Effects of krokodil (desomorphine) use on oral health - a systematic review

Introduction The narcotic drug krokodil is a semi-synthetic drug used as a cheap alternative to heroin. With its active ingredient desomorphine it is a highly addictive and destructive drug mainly used in Russia and Eastern Europe. Relatively little is known about the physical effects of krokodil. With this review we present more insight into oral health problems associated with krokodil use and how the use of this drug could influence dental and oral- and maxillofacial treatment.Methods The online electronic databases Pubmed, Web of Science, Cochrane Library and Google scholar were searched for articles concerning desomorphine or krokodil and oral side effects or pathology. Reference lists of included articles were manually screened for additional publications. Results Thirteen articles were included in this review. In total 684 patients were described in the included publications, mainly retrospective clinical case series and case reports. Eleven studies reported on osteonecrosis of the jaw and two studies reported on other physical and oral side effects associated with desomorphine abuse. Conclusion Osteonecrosis of the maxillofacial bones is a serious and mutilating oral side effect associated with krokodil use. Other oral aspects associated with its use include mucosal changes, high risk of caries and periodontitis. In addition, physical effects of the drug, which indirectly can affect oral health, have also been described. The use of the drug krokodil can interfere with dental and oral- and maxillofacial treatment.