The Oral & Dental Consequences of Methamphetamine Use

描述(由申请人提供)：我们的研究建议源于甲基苯丙胺(MA)滥用与猖獗的龋齿和被认为是低风险的龋齿的牙齿表面之间的联系。通常被称为“冰毒嘴”，这些口服并存的MA使用可能会在免疫受损的人中加剧，这些人患龋齿和牙周病的风险更高。尽管冰毒对个人和社会产生了明显的影响，但由于缺乏对冰毒口腔的生态学研究和操作定义，因此无法建立一个知识库，以帮助牙科专业人员在疾病的早期阶段辨别病情，制定最佳临床做法，并将牙科社区纳入协作护理模式，以治疗使用冰毒对健康造成的后果。我们的前身调查，基于医生对301名MA使用者进行的评估，已经确定广泛的牙科疾病是MA使用者的一种显著的共病。通过经过培训和校准的牙科检查员进行详细的口腔评估，我们现在试图验证我们的医生评估员的初步结果，并评估口腔/牙齿表现在检测和管理提交给牙科诊所的未披露MA使用者方面的判别效用。我们假设，MA使用者患龋齿和口腔疾病的比率和模式将显著不同于国家健康和营养检查调查(NHANES)中与倾向分数匹配的个人队列，并反映MA使用行为的严重性。通过对500名成年MA使用者的横断面调查，我们将：1)验证甲基安非他明(MA)使用者和非MA使用者的龋齿经历和口腔疾病的比率和模式显著不同；2)表征牙齿后果、MA使用模式和其他个人特征之间的关系；3)基于详细的龋齿体验模式，制定牙病综合指数，以帮助牙医可靠地区分隐蔽MA使用者和非MA使用者；以及4)调查MA使用者中负面的“牙齿自我形象”与寻求治疗的意愿之间的关系。一个关键的目标是通过一个基于网络的、可查询的索引数字图像库来总结和传播我们的研究成果，这些图片库记录了各种口腔表现及其与MA使用水平的关联。了解使用MA的口腔后果和相关的社会行为决定因素将有助于牙科专业人员在早期阶段区分这种情况，制定管理后果的最佳实践，并为有针对性的预防和干预策略奠定基础，使牙科社区有意义地参与MA使用者的医疗保健。 公共卫生相关性：滥用甲基苯丙胺(MA)与广泛的龋齿和口腔健康后果有关。我们的研究将建立一个关于MA使用的口头后果和上下文社会行为决定因素的共同知识基础。我们的发现将帮助牙科专业人员在早期阶段区分MA的口腔后果，制定管理后果的最佳实践，并为有针对性的预防和干预策略奠定基础，使牙科社区有意义地参与MA使用者的医疗保健。

DESCRIPTION (provided by applicant): Our research proposal derives from the emerging association of methamphetamine (MA) abuse with rampant dental caries and involvement of tooth surfaces that are considered, otherwise, to be at low risk for decay. Commonly identified by the moniker "meth mouth", these oral co-morbidities of MA use may be exacerbated in immune-compromised individuals who are at increased risk for caries and periodontal disease. Despite the manifest personal and societal impact, the lack of ecological studies and operational definitions of meth mouth have prevented the cultivation of a knowledge base to help dental professionals distinguish the condition in its early stages, formulate best clinical practices and, allow integration of the dental community in a collaborative care model for treating the health consequences of MA use. Our precursor investigation, based on physician-conducted assessments of 301 MA users, has established that extensive dental disease is a distinguishing comorbidity in MA users. Through detailed oral assessments by trained and calibrated dental examiners we now seek to validate the initial findings of our physician assessors and evaluate the discriminant utility of oral/dental manifestations for detecting and managing undisclosed MA users presenting to the dental office. We hypothesize that the rates and patterns of dental caries experience and oral disease in MA users will be significantly different than a propensity-score matched cohort of individuals from the National Health and Nutrition Examination Survey (NHANES) and reflect the severity of the MA use behavior. Using a cross-sectional survey of 500 adult MA users, we will: 1) validate that the rates and patterns of dental caries experience and oral disease are substantially different in methamphetamine (MA) users than non-MA users; 2) characterize the relationship between dental consequences, patterns of MA-use and other individual characteristics; 3) develop a composite index of dental disease, based on a detailed pattern of dental caries experience, that can help dentists reliably distinguish covert MA users from non-users; and 4) investigate the extent to which negative "dental self-image" among MA-users is associated with a willingness to seek treatment. A key goal is to summarize and disseminate our research findings through a web based, queriable, repository of indexed digital images documenting the range of oral manifestations and their association with the levels of MA use. Understanding the oral consequences of MA use and the contextual sociobehavioral determinants will help dental professionals distinguish the condition at an early stage, develop best practices for managing the consequences, and set the stage for targeted prevention and intervention strategies that meaningfully involve the dental community in the healthcare of MA users. PUBLIC HEALTH RELEVANCE: The use of methamphetamine (MA) abuse is associated with extensive dental caries and oral health consequences. Our research will establish a common knowledge base on the oral consequences of MA use and the contextual sociobehavioral determinants. Our findings will help dental professionals distinguish the oral consequences of MA at an early stage, develop best practices for managing the consequences, and set the stage for targeted prevention and intervention strategies that meaningfully involve the dental community in the healthcare of MA users.