Cocaine, polysubstance abuse, and oral health outcomes, NHANES 2009 to 2014

Background Cocaine is the second most abused illicit drug in the United States. To date, no study has examined the association between cocaine use and oral health with a nationally representative sample. Our study examined the association between cocaine use—singly and with other substances—and oral health outcomes, including periodontitis and untreated caries, among US adults. Methods Data for 11,753 individuals, aged ≥30 years, who completed a periodontal examination, in the 2009 to 2014 National Health and Nutrition Examination Survey (NHANES) were analyzed. Descriptive analyses and multivariable binary logistic regression analyses were conducted on weighted data. Results Overall, 17% (20.5 million) of US adults aged ≥30 years had ever used cocaine, with higher likelihood seen among males, non‐Hispanic whites, and those living in poverty. Current cocaine use prevalence was 2.6% (3.2 million). By number of co‐used substances, the odds of having any periodontitis were higher among cocaine users who consumed ≥3 other substances (adjusted OR = 2.47; 95% CI = 1.15 to 5.30) when compared with solely cocaine users. By type of substance co‐used, odds of having untreated caries were greater among those reporting cigarettes (adjusted OR = 1.94; 95% CI = 1.21 to 3.11) or methamphetamine (adjusted OR = 5.40; 95% CI = 1.92 to 15.14) usage. Odds of any periodontitis were higher among those reported ancillary cigarette use (adjusted OR = 2.84; 95% CI = 1.60 to 5.04) compared with cocaine‐only users. Conclusions In addition to a positive association between periodontal disease, dental caries, and cocaine use, select co‐usage elevated the risk of oral disease. Patients should be screened for and counseled regarding substance abuse to facilitate a successful quit.