Substance Misuse Flashcards
What may indicate substance misuse?
Loss of reliability
Mood or behaviour changes
Cannot drive
Requesting specific drugs prescribed
Marks on arms - punctures
Constricted / dilated pupils
Medical implications of substance misuse?
- increased infection rates
- general and oral health neglect
- IE
- BBV
- liver disease (alcoholics)
How can substance misuse affect capacity?
- capacity unlikely if under influence of drugs or alcohol
- postpone tx
Fx of substance misuse on LA?
Cannabis - prolonged acute tachycardia with vasoconstrictor LA
Alcohol - avoid IDB in coagulation defects and avoid lidocaine in compromised liver
Opioids - LA resistance / tolerance
Best anxiety management for those with substance misuse?
IS
- little systemic effect
- no escort needed
IV
- alcohol and opioids synergistic so can hyper respond
- may hypo respond due to BZDP tolerance
- possible vein collapse
Dental implications of substance misuse?
Rampant caries
Poor perio health
NCTSL - attrition and erosion
Hyposalivaiton - opiates and cannabis
Poor OH, poor Denture hygiene
Opportunistic infection
Trauma
Inc risk oral cancer and pre-malignant mucosal lesions
How manage alcoholic pt?
MORNING APPTS
- less likely to be intoxicated
Care with consent if intoxicated
LA not metabolised in liver
Careful with coagulation
May be on DISULFIRAM - if mixed with metronidazole can produce psychotic effect
Avoid GA
Issue with analgesia in opiate addictive pts?
In dependant pts
- simple analgesics often ineffective and require high dose opioids
- NEVER prescribe high dose opioids without consulting relevant medical practitioner
Only indication in dentistry for opiates is
- severe post op pain
Advice for methadone users?
Use a straw as it has high sugar content
Drink water after consumption to prevent regurgitation
Don’t brush immediately after
Dental considerations of opiates?
Poor OH and care / seeking of care
Chronic use = often altered taste so high cariogenic snacks
Reduced analgesia and LA effects
Pts may have BBV - sharps!
Dental FX cannabis?
Generally poor OH and perio
Reduced saliva
Munchies = cariogenic snacks
Anxiety during tx and tachycardia from LA
Inc risk ofc OSCC, candidiasis and infections
Dental implications of cocaine?
Bruxism, clenching and NCTSL
Recession at rubbing of sites
Sinusitis and epistaxis
Periodontitis prevalence
LA can increase BP after recent cocaine usage
- defer tx for 6-24 hours
General practical advise for drug pts? - main takeaways
Avoid adrenaline in patients with history of
- cocaine
- MDMA
- Meth
For BP risk
Avoid LA with adrenaline in those under fx of cannabis
- prolonged tachycardia
Alcohol
- liaise with GMP/gastro prior to tx for FBC for extractions and bleeding risk
SHARPS PRECAUTIONS
