Addiction & Substance Misuse

Question 1

SCD

What are the signs of drug addiction which a patient might present with in the dental surgery ?

Answer 1

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.

Question 2

SCD

What are some medical complications of drug misuse ?

Answer 2

Infection (BBV). General health and dental neglect. Chronic liver disease. Infective endocarditis. Venous thrombosis. Embolism. Cellulitis. Abscess. Thrombocytopenia. Increased bleeding. Nutritional deficiency.

Question 3

SCD

What are some signs and symptoms of smoking addiction ?

Answer 3

Cravings. Anxiety, depression and low mood. Headaches. Disturbed sleep. Weight gain. Irritation. Restlessness.

Question 4

SCD

What are some dental implications of smoking ?

Answer 4

Increased OPC/OCC risk. Smoker’s kertosis. Periodontal disease. Staining. Halitosis. Caries.

Question 5

SCD

What are some medical complications associated with smoking ?

Answer 5

• COPD, chest infection, lung cancer.
• Narrowed arteries, CHD, stroke.
• Stomach ulcers, stomach/kidney cancer.
• Osteoporosis.
• Miscarriage.
• Reduced fertility.

Question 6

SCD

What acronym can be used for how to approach conversation regard smoking cessation with a patient ?

Answer 6

3As - ask, advice, act.

Question 7

SCD

Smoking 3As - what questions would you ASK a patient ?

Answer 7

• 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 ?

Question 8

SCD

Smoking 3As - what are some smoking cessation options which you can advise your patient to engage with ?

Answer 8

• NHS Trakcare smoking cessation.
• Pharmacy - nicotine patches, chewing gum.
• Quit Your Way resources online (NHS).
• Speak to your GP.

Question 9

SCD

ANUG is a dental implication of substance misuse - explain the condition and how it relates to substance misuse ?

Answer 9

• 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.

Question 10

SCD

What are some intra-oral consequences of alcohol misuse ?

Answer 10

Caries, periodontal disease, NCTSL, increased leukoplakia and OCP/OCC risk, glossitis, angular chelitis, RAS, sialosis, xerostomia, erosion.

Question 11

SCD

Some patients who suffer alcohol misuse can be prescribed Disulfiram by their GP - what is the main drug contraindication ?

Answer 11

Metronidazole - psychotic effect.

Question 12

SCD

What drugs should be avoided in patients who suffer alcohol misuse ?

Answer 12

Metronidazole.
NSAIDs.
Sedatives.

Opt for articaine - due to liver cirrhosis.

Question 13

SCD

What is the active component in heroin ?

Answer 13

Diamorphine.

Causes euphoria - large dopamine release then CNS depression.

Question 14

SCD

What are the dental risks of heroin use ?

Answer 14

Trauma. Smooth surface caries. Infective endocarditis. Oral neglect. Enhanced effect of sedatives. Impaired drug metabolism.

Question 15

SCD

What is the consequence of methadone use ?

Answer 15

High sugar - 2.5mg for 5ml.
Risk of smooth surface caries on buccal/labial surfaces.

Question 16

SCD

What can be done to limit the cariogenic effect of methadone ?

Answer 16

• 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.

Question 17

SCD

What two microbes are most responsible for infective endocarditis ?

Answer 17

S. Aureus and S. Viridans.

Question 18

SCD

What three types of patients are most likely to be affected by infective endocarditis ?

Answer 18

Previously had IE.
Congenital heart defects.
Heart valve replacement/repair.

Injectable drugs can increase this risk.

Question 19

SCD

What is the antibiotic prophylaxis regime for infective endocarditis ?

Answer 19

3g sachet of amoxcilin dissolved in water, drank 60 mins before procedure within the dental practice.

Question 20

SCD

What are some risk factors associated with drug use and addicition ?

Answer 20

Genetic. Low socioeconomic status. Peers/family drug use. Time of drug use. Availability of drug. Peer pressure. Abuse. Stress. Coexisting mental health issues.

Question 21

SCD

What are some signs of addiction which you might see in colleagues in the work place ?

Answer 21

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.

Question 22

SCD

What are some physical signs of stress ?

Answer 22

Increased heart rate and BP.
Palpitations.
Muscle tension increases resulting in headaches, jaw stiffness, dizziness, insomnia.
Sweating, blushing, clammy of hands and feet.

Question 23

SCD

What are some mental and emotional signs of stress ?

Answer 23

Confused thoughts.
Focussed on worrying.
Difficulty making decisions.
Impatient.
Anger/frustrations.
Self-doubt.
Anxious.
Unhappiness.
Emotional withdrawal.

Question 24

SCD

As a dentist, how should you cope with stress ?

Answer 24

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.