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	Since this article does not have an abstract, we have provided the first 134 words of the full text and any section headings.

To the Editor: Dr Thomson and colleagues¹ established evidence of an association between cannabis smoking and periodontal disease among young adults. We believe that the discussion could have been extended to other drug abuse.

The study did not provide data on the use of any other illicit drugs in this population, which may have occurred. Methylenedioxymethamphetamine (MDMA, ectasy) may also be associated with gingival and mucosal ulceration and periodontitis.² Chronic gingival application of cocaine may be associated with gingival and mucosal ulceration, periodontitis, and local vasoconstrictive ischemia.³ In association with cocaine use, chronic alcohol consumption may increase periodontitis development.⁴

Given this, the finding of an association between cannabis abuse and periodontal disease must take into account potential confounding by the use of other substances that may also affect oral health.

Financial Disclosures: None reported.

David Balayssac, PhD, PharmD
dbalayssac@chu-clermontferrand.fr
CHU de Clermont-Ferrand
Clermont-Ferrand, France

Aude Zangarelli, PhD, PharmD; Nicolas Authier, PhD, PharmD
UMR INSERM 766
Clermont-Ferrand, France

1. Thomson WM, Poulton R, Broadbent JM; et al. Cannabis smoking and periodontal disease among young adults. JAMA. 2008;299(5):525-531. FREE FULL TEXT 2. Brazier WJ, Dhariwal DK, Patton DW; et al. Ecstasy related periodontitis and mucosal ulceration: a case report. Br Dent J. 2003;194(4):197-199. FULL TEXT | ISI | PUBMED 3. Kapila YL, Kashani H. Cocaine-associated rapid gingival recession and dental erosion: a case report. J Periodontol. 1997;68(5):485-488. ISI | PUBMED 4. Khocht A, Janal M, Schleifer S; et al. The influence of gingival margin recession on loss of clinical attachment in alcohol-dependent patients without medical disorders. J Periodontol. 2003;74(4):485-493. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;299(19):2273.

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RELATED ARTICLE

Cannabis Smoking and Periodontal Disease Among Young Adults
W. Murray Thomson, Richie Poulton, Jonathan M. Broadbent, Terrie E. Moffitt, Avshalom Caspi, James D. Beck, David Welch, and Robert J. Hancox
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