny nose.

Other Oral Effects: Other manifestations include oral candida infections, perforation of palate, bilateral cleft lip and palate in the fetus, angular cheilitis, halitosis, glossodynia, erosive lichen planus, corrosion of gold restorations, and excessive hemorrhage after tooth extraction.^26,27,35 Cocaine users may exhibit buccolingual dyskinesia – a movement disorder characterized by protruding the tongue and pursing the mouth or lips - also known as ‘crack dancing’ or boca torcida (twisted mouth).

Local Anesthesia: The administration of a local anesthetic with vasoconstrictors may result in an acute rise in blood pressure, which could lead to cardiac arrest. There is also a risk of convulsions associated with the combination of lidocaine and cocaine potentiates. Use of epinephrine-impregnated retraction cords is also contraindicated. It is advisable to postpone any dental treatment at least 6 to 24 hours after the use of cocaine.²⁶