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In Reply: Dr Balayssac and colleagues point out the potential for the use of other drugs (including alcohol) and suggest that these may have been involved in the etiology of the chronic periodontal disease observed in the cohort. They cite 3 studies in support of this assertion. The first is a case report featuring a localized periodontal defect associated with the direct and prolonged placement of an MDMA tablet on the gingival tissue.¹ The second is also a case report and describes gingival tissue erosion as a result of the direct placement of cocaine.² Whatever mechanism was involved in the tissue destruction in those 2 cases, it was certainly not chronic periodontitis. The third is a comparison of alcoholics and nonalcoholics that actually found no meaningful difference in periodontal status.³ A systematic review has concluded that there is insufficient evidence for alcohol consumption to be considered a risk factor for . . . [Full Text of this Article]

W. Murray Thomson, PhD
murray.thomson@stonebow.otago.ac.nz
University of Otago
Dunedin, New Zealand

Richie Poulton, PhD
Dunedin School of Medicine
Dunedin, New Zealand

Avshalom Caspi, PhD
Duke University
Durham, North Carolina

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