Substance Misuse Flashcards
what is an addiction
chronic, primary, neurobiological condition influenced by genetic psychosocial and environmental factors
name some risk factors for drug misuse and addiction
home who uses drugs
personality
availability of drugs
method of drug administration
peer pressure
physical and sexual abuse
why do people with drug abuse usually have a history of trauma and are more likely to experience future trauma
initiation of drug abuse is more associated with social and environmental factors
what does prolonged exposure to drugs result in
addiction through rewards pathway
reduced sensitivity of brain to reward systems
what can drugs be classified into
behavioural
pharmacodynamic
legal
give some examples of behavioural classification of drugs
stimulants
opioids
sedative hypnotics
antipsychotics
antidepressants
psychedelics
what are the risks of illicit drug use
increased infection risk
health and social issues
thrombosis
embolism
deep vein thrombosis
endovascular complications
what are the complications of injection drugs
cellulitis
abscess
thrombophlebitis
what are the implications of drug use beyond the drug user
drug deaths including accidents and assaults
drug related crime
drug treatment services
what are drug consumption rooms
healthcare settings providing a safe and clean environment for consumption of drugs under supervision of medical staff and with clean injecting equipment
what are the advantages of a safer drugs consumption facility
reduce public injecting and discarding of needles
reduce sharing of needles and other injecting equipment
improve uptake of addictions care and treatment
what is the role of the GDP in drug abuse
recognise it
emergency dental treatment
comprehensive care
signposting to addiction services
referral to hospital services
maintain dental health during rehabilitation
provide stigma and judgement free dental care
have empathy and awareness of potentially manipulative behaviour
realistic treatment planning
what are the signs of substance misuse
loss of reliability
mood and behaviour changes
impaired driving ability
subjective symptoms with no objective evidence
requesting specific drugs
progressive deterioration in personal appearance
tremors
puncture marks, scars or pigmentation
what are the barriers to accessing dental services for substance misusers
professionals negative perception
pathways are not established for access
low priority of oral health
fear of dentists
self-medication
chaotic lifestyles
fear of judgement
poor attendance and compliance
cost
behaviour
what facilitates accessing dental care for substance misusers
key workers
mobile dental units
what are the consent issues for drug users
do they have capacity if they are dependent on drugs
what is treatment planning like for drug users
assess expectations
have flexible approach
initial stabilisation phase
all management includes diet and oral hygiene advice
keep treatment simple
how does LA with adrenaline interact with cannabis
prolongs acute tachycardia
what are the LA considerations with alcohol
LA is metabolised in liver so need to use minimum doses
avoid IDB in coagulation defects
what are the general dental implications of substance misuse
rampant caries
periodontal disease
NCTSL
masseteric hypertrophy
hyposalivation
poor oral hygiene
opportunistic infections
trauma
oral cancer and mucosal lesions
what is the correlation between drug abuse and oral cancer
more common due to risk factors (smoking, alcohol, direct application of drug to oral mucosa, poor nutritional and immune status, socio-economic status)
what considerations are made for dental treatment for people with alcohol misuse
morning appointments
no metronidazole
avoid GA
avoid aspirin and NSAIDs
liver cirrhosis
consent issues
impaired wound healing
what are the oral features of an alcoholic
caries, perio, NCTSL
increased leukoplakia and oral cancer
glossitis
angular stomatitis
sialosis
rhinophyma
erosion
nocturnal bruxism
dry mouth
what are the dental implications of heroin
trauma
infective endocarditis
enhances sedation agents
oral neglect
impaired drug metabolism
what advise can we give to people who use methadone
use a straw
drink water after consumption
dont brush teeth immediately after
engage with dental services
what are the dental implications with opioids
suboptimal oral hygiene and self care
rampant tooth decay
periodontitis
altered taste preferences
smooth surface caries
reduce LA effectiveness
BBVs
what are the dental implications of cannabis
poor oral health and periodontal health
reduced salivary flow
cariogenic food and drink
anxiety and dysphoria during treatment
prolonged tachycardia with LA
increased leukoplakia, OSCC, candidiasis and oral infections
what are the dental implications of cocaine
bruxism, cleaning and NCTSL
gingival erosions, retraction and ulcerative lesions at site of application
chronic sinusitis, epistaxis and nasal crusting
higher periodontal disease
enhance response to adrenaline
defer dental treatment for 6-24hrs after cocaine
headaches to maxillary teeth
what are the dental implications of MDMA
bruxism
xerostomia
oral ulcers
soft tissue injuries
poor oral hygiene with rampant caries
NCTSL
treatment deferred for 6hrs after last administration
