Sir, I read with great interest S. Joshi et al.1 on cannabis and dental health. The prevalence of drug addiction is increasing in Europe being more common in males than females and involving various types of drugs. These can have local and systemic harmful effects and patients who are addicted to drugs suffer from poor oral hygiene, xerostomia, increased prevalence of periodontal and other oral diseases.

Marijuana abuse can lead to acidic erosion of enamel due to cannabinoid hyperemesis, in which frequent episodes of vomiting occurs. In addition, these patients develop dental caries, inflammation and hyperplasia of gingival, uvulitis, leukoplakia, oral papillomas and tongue carcinoma.2 The chronic abuse of methamphetamine is characterised by large carious lesions in buccal smooth surface areas and fractured teeth due to increased motor activity. It is important to note that a significant level of osteoporosis has also been reported in a high percentage of methamphetamine abusers.3

Cocaine can result in movement disorder and manifest itself as transient chorea4 while heroin can increase the number of decayed, missing and filled teeth.5

These patients develop dental caries, inflammation and hyperplasia of gingival, uvulitis, leukoplakia, oral papillomas and tongue carcinoma, and their nutrition is also compromised. Dentists should be aware of the effects of these drugs in dental management.