ORIGINAL ARTICLE Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 53-57

A cross-sectional study on the association between oral health and vitamin D levels in methadone maintenance treatment program of Iranian population

Amene Taghdisi Kashani1 , Samane Shamollaghamsari2, Amir Hossein Mohammadi3, Hamid Reza Banafshe4, Amir Ghaderi5
1 Department of Pediatric, Faculty of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
2 Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
3 Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, and Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
4 Research Center for Physiology Science, Kashan University of Medical Sciences; Department of Pharmacology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
5 Department of Addiction studies, School of Medical, Kashan University of Medical Sciences; Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran

Date of Submission24-Aug-2021Date of Decision11-Dec-2021Date of Acceptance10-Jan-2022Date of Web Publication29-Mar-2022

Correspondence Address:
Dr. Amir Ghaderi
Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan
Iran

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/iahs.iahs_162_21

Aims: The aim of this study was to investigate the relationship between oral health and Vitamin D levels in patients undergoing methadone maintenance treatment in addiction treatment centers in Kashan. Materials and Methods: This cross-sectional study was performed on 202 patients aged 18–60 years who were referred to methadone maintenance treatment clinics in Kashan. The measurement tool included a demographic information checklist and a modified oral health form of the World Health Organization. 2cc of blood was taken from patients to measure Vitamin D levels. Findings: Out of 181 patients in the study, 73.8% of patients had a methadone dose of <20 cc per day. One hundred twenty-six patients had a history of drug use. In 86.4% of patients, Vitamin D deficiencies were observed. In these patients, moderate gingival problems and moderate-to-severe dental plaque were 60.2% and 71.9%, respectively. Furthermore, the range of decayed, missing, and filled teeth (DMFT) index in these patients was 23.57 ± 7.90. No significant relationship was indicated between DMFT index and Vitamin D level. Conclusions: It is difficult to determine the main causes of oral problems among addicts. Apart from the direct effects of addiction, these patients exhibit a wide range of unhealthy behaviors such as poor oral hygiene, high sugar intake, and poor nutrition. On the other hand, most patients experience reduces in Vitamin D status.

Keywords: Dental health, methadone, oral health, substance-related disorders, Vitamin D

How to cite this article:
Kashani AT, Shamollaghamsari S, Mohammadi AH, Banafshe HR, Ghaderi A. A cross-sectional study on the association between oral health and vitamin D levels in methadone maintenance treatment program of Iranian population. Int Arch Health Sci 2022;9:53-7
How to cite this URL:
Kashani AT, Shamollaghamsari S, Mohammadi AH, Banafshe HR, Ghaderi A. A cross-sectional study on the association between oral health and vitamin D levels in methadone maintenance treatment program of Iranian population. Int Arch Health Sci [serial online] 2022 [cited 2022 Mar 29];9:53-7. Available from: http://www.iahs.kaums.ac.ir/text.asp?2022/9/1/53/341213   Introduction 

Substance abuse has been estimated to be common among 246 million people (or one in 20 people) aged 15–64 in 2013.[1] Drug dependence or substance use disorders (SUDs) have been reported in approximately 10% of subjects. Previous studies have focused more on the serious side effects of drug abuse, such as overdose, hepatitis C or HIV/Acquired immunodeficiency syndrome, and less on oral diseases as a SUD,[2] such as oral cancers, periodontal problems, tooth decay, or dental wear. The mode of abuse and the type of substance are decisive for the exact dental consequences. For instance, cannabis abuse is associated with xerostomia,[3],[4] high rate of decay,[5] and increased risk of oral cancers.[6] Amphetamine abusers exhibited an increase in the risk of dental wear due to bruxism, acute xerostomia, severe decay, and poor overall dental hygiene.[7],[8] Opioid dependence is associated with side effects such as personal inattention, poverty, increased consumption of sugary foods, elevated periodontal problems, dental caries, and poor oral health care.[9] The strong tendency to consume sugary foods can be attributed to the activation of the mu-opiate receptor, altering glucose intake, and blood sugar control. It should be noted that people under methadone maintenance treatment experience such side effects, which may even be exacerbated by the use of high-sugar methadone medications.[10] The snorted, smoked gums, and intravenously injected could be applied by the cocaine. Dental side effects of cocaine abuse include nasal defects, oral disorders, and increased tooth wear due to bruxism.[11],[12] The fact is that the abuse of these substances alone occurs rarely.[4] The majority of abusers reported the simultaneous use of two or more such illicit drugs.[2],[13] For example, substance abuse is typically accompanied with alcohol consumption and smoking, which together have adverse impacts on the oral cavity.[14] The SUD can influence the oral state directly through physiological mechanisms such as xerostomia, increased appetite for snacking, sympathetic activation, dental grinding or clenching, and chemical tooth erosion due to cocaine abuse. The indirect SUD effects are lack of or poor oral health. In addition, difficulty in accessing dental care can exacerbate the development of oral disease.[4],[13] Other aggravating factors include a lack of attention to malnutrition treatment, poor oral hygiene, the use of high-sugar diets, and sporadic dental visit patterns. The dependence and tolerance of these people on analgesics further endangers dental care.[2]

Special attention has been paid to the status of Vitamin D in oral health. Vitamin D deficiency in adults and adolescents leads to a variety of oral health disorders, some of which may be exacerbated by impaired Vitamin D synthesis.[15],[16] Vitamin D, as a steroid hormone, is normally formed by sunlight exposure, or is obtained through dietary supplements.[15],[17] There are limited natural foods that contain Vitamin D, some of which include mackerel, herring, salmon, and cod liver oil.[17] Vitamin D is commonly referred to as Vitamin D2 and Vitamin D3 (cholecalciferol). Vitamin D2 is produced from yeast through the ultraviolet rays of ergosterol. Vitamin D3 is derived from the ultraviolet radiation of 7-dehydrocholesterol from lanolin,[18],[19],[20] which means the bioactivity of Vitamin D3 and is formed in human skin. Plasma levels of Vitamin D are a popular biomarker for these disorders.[21] The purpose of this preliminary study was to determine the correlation between Vitamin D levels and oral health among the Iranian population under methadone maintenance treatment.

  Materials and Methods 

The study was conducted on the cases available from February 2020 to May 2020. The target population comprised patients with SUDs who met the DSM-IV criteria for opioid dependence, receiving methadone maintenance treatment in rehabilitation centers. This cross-sectional study was performed on patients aged 18–60 years who were referred to methadone maintenance treatment clinics in Kashan by random sampling method. The current project was approved by the Ethical Committee of Kashan University of Medical Sciences (IR.KAUMS.MEDNT.REC.1398.120) and participants were enrolled after getting signed informed consent. The measurement tool included a demographic information checklist and a modified oral health form of the World Health Organization.[22] Questionnaires were filled by interviewing the patients about age, history of addiction, smoke status, daily cigarette usage, cigarette usage duration, methadone usage duration, methadone usage dose, employment, educational level, and marital status. After the interview, the clinical examinations were performed by the dentist to assess the decayed, missing, and filled teeth (DMFT) indices. Before the oral examination, one toothbrush and toothpaste were given to each subject. After brushing, patients were examined on a regular chair using a flashlight, a WHO probe, a Williams graded catheter, and a disposable mirror. The DMFT index is a formula that determines the number of rotten, dropped, and filled teeth, the checklist of which is completed for each individual. Blood samples were also taken from 2 cc patients to measure Vitamin D levels whit enzyme-linked immunosorbent assay reader. Vitamin D status <20 ng/mL obtained as Vitamin D deficiency.[23] Results for continuous variables were presented as means and standard deviation or as medians and interquartile ranges if the distributions were skewed and as percentages for categorical data. Data were tested for normal distribution with the Kolmogorov–Smirnov test. The independent t-test or the Mann–Whitney U test was used to evaluate differences in continuous variables between the two groups. Comparisons between categorical variables were performed with the Chi-square test. Differences were considered significant when P < 0.05.

  Results 

Totally, 181 (males) cases with a mean age of 41.64 ± 9.54 years were enrolled in this study. Demographic information of participants is presented in [Table 1]. About 73.8% of patients had a methadone dose of <20 cc per day. One hundred and twenty-six patients had a history of drug use. 86.4% of patients were observed Vitamin D deficiency. In these patients, moderate gingival problems and moderate-to-severe dental plaque were 60.2% and 71.9%, respectively. In addition, the range of DMFT index in these patients was 23.57 ± 7.90 [Table 2]. No significant relationship was indicated between Vitamin D level and DMFT index [Table 3]. DMFT just only associated with age (P < 0.0001), employment (P = 0.003), daily cigarette usage (P = 0.021), cigarette usage duration (P < 0.0001), and methadone usage duration (P < 0.0001).

Table 1: Demographic characteristics and clinical features of participants

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Table 2: Level of vitamin D and decayed, missing, and filled teeth in the study population

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  Discussion 

The effectiveness of Vitamin D in the management and prevention of infectious and chronic inflammatory diseases, including periodontitis, has shown contradictory results. Vitamin D deficiency and oral diseases are two common medical conditions worldwide, which exert significant effects on quality of life and general health.[24],[25],[26],[27] Accordingly, there is a need for further studies in this area using different designs.[28] Therefore, the present study aimed to determine the correlation of oral health with Vitamin D levels among the Iranian population underwent with methadone maintenance treatment, the results of which did not find significant correlations between Vitamin D levels and DMFT index. However, the results show an association of DMFT with age, daily smoking, employment, duration of methadone use, methadone dose, and duration of smoking. Direct comparison of these results was difficult with previous findings. Some of the reported direct functions of Vitamin D include protective effects against oral pathogens, a central role in bone metabolism, and disruption of inflammatory mediators leading to oral tissue damage, thus demonstrating the role of this vitamin in maintaining oral health.[29],[30] Despite these benefits, some findings indicate some disadvantages for this vitamin, including participation in the development of oral diseases at specific concentrations.[31] According to observations, alveolar bone loss and severe oral disease were less common among men receiving high concentrations of Vitamin D.[32] In addition, susceptibility to gingivitis can be alleviated following Vitamin D supplementation by exerting anti-inflammatory effects.[33] The analysis of database related to the US National Health and the Nutrition Examination Survey found that men and women over the age of 50 experienced greater periodontal losses in the lower quintile of serum Vitamin D than in the maximum quintile.[34] However, this study did not find any significant association between DMFT index and serum Vitamin D status among SUD patients. Reportedly, there was a more significant association between Vitamin D and the measure of acute inflammation, including gingival bleeding, rather than with the measure of alveolar bone loss among normal postmenopausal women.[35] Contrary to these reports, many studies have not found the beneficial effects of Vitamin D on oral health. The results of a study (recorded on IRCT) reported no association between periodontal illnesses and Vitamin D concentrations, consistent with findings from periodontal pockets and gingival hemorrhage.[36] One study analyzed the Korea National Health and Nutrition Examination Survey database, and found that there was no significant association between Vitamin D deficiency and oral health status.[37]

Vitamin D deficiency and the risk of oral diseases are strongly related to each other, which can lead to failure of oral treatments, dental defects, caries, and periodontitis.[15] Proper Vitamin D status can reportedly lead to better life expectancy and oral growth. However, there is a need for more evidence to reach a definitive conclusion and issue clinical guidelines on the positive effects of Vitamin D supplementation on oral health.[15] Although our data support the lack of definitive results on the association between Vitamin D and DMFT, the results are of low validity because of having severe Vitamin D deficiency and poor DMFT score. In addition to the normative assessment of oral health and Vitamin D levels, clinicians should consider the patients' self-reported oral problems, and the social and mental aspects of oral conditions.[38]

  Conclusions 

It is difficult to determine the main causes of oral problems among addicts. Apart from the direct effects of addiction, these patients exhibit a wide range of unhealthy behaviors such as poor oral hygiene, high sugar intake, and poor nutrition. On the other hand, most patients experience reduces in Vitamin D levels. Therefore, there is an urgent need to plan for Vitamin D supplementation and dental treatments and to include oral health programs in the general care programs of addicted people.

Acknowledgments

We are thankful to all patients who participated in this project. The present study was supported by a grant from the Vice-chancellor for Research, KUMS, Kashan, and Iran. This research was supported by Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences (KAUMS/98168).

Financial support and sponsorship

The research grant provided by the Research Deputy of Kashan University of Medical Sciences (KAUMS/98168).

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2], [Table 3]