8 - Substance misuse: dental implications Flashcards
6
What is the role of the GDP in patients with substance misuse?
- recognise substance misuse
- signpost to addiction services
- emergency dental treatment
- maintenance of dental health
- realistic treatment planning
- empathy
8
How do you recognise substance misuse?
- loss of reliability
- mood and behaviour changes
- subjective symptoms with no objective evidence
- requesting specific drugs
- deterioration in appearance and hygiene
- tremors
- pupillary change
- puncture marks, scars or pigmentation over veins
4
What is important in the social history for a patient with substance misuse?
- alcohol consumption
- drug consumption, including when last taken “for safety of procedure”
- smoking status
- living arrangement
5
What are the medical implications of substance misuse?
- infection including STI, BBV, TB
- health neglect
- chronic liver disease (impaired drug metabolism, increased bleeding risk, impaired wound healing)
- infective endocarditis
- venous thromboses
How do you manage consent in substance misuse?
- capacity is unlikely if the person is under the influence of drugs or alcohol
- postpone treatment if possible
4
Describe the treatment planning in a substance misuse case.
- flexible approach, anticipate unexpected symptoms between appointments
- initial stabilisation required
- prevention is key
- simple treatment eg ART or SDF
What can cause LA resistance?
Opioid use
What is the interaction between cannabis and LA?
- can cause prolonged tachycardia
- ideally patient should be at least 3 days drug free
What is the interaction between alcohol and LA?
- most LA is metabolised in the liver
- multiple cartridges could cause CNS toxicity
- articaine is best option as metabolised in plasma
- avoid IDB in patients with poor coagulation
4
How is sedation used in substance misuse?
- inhalation is safest
- can develop tolerance
- IV sedation has synergistic effect with alcohol and opioids so should be avoided
- can trigger relapse
9
What are common presentations of substance misuse in the mouth?
- rampant caries on all tooth surfaces
- periodontal disease including necrotising conditions
- NCTSL
- masseteric hypertrophy
- hypo salivation
- poor OH
- opportunistic infection
- trauma
- oral cancer
How can you adjust appointments for an alcoholic?
Morning appointments are better as they are least likely to be under the influence
What is the link between Antabuse and metronidazole?
- disulfiram
- can have psychotic reaction if taken with metronidazole
- amoxicillin is indicated
5
What are the dental implications of opiate use?
- trauma
- infective endocarditis
- oral neglect
- impaired drug metabolism
- enchanted sedative effect
What is methadone?
- used to replace opiate and aid withdrawal
- high sugar content
- caries rate significantly high
