Substance Misuse

Question 1

what is an addiction

Answer 1

chronic, primary, neurobiological condition influenced by genetic psychosocial and environmental factors

Question 2

name some risk factors for drug misuse and addiction

Answer 2

home who uses drugs
personality
availability of drugs
method of drug administration
peer pressure
physical and sexual abuse

Question 3

why do people with drug abuse usually have a history of trauma and are more likely to experience future trauma

Answer 3

initiation of drug abuse is more associated with social and environmental factors

Question 4

what does prolonged exposure to drugs result in

Answer 4

addiction through rewards pathway
reduced sensitivity of brain to reward systems

Question 5

what can drugs be classified into

Answer 5

behavioural
pharmacodynamic
legal

Question 6

give some examples of behavioural classification of drugs

Answer 6

stimulants
opioids
sedative hypnotics
antipsychotics
antidepressants
psychedelics

Question 7

what are the risks of illicit drug use

Answer 7

increased infection risk
health and social issues
thrombosis
embolism
deep vein thrombosis
endovascular complications

Question 8

what are the complications of injection drugs

Answer 8

cellulitis
abscess
thrombophlebitis

Question 9

what are the implications of drug use beyond the drug user

Answer 9

drug deaths including accidents and assaults
drug related crime
drug treatment services

Question 10

what are drug consumption rooms

Answer 10

healthcare settings providing a safe and clean environment for consumption of drugs under supervision of medical staff and with clean injecting equipment

Question 11

what are the advantages of a safer drugs consumption facility

Answer 11

reduce public injecting and discarding of needles
reduce sharing of needles and other injecting equipment
improve uptake of addictions care and treatment

Question 12

what is the role of the GDP in drug abuse

Answer 12

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

Question 13

what are the signs of substance misuse

Answer 13

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

Question 14

what are the barriers to accessing dental services for substance misusers

Answer 14

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

Question 15

what facilitates accessing dental care for substance misusers

Answer 15

key workers
mobile dental units

Question 16

what are the consent issues for drug users

Answer 16

do they have capacity if they are dependent on drugs

Question 17

what is treatment planning like for drug users

Answer 17

assess expectations
have flexible approach
initial stabilisation phase
all management includes diet and oral hygiene advice
keep treatment simple

Question 18

how does LA with adrenaline interact with cannabis

Answer 18

prolongs acute tachycardia

Question 19

what are the LA considerations with alcohol

Answer 19

LA is metabolised in liver so need to use minimum doses
avoid IDB in coagulation defects

Question 20

what are the general dental implications of substance misuse

Answer 20

rampant caries
periodontal disease
NCTSL
masseteric hypertrophy
hyposalivation
poor oral hygiene
opportunistic infections
trauma
oral cancer and mucosal lesions

Question 21

what is the correlation between drug abuse and oral cancer

Answer 21

more common due to risk factors (smoking, alcohol, direct application of drug to oral mucosa, poor nutritional and immune status, socio-economic status)

Question 22

what considerations are made for dental treatment for people with alcohol misuse

Answer 22

morning appointments
no metronidazole
avoid GA
avoid aspirin and NSAIDs
liver cirrhosis
consent issues
impaired wound healing

Question 23

what are the oral features of an alcoholic

Answer 23

caries, perio, NCTSL
increased leukoplakia and oral cancer
glossitis
angular stomatitis
sialosis
rhinophyma
erosion
nocturnal bruxism
dry mouth

Question 24

what are the dental implications of heroin

Answer 24

trauma
infective endocarditis
enhances sedation agents
oral neglect
impaired drug metabolism

Question 25

what advise can we give to people who use methadone

Answer 25

use a straw
drink water after consumption
dont brush teeth immediately after
engage with dental services

Question 26

what are the dental implications with opioids

Answer 26

suboptimal oral hygiene and self care
rampant tooth decay
periodontitis
altered taste preferences
smooth surface caries
reduce LA effectiveness
BBVs

Question 27

what are the dental implications of cannabis

Answer 27

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

Question 28

what are the dental implications of cocaine

Answer 28

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

Question 29

what are the dental implications of MDMA

Answer 29

bruxism
xerostomia
oral ulcers
soft tissue injuries
poor oral hygiene with rampant caries
NCTSL
treatment deferred for 6hrs after last administration