Substance Misuse Dental Implications Flashcards
role of GDP in substance misuse?
- recognise substance misuse in pt & colleagues
- emergency dental tx
- signpost to services
- realistic tx planning
- provide judgement free care
- empathy & awareness
things that can help recognise substance misuse?
- loss of reliability
- mood & behaviour changes
- impaired driving ability
- progressive deterioration in personal appearance & hygiene
- tremors
- constricted/dilated pupils
medical implications with substance misuse?
- increased rates of infection
- general health neglect
- oral health neglect
- chronic liver disease (alcohol abuse)
- infective endocarditis
- venous thrombosis
pain control & Local anaesthesia in cannabis, and alcohol abusers?
Cannabis: LA with adrenaline can prolong acute tachycardia
Alcohol: care with LA that is metabolised in liver, avoid IDB in coagulation defects
general dental implications of substance misuse?
- rampant caries
- periodontal disease (including necrotising)
- NCTSL (erosion & attrition)
- masseter hypertrophy (bruxism)
- hyposalivation (xerostomia)
- poor OH
- Poor denture hygiene
- trauma
- Oral cancer & mucosal lesions
risk factors of oral cancer?
- smoking
- alcohol
- direct application of drug to the oral mucosa
- poor nutritional & immune status
- socio-economic status
best way to manage a pt who may have alcohol misuse?
- morning appointment - less likely to be drunk
- pt may have multi substance misuse (+ smoking for example)
- GA - best avoided, increase vomiting & inhalation of vomit
pts with excessive alcohol misuse can present to the dentist with what conditions?
- Caries, perio, NCTSL
- increased risk leukoplakia & oral cancer
- glossitis
- recurrent aphthous stomatitis (RAS)
- sialosis
- erosion
- dry mouth
pt on methadone is at risk of what?
and what is methadone used for?
- high sugar content
- caries rate is higher
methadone helps to stop taking heroin (controls symptoms of withdrawal)
dental implications of heroin?
- trauma
- infective endocarditis
- enhances sedation
- oral neglect
- impaired drug metabolism
dental advice for methadone users?
- use straw
- water after consumption
- engage with dental services
- prevention!!!!
- sugar free suspension if possible
why avoid adrenaline containing LA for pts on cocaine, ecstasy & methamphetamines?
risk of systemic increase in blood pressure
why avoid adrenaline containing LA for pts on cannabis?
risk of prolonged tachycardia
