Drug abuse and dental patients

Question 1

Define drug abuse

Answer 1

A pattern of pathological behaviour involving continual use of drugs despite social, psychological, or physical consequences.

Question 2

What are some pathological effects of drug abuse?

Answer 2

Cardiac and liver damage, among others

Question 3

What are the 2 types of dependence in drug abuse?

Answer 3

psychological and physical

Question 4

What is psychological dependence in drug abuse?

Answer 4

A compulsive desire to experience drug effects or avoid discomfort.

this outlasts physical and is the major cause of relapse

Question 5

What is physical dependence in drug abuse?

Answer 5

Withdrawal symptoms or disturbances when the drug is stopped or blocked.

Question 6

Define drug tolerance

Answer 6

Decreased effect of a drug due to prior exposure.

Question 7

What are the 3 effects of drug tolerance?

Answer 7

o Decreased number of drug receptors.

o Depletion of essential mediators.

o Decreased plasma concentration with prolonged use.

Question 8

How can we resolve drug tolerance?

Answer 8

Often overcome by increasing the dose.

Question 9

Name 6 types of drugs

Answer 9

alcohol

methamphetamine

MDMA (ecstasy)

cocaine

pink cocaine (tuci)

marijuana (cannabis)

Question 10

Where does alcohol act and where is it absorbed?

Answer 10

acts primarily on CNS (world’s oldest drug)

Toxic to the liver, heart, brain, pancreas, gut, and fetus.

absorbed by 10% via stomach, 90% via small intestine.

Food delays absorption by slowing stomach emptying.

Question 11

Describe alcohol metabolism

Answer 11

o Ethanol → Acetaldehyde (by alcohol dehydrogenase).

o Acetaldehyde → Acetyl CoA (by aldehyde dehydrogenase).

o Enters Krebs cycle → CO₂ + H₂O.

acetaldehyde causes hangover symptoms

Question 12

What % of hospital admissions are alcohol related?

Answer 12

30%

Question 13

What happens in alcohol poisoning?

Answer 13

o Ethanol competes with methanol for alcohol dehydrogenase
o Metronidazole blocks aldehyde dehydrogenase, worsening symptoms.

Question 14

What is alcoholism and how must it be approached?

Answer 14

psychiatric disease

must be approached non-judgmentally

Question 15

What are the oral health impacts of alcohol?

Answer 15

Poor hygiene,

xerostomia,

increased decay,

periodontal disease,

oral cancer risk,

parotid gland enlargement,

tongue changes.

Question 16

What is the nature of methamphetamine?

Answer 16

Potent CNS stimulant; smoked, snorted, swallowed, or injected

was previously used in nasal sprays - currently in ADHD treatment

has high addiction potential due to intense and short-lived euphoria

Question 17

What are the effects of methamphetamine?

Answer 17

o Increased activity, decreased appetite, euphoria.

o Stronger brain effects than amphetamine.

Question 18

What are the long term effects of methamphetamine?

Answer 18

Psychosis,

memory loss,

mood disorders,

brain changes,

aggression.

Question 19

What type of drug is MDMA?

Answer 19

Synthetic stimulant and empathogen

Question 20

What is MDMA taken as?

Answer 20

Pills,

capsules,

sometimes snorted

or smoked.

Question 21

What are the effects of MDMA?

Answer 21

o Serotonin, dopamine, norepinephrine release.

o Euphoria, increased heart rate, empathy, energy.

Question 22

What are the dental implications of MDMA?

Answer 22

Bruxism,

dry mouth,

neglected oral hygiene,

gum disease.

Question 23

What form does cocaine come in?

Answer 23

Powder (“blow”, “snow”),

crack (“rock”).

Question 24

What methods are cocaine consumed?

Answer 24

Snorted,

smoked,

injected,

absorbed through gums.

Question 25

What mechanism does cocaine trigger?

Answer 25

Blocks dopamine reuptake, causes intense reward response.

Question 26

What are the physical effects of cocaine?

Answer 26

o Euphoria, alertness, dilated pupils, tremors, nausea, increased heart rate. o Long-term: Malnourishment, Parkinsonism, fetal damage, psychosis.

Question 27

What are the overdose risks with cocaine?

Answer 27

o Heart attacks, seizures, hallucinations, high BP/temp. o No antidote exists.

Question 28

What are the contents of pink cocaine?

Answer 28

Often MDMA, ketamine, others – not real cocaine.

Question 29

What are the effects of pink cocaine?

Answer 29

Euphoria, sensory stimulation, hallucinations.

Question 30

What are the risks of pink cocaine?

Answer 30

Highly unpredictable, potentially toxic.

Question 31

What are the oral health impacts of pink cocaine?

Answer 31

Similar to MDMA—dry mouth, bruxism, decay, gum disease.

Question 32

From what plant source does marijuana come from?

Answer 32

Cannabis sativa/indica with active component THC (increased significantly from 0.5%-2% to over 10%)

Question 33

How is cannabis consumed?

Answer 33

Smoked (joints, bongs), eaten (edibles), brewed (tea), or vaporized.

Question 34

What are the effects of marijuana?

Answer 34

o Short and long-term brain impact. o THC passes quickly into bloodstream via lungs.

Question 35

How should drug abuse be managed?

Answer 35

multidisciplinary approach (with medical professionals and addiction therapists) establishing trust and non-judgemental detailed history and screening (AUDIT C and Drug abuse screening test) emergency management elective dental care (postpone non-urgent procedures) treatment planning considerations oral health education and prevention liaison and referral follow up and recall

Question 36

How must bruxism be managed?

Answer 36

night guards and muscle relaxants

Question 37

How can xerostomia be managed?

Answer 37

saliva substitutes sugar free lozenges increased water intake

Question 38

How can periodontal disease be managed?

Answer 38

professional debridement antimicrobial rinses regular maintenance

Question 39

How can oral infections and ulcerations be managed?

Answer 39

address underlying cause improve immunity apply topical treatments

Question 40

How can oral cancer be managed?

Answer 40

conduct regular soft tissue examinations refer for biopsy if suspicious lesions found