title: Methamphetamine Users Have Increased Dental Disease: A Propensity Score Analysis.
abstract: Methamphetamine (MA) users are assumed to have a high burden of tooth decay. Less clear is how the distribution and severity of dental caries in MA users differ from the general population. Using a covariate-balancing propensity score strategy, we investigated the differential effects of MA use on dental caries by comparing the patterns of decayed, missing, and filled teeth in a community sample of 571 MA users with a subset of 2,755 demographically similar control individuals selected from a National Health and Nutrition Examination Survey (NHANES) cohort. Recruited over a 2-y period with a stratiﬁed sampling protocol, the MA users underwent comprehensive dental examinations by 3 trained and calibrated dentists using NHANES protocols. Propensity scores were estimated with logistic regression based on background characteristics, and a subset of closely matched subjects was stratified into quintiles for comparisons. MA users were twice as likely to have untreated caries (odds ratio [OR] = 2.08; 95% confidence interval [95% CI]: 1.55 to 2.78) and 4 times more likely to have caries experience (OR = 4.06; 95% CI: 2.24 to 7.34) than the control group of NHANES participants. Additionally, MA users were twice as likely to have 2 more decayed, missing, or filled teeth (OR = 2.08; 95% CI: 1.29 to 2.79) than the NHANES participants. The differential involvement of the teeth surfaces in MA users was quite distinctive, with carious surface involvement being highest for the maxillary central incisors, followed by maxillary posterior premolars and molars. Users injecting MA had significantly higher rates of tooth decay compared with noninjectors (P = 0.04). Although MA users experienced decayed and missing dental surfaces more frequently than NHANES participants, NHANES participants had more restored surfaces, especially on molars. The high rates and distinctive patterns of dental caries observed could be used 1) to alert dentists to covert MA use in their patients and 2) as the basis for comprehensive management strategies.
authors.affiliation: School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA vhetty@ucla.edu.
authors.forename: V
authors.initials: V
authors.lastname: Shetty
authors.affiliation: School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Harrell
authors.affiliation: School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Clague
authors.affiliation: Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Murphy
authors.affiliation: National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Dye
authors.affiliation: Integrated Substance Abuse Programs, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Belin
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications*; D016022:Case-Control Studies; D004245:DMF Index; D003731:Dental Caries / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine; D009749:Nutrition Surveys; D057216:Propensity Score; D009057:Stomatognathic Diseases / Q000453:epidemiology / Q000209:etiology*
chemical_list: D008694:Methamphetamine
keywords: NHANES controls; distinctive patterns; epidemiology; high rates; methamphetamine use; propensity score matching