6. / BRIEF RESUME OF INTENDED WORK:
6.1 Need for the study:
Drug dependence is a complex & multidimensional problem. All the dependence producing substances have a hedonic effect. This pleasurable effect becomes so insistent that it dominates the lifestyles of the individual and damages his or her quality of life or the habit itself causes actual harm to the individual or the community. So the problem is not merely of an individual, a drug or a community, but the interaction between the triad. In different societies, the three most commonly used therapeutic drugs are nicotine, caffeine and ethanol.1
During the 1990s the annual global prevalence rate of illicit drug use was estimated to be in the range of 3.3- 4.1%. Based on a world population of 5.8 billion (1997), this would translate to 191- 238 million people consuming an illicit drug atleast once in a given year.2
The prevalence of drug abuse in India for cannabis was 3.2% in 2000, Opiates was 0.4% in 2001, Amphetamines was 0.02% in 2001 and for Ectasy it was 0.01% in 2004.3
In India, traditionally substances like opium, charas, bhang and ganja were used by some sections of the society sometimes as a recreational or leisure activity and sometimes as a religious ceremony. Abuse of alcoholic beverages and tobacco are endemic in many societies. Within a decade or so the increase in drug abuse in various segments of the society has led to an alarming rise in tensions. Furthermore the prevalence of diseases such as endocarditis, Hepatitis- B and HIV is high amongst them .1, 4, 5.
A number of studies suggest that the beginning of the drug abuse epidemic in India started after 1981 although its existence dates back to the pre historic times. This problem is increasing day by day and has invaded the home, work place, place of worship & educational institutions affecting individuals of all ages and classes.1
The situation is likely to worsen further if adequate measures are not taken care. Hence it is of utmost importance to clearly identify the vulnerable groups and provide them with proper help.1
The studies performed in different countries, demonstrated high caries prevalence, poor gingival health, poor motivation & oral hygiene practices with drug abusers. In the past decade, there have been a limited number of studies on dental health status among drug addicts. 5
Hence an attempt has been made to assess the oral health status and treatment needs of substance abusers attending de- addiction centres in Bangalore
6.2 Review of Literature:
A study1 was conducted by Minquan Du et al in the Hubei province drug cessation camp in 1999 on a sample consisting of 520 subjects using heroin to report the oral health status and to determine the risk factors. The results showed that the mean DMFT for all drug users was 4.2, majority of them was decay only (92%) and that DMFT increased with age. The proportions of bleeding on probing, calculus, shallow pockets & deep pockets were 42%, 95%, 42% & 8% respectively.
The debris index score was 3.2 for all ages. 6% had mucosal lesions atleast at one site. Those who had taken drugs for more than 6 years were twice likely & those with high education were 1 ½ times likely to have a DMFT more than 7.
Those who had taken drugs orally were 3 ½ times more likely to have calculus & debris than the ones who had taken intravenous drugs. He concluded that there is a significant increase in the dental caries and periodontal problems in the addicts.
A study6 was conducted by Scheutz F on the dental health in a group of drug addicts attending an addiction centre between 1977- 1981 to describe the state of dental health in a group of drug addicts. the sample consisted of the 134 intravenous drug abusers aged b/w 18- 37 yrs, mean age being 25 yrs. The mean DMFT was 18.3 and the mean DMFS was also high and its components varied with age, with more teeth missing in the older age groups and a higher DMFS in individuals more than 24yrs. The oral hygiene was generally poor with abundant plaque formation on all teeth, mean Visible Plaque Index = 77.4. A high degree of gingival inflammation was found frequently, mean Bleeding Index = 71.3.
A study5 was conducted by Italo Francesco Angelillo, Guido Maria Grasso, Gaetano Sagliocco, Paolo Villari & Marcello Mario D’ Errico on dental health in a group of drug addicts in a community therapeutic centre in Mercato San Severino, Italy during the period December 1988 through June 1989 to determine the caries prevalence, periodontal health & oral hygiene status. The sample consisted of about 121 subjects. They found that 6.5% of the subjects were caries free. 11.4% in the group aged 26- 29were caries free, 8.7% in 18- 21 yrs old, 2.4% in 22 25 yrs old & no caries free subjects above the ages 29 yrs. The mean DMFT scores for all ages was 12.9 ± 6.5.The D component was the major component of the subjects below 25 yrs & the M component in subjects over 29 yrs. The mean DMFS value for all ages was 36.2 ± 32.6.The DS was 17.4, the MS was 14.9 & FS 3.9. The periodontal index was calculated & the Periodontal Index for all age groups was1.37. The mean OHI- S score was1.17 for debris & 0.54 for Calculus Index.
Astudy4 was conducted by Molendijk B, Ter Horst G, Kasbergen M, Truin G J & Mulder J in the year 1994 for a period of about 5 months to describe the dental health status of a group of drug addicts in a de- addiction centre. Brushing frequency of less than once in a day was seen in 18% of addicted group & only 4% in Dutch dentate population.The OHI-S & bleeding scores indicate that the oral hygiene status of addicts is much worse than that of the general population. Cervical plaque in the youngest 3 age groups in the addicts were 76.5%, 82.4% & 88.2% but in the general population it is 30%, 24% & 21%The study showed that drug addicts have significantly more caries , more missing teeth & less no of teeth filled than the general population .
6.3 Objectives of the study:
1. To study the oral health status and treatment needs of substance abusers attending de- addiction centres in Bangalore.
7. / MATERIALS AND METHODS
7.1 Source of Data:
De- addiction centres of Bangalore city.
7.2 Method of collection of data(including sampling procedure, if any):
Study population
There are 17 De- addiction centres in Bangalore which was obtained after surveying and cross checking with de- addiction centres as there is no official list available. Out of the 17 de- addiction centres, 5 will be selected randomly using the lottery method. The 5 de- addiction centres will be visited from June 2009 onwards. The study population will consist of individuals attending the Out patient department as well as ward patients of the selected de- addiction centres. The data regarding the demography and socioeconomic status will be obtained using a structured questionnaire. The oral health status of these patients will be determined based on the modified WHO proforma1997.
The examination will be done using natural light, mouth mirror and CPI probe.
The data will be statistically analyzed using prevalence rate, student ‘t’ test, analysis of variance and multivariate analysis.
7.3 Does the study require any investigation or intervention to be conducted on patients or other Humans or Animals? If so, please describe briefly.
Yes
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / List of references:
  1. Singh Brijender, Singh Vijender, Vij Aarti. ‘Sociodemographic Profile of Substance Abusers Attending a De- Addiction Centre in Ghaziabad’. Medico- Legal Update.2006; 6, No 1.
  2. Minquan Du, Raman Bedi, Luhua Guo, Javkie Champion, Mingwen Fan, & Ruth Holt. Oral health status of heroin users in a rehabilitation centre in Hubei province, China. Community Dental Health 2001; 18: 94- 98.
  3. World Drug Report 2006, Vol 2
  4. Molendijk B, Ter Horst G, Kasbergen M, Truin G J & Mulder J. ‘Dental health in Dutch drug addicts’. Community Dent Oral Epidemiol 1996; 24:117- 119.
  5. Italo Francesco Angelillo, Guido Maria Grasso, Gaetano Sagliocco, Paolo Villari & Marcello Mario D’ Errico. ‘ Dental Health in a Group of drug addicts in Italy’. Community Dentistry and Oral Epidemiology 1991; 19: 36- 37.
  6. F. Scheutz. ‘ Dental health in a group of drug addicts attending an addiction clinic’. Community Dentistry and Oral Epidemiology 1984; 12: 23- 28.
  7. United Nations Office for Drug Control and Crime Prevention, 1997