A Comparative Feasibility Study to Assess the Prevalence and Severity of Dental Caries in Incarcerated People Who Abuse Methamphetamine

The prevalence and severity of dental caries in incarcerated people who abuse drugs are
unknown but an inmate reporting to the dental clinic typically presents with myriad
findings: oral signs of uncontrolled decay on the buccal smooth surfaces of the posterior
teeth and interproximal surfaces of the anterior teeth, excessive tooth wear due to grinding
and clenching, and gingival inflammation. The primary risk factors for the development of
caries appear to be the combination of xerostomia, frequent consumption of carbonated soft
drinks, high dental plaque levels and nonexistent or inadequate oral hygiene. Since some of
these findings are seen in the other disease states, specifically in substance abuse cases,
the diagnosis is often not clear. The objective of the project is to design a cross
sectional comparative feasibility study that will estimate the prevalence, pattern, and
severity of untreated dental decay for three types of inmates: methamphetamine abusers,
substance abusers not identified as methamphetamine users, and non-substance abusers,
focusing in on methamphetamine abusers as the highest risk group.

Recruitment will be accomplished using a 2-phased process. Phase I. An invitation letter
explaining the study purpose and its relevance to oral health in a correctional setting will
be mailed to the inmate population at two Federal Bureau of Prisons' institutions who
entered the prison system during the first half of 2009. Dublin, a female FCI located in
Northern California and Butner, a male FCC located in North Carolina were the selected
facilities due to the high incidence of drug abusers among their inmates. The letter, which
will invite all inmates to participate in the study, will inform the inmate should they
consent to participate in the study that they will have their existing dental record
confirmed, Central File reviewed for DSM-IV diagnosis pertinent to the study, and that they
will be given a study questionnaire. Positive responses to the invitation letters will be
returned to Dr. Johnson at head quarters in Washington DC. The psychology division will
code the volunteer inmates into the three study groups.

Phase II. The first 30 chronologically documented volunteers in each study group category
will be scheduled an appointment. A consent form will be read and explained to each inmate,
in either English or Spanish as appropriate and his/her signature obtained as his/her
informed consent.

Each question on the study questionnaire will be read to the inmate volunteer and the
Research Associate will record the answer. A retrospective comparative study will then be
employed utilizing the inmate's initial dental intake exam (routinely administered by the
Federal Bureau of Prisons' dental department). The dental chart will be abstracted for
dental caries. The pattern of surface-specific dental caries (DFS index) will be described
and analyzed. The focus will be on the levels of untreated and treated disease diagnosed in
a 4-zone partition of the oral dentition, representing a modification of the zones
identified in the Grainger's caries severity index scoring system as this partition allows
focus on decay patterns of anterior tooth surfaces. The multivariate summary of disease
levels within each zone will be derived and statistically compared across the three study
groups using Hotelling's t2-test (the multivariate extension of the Student-t test). The
results of the study will be used to do a preliminary assessment between methamphetamine
drug abuse and oral health and determine whether a prospective clinical study is warranted.