Substance misuse Flashcards
Dependence divided into …..
psychological and physical.
Physical dependence
Physical; or neuroadaptation, is characterised by physical disturbances when the drug is suspended, or when its actions are antagonized
Psychological dependence
Psychological; Feeling of satisfaction or psychic drive requiring periodic or continuous administration of the drug to produce pleasure, or avoid discomfort.
PSYCHOLOGICAL DEPENDENCE OFTEN OUTLASTS PHYSICAL DEPENDENCE AND IS THE MAJOR CAUSE OF RELAPSE IN TREATED ADDICTS.
Drug tolerance
• Tolerance is the reduction in the effect of the drug due to prior exposure and is dependant on the dose and frequency of the exposure.
• The physiological basis for tolerance can be due to the decrease in the number of drug receptors, depletion of essential mediators, or a decrease in the plasma concentration with prolonged usage.
Tolerance may be overcome by increasing the dose of the drug.
Challenges in the dental management of substance abusers:
Pain control and management
Should use local without vasoconstrictor/ not treat patients that appear high/ not treat patients that are high on meth amphetamine/ dental professionals should be knowledgable about substance abuse/ longer acting drugs such as bupivicaine could be used for procedures requiring longer anaesthesia, therfore cutting down on the quanitity of drugs used/ drug abusers may claim an allergy to codeine in order to receive stronger drug such as morphine or hydrocodone (not really applicable to general practice in the UK)
Xerostomia
Unkown mechanism but: quality and quanitity of saliva affected
Elevation of metabolism, leading to dehydration
Lack of general self regulation of hydration levels, (abusers don’t eat or drink regularly)
The risk of dental caries, tooth substance loss/wear and periodontal disease is considerably increased by xerostomia
Soft tissue/ mucosal/ cutaneous damage
Very common in cocaine users/ some user snot coke, leads to damage of nasal tissue and can perforate/ some rub on to gingival tissues, leads to recession and possible buccal caries, if mixed with icing sugar-corn flour/ cocaine has a vasocontrictive effect leading to ulceration and atrophy of the tissues/ morphine experts an inhibitory effect on the phagocytosis of candida by macrophages, so together with reduces saliva formation/function can lead to oral candidosis/ smoking cannabis, cocaine, spice can lead to tissue dysplasia
Temperomandibular joint disorders, including bruxism, clenching and grinding
Very common in chronic substance abusers
One research paper showed 75% of people ‘ felt like chewing something’ after taking such drugs
Can lead to early tooth loss
Aggreviates the effects of periodontal disease
Diet
Substance abusers usually have unhealthy diets as a consequence of their chaotic lifestyle
Often have poor or suppressed appetites, altered taste and smell sensations
Often crave for sugar, of which they consume huge amounts
Priority is not to maintain good dietary habits, but to secure next hit
Tips on talking with patients about substance abuse
Communicate your concern Offer support Avoid shaming Ask non-judgemental questions Develop trust and offer hope
Acetaldehyde is the cause
Metronidazole inhibits aldehyde dehydrogenase
Acetaldehyde is the cause of majority of the unpleasant affects of alcohol hangover
Eg flushing, sweating, nausea
Metronidazole inhibits aldehyde dehydrogenase leading to acetaldehyde accumulation in tissue
30% of hospital admissions alcohol related, need to establish if other drugs involved or whether methanol the cause of intoxication
process of alcohol through the body:
Alcohol passes cell membrane very readily
Alcohol dehydrogenase breaks alcohol into acetaldehyde
Aldehyde dehydrogenase to acetyl co-enzyme A then into krebs cycle, finally produceing carbon dixoide and water
Define Alcoholism
Alcoholism is psychiatric condition which oral health care providers must treat as a specific disease without moral implications
Often occurs in individuals who are financially solvent and try to lead reasonably normal lives
Many patients try to mask their addiction with perfumes or after shave, and mints or chewing gum
Alcoholism affect on general health
Gerenal health: Malnutrition Vit deficiences especially vit B complex Jaundice Neurological disorders eg tremor Liver dysfunction Aggravated cardiovascular disease Drug interactions Imparied coordination Personality changes Immunosupression Memory loss
Alcoholism affect on oral health
Oral health Poor oral hygiene Uvulitis Increased decayed, missing or filled teeth Periodontal disease Oral mucosal changes Changes in appearance of tongue Enlarged parotid glands Xerostomia Predisposition to oral cancer
