substance misuse - dental implications Flashcards

1
Q

Name 4 signs of substance misuse

A

Loss of reliability
Mood and behaviour changes
Impaired ability to drive
Tremors

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2
Q

Name 4 barriers to accessing dental services relating to substance misuse

A

Low priority of oral health compared with drug use
Chaotic lifestyles
Poor attendance and compliance
Cost - frequent changes in or loss of employment

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3
Q

How should you take a drug history?

A

Number of units comsumed per week
The use of drugs - prescription or recreational
Quantity and duration of drugs
Smoking status
Living arrangements

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4
Q

Give 4 medical implications of substance misuse

A

Any from:
Increased rate of infection
BBVs
Infective endocarditis
Oral health neglect
General health neglect

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5
Q

Why may consent be an issue in alcoholics?

A

Capacity is unlikely when patient is under the influence of drugs or alcohol

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6
Q

How does tx planning change when substance misuse is present?

A

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

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7
Q

How may pain control and LA be affected in substance misuse?

A

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

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8
Q

How can anxiety be managed in substance misuse?

A

Inhalation is the safest type of sedation
GA and IV sedation can trigger relapse
Venous access may be difficult

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9
Q

Give 4 general dental implications of substance misuse

A

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

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10
Q

Give 5 reasons oral cancer is more common in substance misuse?

A

Smoking
Alcohol
Direct application of drug to the oral mucosa
Poor nutritional and immune status
Socio-economic status

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11
Q

What can help treating alcoholics?

A

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

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12
Q

Name 4 dental implications seen in alcohol misuse?

A

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

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13
Q

What is the only indication for prescribing opiates?

A

Severe post-op pain

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14
Q

Give 5 dental implications of opiates (heroin)

A

Trauma
Infective endocarditis
Enhanced sedative effects
Oral neglect
Impaired drug metabolism

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15
Q

Describe methadone

A

Thick green syrup
5ml methadone = 2.5mg sugar
High caries rate

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16
Q

What dental advice should be given to methadone users?

A

Use a straw
Drink water after consumption to prevent regurgitation
Don’t brush teeth immediately after
Use enhanced prevention

17
Q

What are the dental implications of cannabis?

A

Oral cancer risk
Xerostomia
Caries

18
Q

What are the dental implications of cocaine?

A

Ulceration on gingivae
NCTSL
Caries
Orofacial pain

19
Q

Why may cocaine impair treatment?

A

Interaction with LA - delay tx 6-24 hours after administration

20
Q

When should you avoid adrenaline containing LA?

A

Pts on cocaine, ecstasy and methamphetamines for risk of systemic increase in BP
Pts on cannibis due to risk of prolonged tachycardia

21
Q

What should you do if your pt is an alcoholic and you need to do invasive tx?

A

Liaise with GP/gastro doc
FBC, coag screen, LFT pre-op to determine bleeding risk
Onward referral if required