Addiction & Substance Misuse Flashcards
SCD
What are the signs of drug addiction which a patient might present with in the dental surgery ?
Loss of reliability. Mood changes. Impaired ability to drive. Requesting specific drugs. Memory loss. Tremors. Dilated/constricted pupils. Loss of personal hygiene and self care.
SCD
What are some medical complications of drug misuse ?
Infection (BBV). General health and dental neglect. Chronic liver disease. Infective endocarditis. Venous thrombosis. Embolism. Cellulitis. Abscess. Thrombocytopenia. Increased bleeding. Nutritional deficiency.
SCD
What are some signs and symptoms of smoking addiction ?
Cravings. Anxiety, depression and low mood. Headaches. Disturbed sleep. Weight gain. Irritation. Restlessness.
SCD
What are some dental implications of smoking ?
Increased OPC/OCC risk. Smoker’s kertosis. Periodontal disease. Staining. Halitosis. Caries.
SCD
What are some medical complications associated with smoking ?
- COPD, chest infection, lung cancer.
- Narrowed arteries, CHD, stroke.
- Stomach ulcers, stomach/kidney cancer.
- Osteoporosis.
- Miscarriage.
- Reduced fertility.
SCD
What acronym can be used for how to approach conversation regard smoking cessation with a patient ?
3As - ask, advice, act.
SCD
Smoking 3As - what questions would you ASK a patient ?
- Do you smoke ?
- Have you ever smoked ?
- How long have you smoked for ?
- What is it you smoke ?
- How many do you smoke a day ?
- What time of day do you have your first cigarette ?
- Are you aware the medical and dental implications of stopping smoking ?
SCD
Smoking 3As - what are some smoking cessation options which you can advise your patient to engage with ?
- NHS Trakcare smoking cessation.
- Pharmacy - nicotine patches, chewing gum.
- Quit Your Way resources online (NHS).
- Speak to your GP.
SCD
ANUG is a dental implication of substance misuse - explain the condition and how it relates to substance misuse ?
- Painful ulceration of interdental papillae with grey/yellow sloughing, causing halitosis and submandibular lymphadenopathy.
- Not caused by dental plaque, but can be made worse by it.
- Associated with smoking, immunosuppression (HIV, AIDS, haematinic deficiency, nutritional deficiency), psychological stress.
SCD
What are some intra-oral consequences of alcohol misuse ?
Caries, periodontal disease, NCTSL, increased leukoplakia and OCP/OCC risk, glossitis, angular chelitis, RAS, sialosis, xerostomia, erosion.
SCD
Some patients who suffer alcohol misuse can be prescribed Disulfiram by their GP - what is the main drug contraindication ?
Metronidazole - psychotic effect.
SCD
What drugs should be avoided in patients who suffer alcohol misuse ?
Metronidazole.
NSAIDs.
Sedatives.
Opt for articaine - due to liver cirrhosis.
SCD
What is the active component in heroin ?
Diamorphine.
Causes euphoria - large dopamine release then CNS depression.
SCD
What are the dental risks of heroin use ?
Trauma. Smooth surface caries. Infective endocarditis. Oral neglect. Enhanced effect of sedatives. Impaired drug metabolism.
SCD
What is the consequence of methadone use ?
High sugar - 2.5mg for 5ml.
Risk of smooth surface caries on buccal/labial surfaces.
SCD
What can be done to limit the cariogenic effect of methadone ?
- Use straw.
- Drink water after use.
- Regular dental check ups and prevention through engagement with dental services.
- Do not brush immediately.
- Sugar free preparations are available - not as beneficial.
SCD
What two microbes are most responsible for infective endocarditis ?
S. Aureus and S. Viridans.
SCD
What three types of patients are most likely to be affected by infective endocarditis ?
Previously had IE.
Congenital heart defects.
Heart valve replacement/repair.
Injectable drugs can increase this risk.
SCD
What is the antibiotic prophylaxis regime for infective endocarditis ?
3g sachet of amoxcilin dissolved in water, drank 60 mins before procedure within the dental practice.
SCD
What are some risk factors associated with drug use and addicition ?
Genetic. Low socioeconomic status. Peers/family drug use. Time of drug use. Availability of drug. Peer pressure. Abuse. Stress. Coexisting mental health issues.
SCD
What are some signs of addiction which you might see in colleagues in the work place ?
Loss of reliability. Mood changes. Self-prescribing of mood-latering medications. Complaints about deteriorating attitude. Professional and personal isolation. Sloppy record keeping. Drug shortages. Inappropriate prescriptions.
SCD
What are some physical signs of stress ?
Increased heart rate and BP.
Palpitations.
Muscle tension increases resulting in headaches, jaw stiffness, dizziness, insomnia.
Sweating, blushing, clammy of hands and feet.
SCD
What are some mental and emotional signs of stress ?
Confused thoughts.
Focussed on worrying.
Difficulty making decisions.
Impatient.
Anger/frustrations.
Self-doubt.
Anxious.
Unhappiness.
Emotional withdrawal.
SCD
As a dentist, how should you cope with stress ?
Tell colleagues.
Use support groups - British Doctors and Dentists Group.
Engage with medical services.
Spend time with family.
Practice relaxation techniques.
Find a hobby.
Minimise work balance.
