BDS4 Psychiatric illness and substance misuse in dentistry Flashcards
Who is at risk of poor mental health - CHILDHOOD RELATED?
Parental use of alcohol/ drugs during pregnancy
Maternal stress during pregnancy
Low birth weight
Poor parental mental health
Parental unemployment
Child abuse and adverse experiences
Use of cannabis
Who is at risk of poor mental health - ADULTHOOD?
Lower income and debt
Violence
Stressful life events
Housing
Fuel poverty
Unemployment
Experience of abuse
What are the dental implications of depression?
Won’t seek treatment
Neglected OH
Increased caries and periodontal disease
Chronic facial pain
Burning mouth or sore tongue
TMD
Dry mouth
What is neuroses and what are some of the conditions that come under this?
A condition related to a patient’s mental health where the patient retains contact with reality.
Anxiety
Depression
Panic disorder
Phobia
What are some protective factors for mental health?
No negative/ adverse early childhood experiences
Strong social support networks
Socioeconomic factors including access to resources
Employment and other purposeful activity
High self-esteem
Good physical health
What is tardive dyskinesia and what is the cause?
Involuntary movements of the tongue, lips, face, trunk and extremities
Affects 15-20% of patients who have been receiving antipsychotics.
What is psychosis and what conditions fall under this term?
Psychosis is an umbrella term for mental health conditions where the person loses touch with reality e.g. hallucinations or delusions
Schizophrenia
Bipolar
What are some causes of psychosis?
A traumatic experience
Stress
Drug/ alcohol misuse
Side effects of prescribed medication
Physical condition e.g. brain tumour
What are the oral implications of substance misuse?
Rampant caries - rapidly progressing caries affecting all tooth surfaces
Periodontal disease including necrotizing conditions
Masseteric hypertrophy - Bruxism
Hyposalivation – xerostomia secondary to opiates and cannabis
Opportunistic infections
Trauma
Oral cancer and mucosal lesions
What do you need to consider when giving LA to an alcoholic, and what LA should be used?
LA metabolised in the liver - keep doses to a minimum.
Articaine - 90-95% metabolised in the blood and only 5-10% metabolised in the liver
List some barriers for addiction sufferers to accessing dental services?
Pathways not established for access
Low priority of oral health compared to drug use
Self-medication (pain)
Chaotic lifestyles
Fear of judgement or prejudice from the dental team
Poor attendance
Cost
What are the medical implications of substance misuse?
Increased rates of BBV
General health (including oral) neglect
Chronic liver disease - alcohol abuse
Infective endocarditis
Venous thrombosis
Dental implications of bipolar disorder
Depends on if they are up or down currently
Depression:
- Poor OH
- Increased caries
- increased perio disease
Mania
- Overzealous use of OH resulting in NCTSL abrasion
Common short-term side effect of halperidol and phenothiazines (anti-psychotic drug)?
Orthostatic hypotension- fall in blood pressure when stand up - dental implication - raise slowly from the chair
Hypersalivation
Name some positive symptoms of schizophrenia?
Hallucinations
Delusions
Muddled thinking
Feelings of being controlled
