Surgical treatment of jaw osteonecrosis in “Krokodil” drug addicted patients

Repeated subcutaneous administrations of krokodil causes skin necrosis and internal organs toxicity in Wistar rats: putative human implications

“…Isakova et al () described that cats with chronic kidney disease can develop pathological fractures, loose teeth, and “rubber jaw” syndrome as a consequence of bone demineralization. These symptoms are also present on krokodil users as previously described (Alves et al, ; Poghosyan et al, ). Therefore, krokodil users should be considered as hyperphosphatemic patients and phosphorous levels analytically monitored.…”

“…These symptoms are also present on krokodil users as previously described (Alves et al, 2015a;Poghosyan et al, 2014). Therefore, krokodil users should be considered as hyperphosphatemic patients and phosphorous levels analytically monitored.…”

“…Such damage often cause the flesh to rot, making the bone and muscle prone areas for infectious processes (Katselou et al, 2014), giving the characteristic "flesh eating" or "flesh rotting" designation to this drug. Osteonecrosis has also been reported as a clinical complication in krokodil abusers (Poghosyan, Hakobyan, Poghosyan, & Avetisyan, 2014), and in many cases, extensive amputation is required (Katselou et al, 2014). The exposure to high concentrations of iodine may lead to endocrine system disruption and thyroid disorders, whereas the presence of heavy metals can cause harm in the nervous system and liver and kidney failure during chronic abuse (Lee, Bradley, Dwyer, & Lee, 1999).…”

Oral manifestations of illicit drug use

“…The homemade production of desomorphine by the combination of codeine‐containing products (analgesic or antitussive preparations) and other readily available ingredients such as iodine, soda, red phosphorus, gasoline and hydrochloric acid produces an injectable liquid. The route of administration is usually by either intramuscular or intravenous injection, making the user susceptible to the harmful effects of the other components . Desomorphine gained its moniker, ‘krokodil’, ‘crocodile’, ‘croc’ or ‘krok’ due to the adverse effect the injection produces, which is a black and green discoloured, flaking skin, similar to that of a crocodile …”

“…In the vast majority of cases (92.3%), tooth removal was the trigger for the development of ONJ, where bone exposure can occur up to 12 months after the extraction . In addition to exposed bone, other reported clinical signs included swelling of the adjacent oral mucosa, intra‐ and extra‐oral fistulas in the surrounding area, together with associated pain . Other reported risk factors for ONJ in users include poor‐quality dentures, failed endodontic treatment, periodontitis, acute and chronic trauma of the oral cavity and poor oral hygiene .…”