8 - Substance misuse: dental implications Flashcards

1
Q

What is the role of the GDP in patients with substance misuse?

A
  • recognise substance misuse
  • emergency dental treatment
  • signpost to addiction services
  • maintenance of dental health
  • realistic treatment planning
  • empathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you recognise substance misuse?

A
  • loss of reliability
  • mood and behaviour changes
  • subjective symptoms with no objective evidence
  • requesting specific drugs
  • deterioration in appearance and hygiene
  • tremors
  • pupillary change
  • puncture marks, scars or pigmentation over veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is important in the social history for a patient with substance misuse?

A
  • alcohol consumption
  • drug consumption, including when last taken “for safety of procedure”
  • smoking status
  • living arrangement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the medical implications of substance misuse?

A
  • infection including STI, BBV, TB
  • health neglect
  • chronic liver disease (impaired drug metabolism, increased bleeding risk, impaired wound healing)
  • infective endocarditis
  • venous thromboses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage consent in substance misuse?

A
  • capacity is unlikely if the person is under the influence of drugs or alcohol
  • postpone treatment if possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the treatment planning in a substance misuse case.

A
  • flexible approach, anticipate unexpected symptoms between appointments
  • initial stabilisation required
  • prevention is key
  • simple treatment eg ART or SDF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can cause LA resistance?

A

Opioid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the interaction between cannabis and LA?

A
  • can cause prolonged tachycardia
  • ideally patient should be at least 3 days drug free
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the interaction between alcohol and LA?

A
  • most LA is metabolised in the liver
  • multiple cartridges could cause CNS toxicity
  • articaine is best option as metabolised in plasma
  • avoid IDB in patients with poor coagulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is sedation used in substance misuse?

A
  • inhalation is safest
  • can develop tolerance
  • IV sedation has synergistic effect with alcohol and opioids so should be avoided
  • can trigger relapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common presentations of substance misuse in the mouth?

A
  • rampant caries on all tooth surfaces
  • periodontal disease including necrotising conditions
  • NCTSL
  • masseteric hypertrophy
  • hypo salivation
  • poor OH
  • opportunistic infection
  • trauma
  • oral cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you adjust appointments for an alcoholic?

A

Morning appointments are better as they are least likely to be under the influence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the link between Antabuse and metronidazole?

A
  • disulfiram
  • can have psychotic reaction if taken with metronidazole
  • amoxicillin is indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the dental implications opiate use?

A
  • trauma
  • infective endocarditis
  • oral neglect
  • impaired drug metabolism
  • enchanted sedative effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is methadone?

A
  • used to replace opiate and aid withdrawal
  • high sugar content
  • caries rate significantly high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What advice can you give methadone users?

A
  • use a straw
  • drink water after consumption
  • don’t bruhs teeth immediately after
  • engage with dental services
  • prevention is key
  • sugar free suspension if possible
17
Q

What risks are associated with cannabis?

A
  • oral cancer
  • psychosis and schizophrenia
  • impairment in memory and cognitive function
  • xerostomia
  • caries
18
Q

How can cocaine use present in the mouth?

A
  • unusual ulceration on gingiva
  • NCSTL
  • caries
  • orofacial pain
  • palatal/nasal perforation in severe cases
19
Q

What is the interaction between cocaine and LA?

A
  • adrenaline can have additive effect
  • delay 6-24 hours