Substance abuse 2- Dental Implications Flashcards
What is the role of the GDP when treating patients who suffer from substance abuse?
Recognise in patients/colleagues
Emergency treatment
Signpost to addiction services
-> referral to hospital
Maintain dental health during rehab
Provide comprehensive judgement feee dental care
Empathy for behaviour
Realistic treatment planning
What are the causes of substance abuse?
Social deprivation
Poor housing
Adverse childhood experiences
Poor role models
Low educational aspiration
Lack of opportunities
Barriers to advancement
High unemployment
How can we recognise substance abuse?
Loss of reliability
Mood and behaviour changes – present defensively, angry or challenging
Impaired ability to drive
Subjective symptoms with no objective evidence
Requesting specific drugs
Progressive deterioration in personal appearance and hygiene
Tremors
Constricted or dilated pupils
Puncture marks, scars or pigmentation over veins
What are the barriers for people with substance abuse issues accessing dental services?
Professionals’ negative perception of these people- fear of judgement or prejudice
Pathways are not established for access
Low priority of oral health compared with drug use
Fear of dentists including needle phobia
Self-medication
Chaotic lifestyles.
Poor attendance and compliance
Cost: frequent changes in or loss of employment
Behaviour
What are the facilitators to access for dental care in people with substance abuse issues?
Housing
Education
Counselling
Support networks
BBV vaccinations
Life skills
Parenting skills
Pregnancy support
What can help people with homelessness and substance abuse issues access dental care?
Mobile dental units
Why is it important to take a thorough history in patients with substance abuse issues?
Assessing risk and patient motivation
What questions should we ask patients who we suspect may abuse substances about (sensitively)?
Alcohol consumption- number of units
Use of drugs- prescription and recreational
-> quantity
Smoking status
Living arrangements
What are the medical implications of substance misuse?
General/Oral health neglect
Increased risk of infection- TB, BBV, STI
Chronic liver disease- impaired drug metabolism and bleeding risk
IE
Venous thrombosis
What are patients with substance abuse issues more at risk of in terms of social history?
Assaults , theft, prostitution
Maxillofacial injuries
Sharing of needles- BBV
Family disruption
Change in address (or no address)
Prison
Attempted rehab
Chaotic lifestyle
What should be done if a patient is abusing substances and needs to consent to treatment?
Many drug users have fluctuating capacity
-> postpone treatment if you suspect them to be under influence
What are some examples of alcohol related brain damage?
Wernicke’s encephalopathy
Korsakoff’s syndrome
What should be done when treatment planning for patient with substance abuse issues?
Assess patient expectations and be realistic
Flexible approach- patient may present with unexpected symptoms requiring additional tx
Initial stabilisation- remove active caries/extripate as required and place temporaries
All management should include
-> Diet and OHI
-> Enhanced prevention- F toothpaste, FV, mouthwash, tooth mouse, gum
Keep treatment simple during substance misuse- ART/SDF
What are the effects of LA in patients who abuse different substances?
LA resistance- opioid users/anxiety disorders
Cannabis- ADR can prolong acute tachycardia (avoid)
Alcohol
-> LA metabolised in liver, keep doses to a minimum (2 can trigger CNS toxicity in severe liver disease)
-> Avoid IDB if coagulation issue
What else must dentist be careful with when giving LA to patients with substance abuse issues?
Pain described by patient should be consistent with clinical findings
-> if not patient may be motivated to receive treatment to feel effects of anaesthetic
