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 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

Oral and dental health of users of psychoactive substances  

at the Andranomena centre in Toliara 
 

Authors: Randriamalala Njarasoa Charlette1,  Andriamanjato Hasina Menja2,Andrianjafinoro Tsiriniaina 

Hasinjanahary1, Rakotonirina Faliniaina Paul1,Ramaroson Juvence3 

1 : Formerintern in Odontostomatology, Institute of Tropical Odonto-Stomatology of Madagascar, University of 

Mahajanga Madagascar 

2 : former intern in psychiatric, University Hospital, Tuléar, Madagascar 

3 : Full Professor in Odontostomatology, Institute of Tropical Odontostomatology of Madagascar,University of 

Mahajanga Madagascar 

Abstract 

The use of psychoactive substances can have a negative impact on general health, social life and oral 

health.  The consequences from an oral health point of view are manifold and will depend on the products 

consumed, the mode of consumption, the duration of the addiction and the quantity ingested.  

The aim of this study was to evaluate the oral and dental condition of drug addicts at the Foyer d'amitié 

Andranomena Toliara support centre for the mentally ill.  

Our sample consisted of 40 male patients, with an average age of 26.8 years. Cannabis use alone was 

reported by 37.5% of patients, and co-addiction with alcohol was recorded in 27.5% of cases and 22.5% for 

tobacco. 

 The DCAO index was 17.4 for 11.2 decayed teeth, 5.4 missing teeth and 0.8 filled teeth.  

For periodontal status, we used the Community Periodontal Index in Treatment Needs (CPITN).  

According to the CPITN scale, 85% of patients were in code 2, requiring scaling and oral hygiene education.    

Patients who use psychoactive substances are at high risk of dental caries and periodontal disease. Oral 

and dental care is necessary to improve patients' quality of life. 

Key words: users of psychoactive substances, oral condition, CAO index, periodontal condition 

 

Introduction 

 According to Saint-Pierre, a doctor of dental surgery and psychotherapist, the mouth is a place of 

pleasure, but it can also become a place of danger, where drugs and psychotropic substances pass through [1].  

The word "drug" is defined as "any substance that alters the functioning of the mind and/or body". A drug or 

psychoactive substance refers to a medicine that affects the central nervous system and alters consciousness 

and/or perceptions [2]. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

 Psychoactive substances are classified as licit, for example alcohol, tobacco or illicit products such as 

cannabis, amphetamine, cocaine and opiates [3].  

The oral area partly reflects our state of health. However, the use of psychoactive substances can have 

a negative impact on general health, social life and oral health.  The consequences from an oral and dental 

point of view are manifold and depend on the products consumed, the mode of consumption, the duration of 

the addiction and the quantity ingested. 

According to a study carried out in Norway in 2019, 78% of illicit drug users suffer from dental caries 

and periodontal disease [4]. 

In Australia in 2019, multiple substance users have more decayed and missing teeth than non-users [5]. 

In Madagascar, few studies have been carried out on the prevalence of oral health and the use of 

psychoactive substances. 

The general objective of this study is to assess the oral and dental condition of drug addicts at the 

Andranomena Toliara Support Centre.  

Methodology 

  The study took place at the Centre d'accompagnement des malades mentaux at the Foyer d'amitié 

Andranomena Toliara. A cross-sectional prospective descriptive study was carried out. The study period ran 

from January 2020 to March 2020. 

All patients who had taken psychoactive substances and stayed at the centre during the study period 

were included in the study. Patients who refused to take part in the survey or who had difficulty answering the 

questionnaire were excluded. 

 We opted for an exhaustive sampling method given the numbers of patients accommodated at the 

centre. The sample consisted of 40 participants 

Two assessment criteria were used to evaluate the oral condition of patients: firstly, the DMF (Decayed, 

Missing, Filled) index, which is used to measure the incidence of caries disease in the population. This index is 

calculated by totalling the number of decayed, missing and filled teeth in permanent dentition over the 

number of subjects examined [6], then The Community Periodontal Index in Treatment Needs (CPITN) was 

used to assess the periodontal care needs of our population. This index used clinical criteria recognised in the 

prevention and treatment of periodontal disease, such as the quantification of periodontal pockets, gingival 

inflammation and the presence of dental plaque. The principle is to assign a score according to the periodontal 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

condition of the teeth examined. The results were presented using a scoring system to define the need for 

periodontal care [7]. 

 

Table I: CPITN scale 

 

Co

de 

0 

No bleeding, no tartar, no pockets 
 No need for care  

Co

de 

1 

No bleeding, no tartar, no pockets  
 

Teaching oral hygiene (EHO)  
 

Co

de 

2 

Max. 3 mm pocket with tartar or overflowing filling 

(black area of probe completely visible)  
 

Scaling, EHO, removal of overflowing fillings  
 

Co

de 

3 

4 to 5 mm pocket (black area of probe partially 

masked)  
 

Complex periodontal therapy including 

surfacing  
 

Co

de 

4 

Minimum 6 mm pocket (black area of probe 

completely hidden)  
 

Complex periodontal therapy, including 

surgical or non-surgical planing as required  
 

Co

de 

5 

Edentulous area or 1 tooth  
 

Complex periodontal therapy and prosthetic 

rehabilitation  
 

 

 Pre-prepared, tested survey forms were used to collect data, and an interview was carried out as well 

as a thorough oral examination to gather information. 

Data were processed and analysed using SPSS for Windows, version 20. The results were considered 

significant for a value of p<0.05. 

 The confidentiality of information, professional secrecy, medical ethics and the privacy of participants 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

are respected. 

The reliability of the results of this study depends on the sincerity of the participants' answers and their 

recall. 

Results 

TABLE II: Breakdown of users of psychoactive substances by social profile  

 

Patient profile 

 

N %  

Type   

Male 40 100 

Female 0 0 

Age range   

[15 to 25 years[ 17 42,5 

[25 to 35 years old[ 16 40 

[35 to 45[ 4 10 

≥ 45 years 3 7,5 

Total 40 100,0 

 The entire sample was male. The most common age bracket was [25 to 35[, with 40% of the sample 

being male. 

 

 

 

 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

 

 

 

 

Table III: Breakdown of the sample by consumption of psychoactive substances 

 

Psychoactive substances N %  

Cannabis 15 37,5 

Alcohol + Cannabis 11 27,5 

Tobacco + Cannabis 9 22,5 

Alcohol + tobacco + cannabis 4 10 

Other drugs 1 2,5 

Total 40 100,0 

Cannabis is the substance most used by our sample (37.5%). However, co-addiction with other legal 

substances was observed, including alcohol in 27.5% of cases and tobacco in 22.5%. 

 

Table IV: Breakdown of sample by cao index 

 

Tooth decay Filled tooth Missing tooth DFMT index Standard 

deviation  

 

11,2 0,8 5,4 17,4 9,1 

 

The DFMT index was 17.4 for 11.2 decayed teeth, 5.4 missing teeth and 0.8 filled teeth. 

 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

 

 

 

 

 

Table V: Breakdown of the sample by start of consumption and cao index 

 

Age at start of 

consumption  

(in years) 

  

DFMT 

 DFMT ˂ 3 3≤ DFMT˂ 8 DFMT ≥ 8 Total 

 N % N % N % N % 

[15 to 24 years[ 0 0 2 5 21 52,5 23 57,5 

[25 to 34 years[ 0 0 3 7,5 7 17,5 10 25 

[35 to 45 years[ 2 5 4 10 1 2,5 7 17,5 

Total 2 5 9 22,5 29 72,5 40 100 

Fifty-two point five percent (52.5%) of patients who started taking psychoactive substances between 

the ages of 15 and 25 have an DFMT ≥ 8 

 

Table VI: Breakdown of the sample by cpitn indicator 

CPITN index N %  

Code 0 0 0 

Code 1 0 0 

Code 2 34 85 

Code 3 3 7,5 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

Code 4 2 5 

Code 5 1 2,5 

Total 40 100,0 

 

According to the CPITN index, code 2 is the most common with 85%, although no people were 

registered in codes 0 and 1. 

 

Table VII: Breakdown of sample by consumption start and cpitn index 

 

CPITN Age of onset 

[15 to 25 years[ [25to35 years[ [35 to45 years[ Total 

N                     % N                    % N                    % N                    % 

Code 0 0                      0  0                   0 0                      0 0                     0 

Code 1 0                       0  0                   0 0                      0 0                     0 

Code 2 16                  40 12                30 6                   15 34                 85 

Code 3 2                      5 1                   2,5 0                     0 3                  7,5 

Code 4 2                       5 0                    0 0                     0 2                    5 

Code 5 1                    2,5 0                      0 0                    0 1                 2,5 

Total 20                 52,5 13              32,5 6                    15 40                100 

An age of onset of consumption of [15 to 25 years] had codes 2, 3, 4 and 5 with 40%, 5%, 5% and 2.5% 

respectively. 

Discussion 

Social profile of patients 

What can we say? This study ismade up of 40 male patients, according to the study carried out by 

Alson in 2018 on sociodemographic and clinical factors linked to cannabis use in the psychiatric department of 

the Joseph Raseta Befelatanana University Hospital, 94% of the study population was male [8]. Moreover, the 

friendship centre is a residential site run by brothers, hence the totality of the male population in our study; 

 The mean age of the study population was 26.8 years. The extremes of age ranged from 15 to 48 years;  

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

 On the other hand, a case control study carried out by Arora in 2019 showed that the average age of drug 

addicts was 30.8 years [9]. 

Consumption of psychoactive substances  

 Thirty-seven point five per cent (37.5%) of patients used cannabis alone, and co-addiction with alcohol 

was recorded in 27.5% of cases and 22.5% for tobacco. 

According to Joshi in 2016, substance use is systematically associated with smoking and alcohol 

consumption, both of which have harmful effects on the oral cavity [10]. 

 

Caries and users of psychoactive substances 

Our population suffers from polycaries with a DMFT index of 17.4 for 11.2 decayed teeth, 5.4 missing 

teeth and 0.8 filled teeth (standard deviation 9.1, minimum 0, maximum 20).  

Baghaie et al in 2017 showed that opiate users had more decayed teeth + 5.6 and fewer missing teeth 

than controls (-0.4) [11]. A case-control study was carried out in Brazil in 2018 confirming that there were 

more decayed and missing teeth and fewer filled teeth than controls [12]. 

In fact, dental caries is the result of tooth demineralisation due to the acids produced by the 

fermentation of sugars by bacteria [13]. However, among consumers, hyposalivation and even xerostomia are 

common [14], and the buffering effect of saliva is reduced, leading to an increased risk of dental caries [15]. 

 Fifty-two point five (52.5%) of the patients who started taking psychoactive substances between the 

ages of 15 and 25 had a DMFT > 8. This result is highly significant. 

 According to a meta-analysis carried out in 2015, the longer the duration of drug use, the greater the 

risk to oral health. A significantly higher DMFT was recorded in patients reporting use of 4 years or more [16]. 

In addition, poor oral hygiene, frequent sugar intake, no dental visits, an irregular lifestyle and long-

term drug use increase the vulnerability of psychoactive substance users to caries [17].  

Periodontal status and psychoactive substance users 

 According to the CPITN scale, 85% of patients are in code 2, requiring scaling and oral hygiene 

education.  However, 12.5% of the sample require more complex periodontal therapy (codes 3 and 4).  

A 2017 meta-analysis of oral health and drug use found that drug users are more likely to have 

periodontal disease than non-users [11]. 

A highly significant association was recorded between the CPITN index and the onset of drinking age. 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

 This could be explained by the fact that poor oral hygiene leads to the proliferation of bacteria in 

plaque and gingival pockets, as well as initiating the development of inflammation leading to periodontitis, 

and by the effect of psychoactive substances on the periodontium itself [18].  In addition, smoking is a major 

risk factor for periodontal disease, which is widespread among illicit drug users [19]. 

Conclusion 

 In conclusion, this study provided an overview of the oral health of patients addicted to psychoactive 

substances. They are at high risk of dental caries and periodontal disease. Oral health care is necessary to 

ensure that mastication and digestion function properly, and to improve patients' aesthetics and quality of life. 

A KAP (Knowledge, Attitude, Practice) study of users of psychoactive substances on oral and dental health is 

planned. 

Conflicts of Interest 

We declare that no conflicts of interest arose during this study. 

References 

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[2] Hanson GR, Venturelli, PJ, Fleckenstein AE. Drugs and Society. 2005. Jones & Bartlett: 9th edn. Sudbury. 

[3] United Nations Office on Drugs and Crime: World Drug Report 2008.  

[4] Djou R, Dewi TS. Oral Manifestation Related to Drug Abuse: A Systematic Review: Manifetasi oral terkait 

penggunaan obat-obatan terlarang: Sebuah tinjauan sistematis. Dentika Dental Journal. 2019;22(2):44-51 

[5] Teoh L, Moses G, McCullough M. Oral manifestations of illicit drug use. Australian Dental Journal. 

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[6] World Health Organization, editor. Oral health surveys: basic methods. 5th edition. Geneva: World Health 

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IJO - INTERNATIONAL JOURNAL OF HEALTH SCIENCES AND NURSING  
 ( ISSN: 2814-2098 )                                                                                                        Randriamalala Njarasoa Charlette¹* 

https://ijojournals.com/index.php/                                                                                         Volume 07 || Issue 01 || January., 2024 || 
 

 

 

 

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