Substance Abuse Flashcards
What is tobacco?
- Toxic to humans; nicotine naturally occurring
- Depletes nutrients and absorbs chemicals from soil
What are some different forms of tobacco?
- Smokeless tobacco
- Electronic nicotine delivery systems (ENDS)
- Waterpipes (hookah)
- Dissolvable and gel tobacco forms
- Not safe substitute
What is the risk for tobacco in the systemic health?
Causes cancer throughout the body
What are some oral manifestations of tobacco use
Pale pink, fibrotic gingiva
Halitosis
Leukoplakia
Stomatitis
Sialometaplasia
Periodontitis
Increased rate, severity, CAL,
bone loss, probing depths
Tooth loss
Delayed healing
Implant failure risk
Squamous cell carcinoma
Oral and pharyngeal cancer risk
Oral Manifestations of
Smokeless Tobacco Use
Leukoplakia
Nicotine stomatitis
Smoker’s melanosis
Hairy tongue
Periodontitis
Implant failure risk
Necrotizing gingivitis
halitosis
Medical Treatment Strategies
Self-help:Cold turkey, gradual decrease, ENDS substitute, OTC nicotine-replacement
Assisted interventions by HCP
FDA approved pharmacotherapies
Chantix, Wellbutrin
Counseling
Acupuncture, hypnotherapy
Nicotine replacement therapy
What are the dental management for
Review MH for tobacco
use history
Type of product? How
often used? How long?
Tried other forms?
Ask if interested in
quitting.
* If not, discontinue conversation
* Educate about oral effects
* You are a resource for
cessation services.
Conduct a thorough
IO/EO for signs of
tobacco use
Evaluate for increased
stain, calculus, caries,
inflammation, signs of
periodontal problems
NSPT: Jeopardizes
healing, lessened
outcomes of treatment,
cessation improves
results
What is the motivational interviewing ?
- Resist
- Understant
- Listen
- Empower
What are the 5A’s and R’s?
A- Ask, Advise, Asist, Assess, Arrange
R- Repition, Relevance, Risks, Rewards , Roadblocks
What are the causes of alcohol abuse?
- Genetics: GABRA2 and CHRMS2 (genes)
- Biopsychosocial: (children of alcohol dependednt parents)
- Environmental
What are the signs of Alcohol abuse?
Craving
Loss of control
Tolerance
Physical dependence
What are stages of alcohol metabolism?
- First: ingestion and absorption
- Second: Liver metabolism
- Third: Diffusion
Metabolized more slowly than absorbed: Rate dependent on: age, gender, adipose (fatty) tissue, food ingestion
What are some health hazards
Wernicke-Korsakoff’s Syndrome
Brain disorder of cerebellum: thiamine deficienc
What are some medical management:
- Abstinence
- Detoxification management
- Pharmacotherapy: anticonvulsant, alcohol-sensitizing agents, anticraving agents (naltrexone, acamprosate)
- Rehabilitation
What is dental management for alcholol abuse?
Health history / Screening
Medications?
Other intervention or treatment program?
Referral
Oral Manifestations of Alcohol Use & Abuse
Breath and body odor of alcohol and of tobacco
Skin: Redness of forehead, cheeks, nose petechiae
Face color: Light yellowish brown → jaundice
Eyes: Red, baggy eyes or puffy facial features
Evidence of trauma
Angular cheilitis
Swollen parotid glands
Tremor of hands, tongue, eyelids
What are some considerations for any drug use?
Drug use varies from recreational use to addiction
Daily drug use varies = questioning at each appointment
No classic cultural, socioeconomic, or educational profile for
a substance abuser
Chemical dependency = illness
What is the clinical presentations for marijuana?
Clincial Presenstation
Altered sense of time and distance
perception; anxiety, paranoia, delusions
Dental Management
* ID signs and symptoms of use
* Postpone treatment if used by a patient
with ischemia or heart failure
* Refer to physician
What are the clinical presentation opioids?
Euphoria, decreased pain perception, sedation,
orthostatic hypotension
* Overdose
* slow, shallow respirations, bradycardia, lowered
body temperature, unresponsiveness
* Withdrawal
* GI upset, muscle cramps, rhinorrhea, irritability
What are the medical and dental management for opioids?
Administer Narcan to reverse effects of overdose
Dental: identify drug-seeking behavior
What are the clinical presentation for cocaine?
Sense of well-being, heightened awareness, anorexia,
needing less sleep, restlessness, elation, agitation, panic,
paranoia, hallucinations and delusions, euphoria,
heightened sexual desire, tachycardia, arrhythmias, HBP,
chills, nausea, vomiting, visual needle tracks
*Overdose
*MI, arrhythmia, CVA, respiratory arrest, depression
What are the Medical and Dental management for cocaine ?
Increased risk for Hep B, Hep C, HIV, if injected.
Dental Management
No anesthesia with epinephrine for at least 6 hrs. after use
What are the clinical presentation Methamphetamines
Same as cocaine use; violent
behavior; hyperactivity, increased
physical endurance
* Cessation Symptoms
* Depression, sleepiness, or difficulty
sleeping
what are the dental management about methamphetamines ?
No dental treatment for patients who
are high
What are the clincial presentation during withdrawal of sedative hypnotics?
Nausea, vomiting, weakness,
tachycardia, sweating,
orthostatic hypotension, tremor,
loss of appetite, weight loss,
tinnitus, delirium, hallucinations
What are the dental management sedative hypnotics ?
Do not treat if patient is not
awake asunable to provide
consent
What are the dental management sedative hypnotics
Requires aggressive approach to
prevention and treatment of dental
disease
Diets include foods that increase risk
for dental disease
Considerations:
OHI
Timing of procedures
Positive communication
Appropriate pain control
Consult with physician regarding
management of condition
What are extraoral presentations?
Eyes
Arms
What are some Oral Manifestations
Caries
Recession
Xerostomia
Tongue coated;
glossitis
Heavy calculus
deposits
Moderate to severe
inflammation
Increased bleeding
Periodontal
infections
Chipped, fractured
teeth
Stained teeth
Attrition
Erosion
What are the oral manifestation marijuana?
- Pre-malignant lesions
- Periodontal infection
- Leukoplakia
What are the oral manifestation Ecstasy?
Xerostomia
Attrition
TMJ pain
Rampant caries
What are the oral manifestations of cocaine?
Perforation
Gingival recession
Erosive caries
What are the oral manifestations for meth mouth?
Severe cervical
Caries
Rampant caries
Periodontal infection