substance misuse - dental implications Flashcards
Name 4 signs of substance misuse
Loss of reliability
Mood and behaviour changes
Impaired ability to drive
Tremors
Name 4 barriers to accessing dental services relating to substance misuse
Low priority of oral health compared with drug use
Chaotic lifestyles
Poor attendance and compliance
Cost - frequent changes in or loss of employment
How should you take a drug history?
Number of units comsumed per week
The use of drugs - prescription or recreational
Quantity and duration of drugs
Smoking status
Living arrangements
Give 4 medical implications of substance misuse
Any from:
Increased rate of infection
BBVs
Infective endocarditis
Oral health neglect
General health neglect
Why may consent be an issue in alcoholics?
Capacity is unlikely when patient is under the influence of drugs or alcohol
How does tx planning change when substance misuse is present?
Assess pts expectations first
Initial stabilisation phase often required
Always include diet advice, OHI and enhanced prevention
Keep plan simple during active substance misuse - ART and SDF
How may pain control and LA be affected in substance misuse?
LA resistance in opioid users
Cannabis - LA with adrenaline can prolong acute tachycardia
Alcohol - care with LA metabolised in liver - use articaine
Dependent pts may request prescriptions for medication when not appropriate
How can anxiety be managed in substance misuse?
Inhalation is the safest type of sedation
GA and IV sedation can trigger relapse
Venous access may be difficult
Give 4 general dental implications of substance misuse
Any from:
Rampant caries affecting all tooth surfaces
Periodontal diseases including necrotising conditions
NCTSL
Masseteric hypertrophy - bruxism
Hyposalivation
Poor OH
Oral cancer and mucosal lesions
Give 5 reasons oral cancer is more common in substance misuse?
Smoking
Alcohol
Direct application of drug to the oral mucosa
Poor nutritional and immune status
Socio-economic status
What can help treating alcoholics?
Morning appointments - most likely to be sober
Sedatives have additive effect with alcohol
GA best avoided
Watch disulfiram commonly given to alcoholics - has a reaction with metronidazole
Paracetamol is the safest analgesic
Impaired wound healing if pt is immunocompromised
Avoid metronidazole
Name 4 dental implications seen in alcohol misuse?
Any from:
Advanced caries, periodontal disease and NCTSL
Increased risk of leukoplakia and oral cancer
Angular stomatitis
Glossitis
Erosion due to acidic alcohol and increased incidence of gastric reflux and vomiting
Nocturnal bruxism is common
Dry mouth secondary to dehydration and vomiting
What is the only indication for prescribing opiates?
Severe post-op pain
Give 5 dental implications of opiates (heroin)
Trauma
Infective endocarditis
Enhanced sedative effects
Oral neglect
Impaired drug metabolism
Describe methadone
Thick green syrup
5ml methadone = 2.5mg sugar
High caries rate