Running Head: ORAL EFFECTS OF COCAINE

Oral Effects of Cocaine:

Recognizing and Understanding Signs, Symptoms, and Disease States
Cecily Fontenot
Christen Kennon
Moriah Wallace
Lamar Institute of Technology

Running Head: ORAL EFFECTS OF COCAINE

In 2006, a survey was conducted which revealed an estimated 2.4 million cocaine abusers
in the U.S. According to Maloney (2010), Cocaine (benzoylmethlecgonine) is an alkaloid
extracted from the leaf of Erythoxlum coca bush (p. 36). Our goal is to inform and educate
practicing dental hygienists how to recognize the signs and symptoms of cocaine abuse in the
oral cavity in order to provide the highest standard of dental treatment. We hope to achieve this
by addressing certain symptoms and disease states that can emerge from the use of cocaine. Drug
interactions, dental complications, treatment, and overall patient health will help provide the
clinician with a better understanding of how to produce a proper treatment plan. This
presentation includes the signs, symptoms and effects of Nasal Non-Hodgkins Lymphoma
(NHL), palatal defects and their symptoms, and the oral administration of cocaine.
According to Hofstede and Jacob (2010), non-Hodgkins lymphoma (NHL) is a
malignancy that causes destruction of tissue due to tumor lysis and ischema (p. 1). Users of
cocaine that contract NHL typically present with symptoms such as oronasal fistulas, septal
perforations, autorhinectomy, and extensive mid-facial necrosis (Hofstede, Jacob, 2010, p. 3). All
of the preceding symptoms are associated with inflammation and discomfort. The treatment
required for nasal lymphoma includes surgery, chemotherapy, and radiotherapy. Since the dental
professional consults with the patient on a regular basis, it is necessary for them to identify the
oral lesion early on and refer the patient to a head and neck surgeon for proper diagnosis and
treatment. Nasal non-Hodgkins lymphoma is just one of the many negative effects of cocaine.
Additionally, palatal defects can occur as well.
Palatal defects are a major consequence of using cocaine. These defects can include
difficulty with speech, formation of cleft palate, and difficulty swallowing. Distortive speech can
occur when the tongue hits the palate if a lesion is present. As the sounds escape into the nasal

Running Head: ORAL EFFECTS OF COCAINE

cavity, the speech becomes hypernasal and difficult to understand. A cleft palate can form with
the use of cocaine. This is essentially a cavity in the palate, but can be repaired by
implementation of the Furlow double-opposing Z-plasty. According to Randall and Salyer, this
technique has since been modified to incorporate anterior hard palate flaps and is one of the most
frequently used techniques for congenital cleft palate repair (Randall et al., 1986; Salyer et al.,
2006) (Teng, Steinbacher, 2013, p. 494). This procedure is effective and reliable for patients;
however, the patient must abstain from cocaine for at least one year upon receiving treatment. In
a study conducted by Hofstede and Jacob (2010), Mastication of food and swallowing was also
challenging as the bolus was pushed into the nasal cavity with subsequent nasal regurgitation (p.
3). In this particular scenario, the patients lesion on their palate allowed the masticated food to
be pushed up through the lesion, into the nasal cavity, and out of the patients nose. This could
potentially cause inflammation, infection, and chronic discomfort. Cocaine not only affects the
nasal cavity, but can also affect the oral cavity when placed directly on the gingiva.
Oral use of cocaine can produce several negative effects. Studies conducted by
Shekarchizadeh, Khami, Mohebbi, Ekhtiari, and Virtanen (2013) suggest that local application
of cocaine onto the gingiva by addicts to test its quality may lead to gingival recession (p. 931).
This condition can worsen, causing the teeth to become mobile while losing their structure. In
serious cases, these instances can result in an edentulous patient, developing the need for
dentures. Other side effects of oral use include bleeding gums, bad taste and odor in [the
patients] mouth, loose teeth, abscessed teeth, and frequent toothaches (Bassiouny, 2012, p. 40).
These symptoms can be treated with patient education, substance control, and proper oral
hygiene care.
This presentation includes the signs, symptoms and effects of Nasal Non-Hodgkins

Running Head: ORAL EFFECTS OF COCAINE

Lymphoma (NHL), palatal defects and their symptoms, and the oral administration of cocaine.
Maloney said it best, as with all patients, we have a mandate to do no harm (2010, p. 38).
Upon consideration of all of the preceding conditions, it is important for the dental professional
to be able to identify the early onset of malformations due to cocaine abuse. Together, we can
work as a team to educate patients properly while ensuring effective treatment.

Running Head: ORAL EFFECTS OF COCAINE

Oral Effects of Cocaine:

Recognizing and Understanding Signs, Symptoms, and Disease States
Moriah Wallace
Cecily Fontenot
Christen Kennon
Lamar Institute of Technology