Nicotine may be a contributing factor in cases of cracked or broken teeth. This hypothesis is supported by the significant association between nicotine-containing EC users and cracked or broken teeth. This hypothesis is also supported by the report that the messenger RNA expression of dentin matrix acidic phosphoprotein-1, bone sialoprotein, and alkaline phosphatase activity were significantly decreased in nicotine-treated human dental pulp cells of smokers, and mineralized nodule formation was also inhibited by nicotine in human dental pulp cells [16]. Namely, the functions of dentin matrix synthesis and mineralization may be decreased in the dental pulp cells of smokers. This hypothesis is also upheld by the recent findings that direct exposure of human dental pulp cells to nicotine results in an inflammatory response that could have a role in pulpal inflammation onset, a pathological condition that may eventually progress to pulp necrosis [25]. Dental caries can have serious and lasting complications. A recent report demonstrated a positive association between dental trauma and dental caries in permanent teeth [26]. Nicotine also enhances Streptococcus mutans biofilm formation and biofilm metabolic activity, increasing the development of caries [27]. Acid production of biofilms decreases the local pH to a level that boosts demineralization of the dentin and enamel, resulting in potential synergism between chemical and mechanical modes [28]. EC inhalation has been shown to alter innate immunity and increase the virulence of colonizing bacteria [29]. In addition, a previous study reported that EC could not deliver nicotine to the blood stream at levels equal to tobacco cigarettes within the same time-period of use, and suggested that nicotine from EC aerosols are not absorbed from the lungs but from the oral mucosa, that nicotine absorption occurs at a similar rate to nicotine-replacement therapies, and that a significant part of the nicotine deposited to the oral mucosa seemed to be swallowed [30]. Xerostomia, due to EC use, may be related to cracked or broken teeth [31]. Xerostomia causes a reduction in the crack growth resistance of dentin [32]. In general, xerostomia may be related to a reduction in the level of salivary flow rate due to aging, some medications or other conditions [33]. The hypothesis is supported by the review that the common health hazards of EC use include dry mouth, mouth or tongue sores/inflammation, and dryness of the mucus membrane [34]. Lead, due to solder from EC, may be one of the causes for cracked or broken teeth. This hypothesis is supported by the report that environmental lead exposure was associated with an increased prevalence of dental caries among children aged 5 to 17 years in the US population [35]. In addition, lead was measured in the leachate of disposed electronic cigarettes at levels as high as 50mg/L by the Waste Extraction Test and 40mg/L by the Toxicity Characteristic Leaching Procedure [36].
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Crack cocaine (free-base cocaine) smokers belong to a subgroup of marginalized drug users exposed to severe health risks and great social harm. Detection of the urinary, pyrolytic biomarker methylecgonidine (MED) and its metabolite ecgonidine (ED) secures an unambiguous confirmation of crack cocaine smoking. Although prevalence studies of cocaine based upon self-reporting may not be accurate, laboratory analysis is seldom used for neither diagnostic purpose nor early identification of crack cocaine smoking, which is far more severe than snorting cocaine. A new analytical method was validated for MED, ED and other relevant cocaine metabolites using automated liquid handling and column switching coupled to liquid chromatography and tandem mass spectrometry. Limit of quantification was 30 ng/mL for ED and MED. This method was applied in a laboratory study of urine samples (n = 110) from cocaine users in Denmark subjected to routine drugs-of-abuse testing. Crack cocaine smoking was confirmed by the presence of MED and/or ED. Eighty-four samples (76.4%) were found positive for crack cocaine smoking in this group of problematic cocaine users. MED was only detected in 5.9% of the positive samples. The study shows a prevalence 3-fold higher to that recently suggested by European Monitoring Centre for Drugs and Drug Addiction. We therefore advocate that the urinary biomarkers MED and ED are included in routine testing methods for clinical toxicology. This may lead to an earlier identification of crack cocaine smoking and possibly prevent a more severe drug use. The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
In Brazil, crack cocaine use remains a healthcare challenge due to the rapid onset of its pleasurable effects, its ability to induce craving and addiction, and the fact that it is easily accessible. Delayed action on the part of the Brazilian Government in addressing the drug problem has led users to develop their own strategies for surviving the effects of crack cocaine use, particularly the drug craving and psychosis. In this context, users have sought the benefits of combining crack cocaine with marijuana. Our aim was to identify the reasons why users combine crack cocaine with marijuana and the health implications of doing so. The present study is a qualitative study, using in-depth interviews and criteria-based sampling, following 27 crack cocaine users who combined its use with marijuana. Participants were recruited using the snowball sampling technique, and the point of theoretical saturation was used to define the sample size. Data were analyzed using the content analysis technique. The interviewees reported that the combination of crack cocaine use with marijuana provided "protection" (reduced undesirable effects, improved sleep and appetite, reduced craving for crack cocaine, and allowed the patients to recover some quality of life). Combined use of cannabis as a strategy to reduce the effects of crack exhibited several significant advantages, particularly an improved quality of life, which "protected" users from the violence typical of the crack culture. Crack use is considered a serious public health problem in Brazil, and there are few solution strategies. Within that limited context, the combination of cannabis and crack deserves more thorough clinical investigation to assess its potential use as a strategy to reduce the damage associated with crack use.
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