SPECIAL CARE substance abuse

Question 1

list types of drug abuse seen in dental patients and there % incidence?

Answer 1

> 50% binge drink
33% drank out with recommended guidelines
33% used cannabis
ecstasy and cocaine used ‘regularly’
more common in males

Question 2

what are the 5 most common drugs used in scotland?

Answer 2

cannabis
cocaine
ecstasy
amphetamines
heroin

Question 3

what are types of stimulants (uppers)?

Answer 3

caffeine
nicotine
cocaine
amphetamine
ecstasy

Question 4

what are the types of depressants (downers)?

Answer 4

alcohol
solvents
heroin
morphine
benzodiazepines

Question 5

what are the types of hallucinogenics?

Answer 5

LSD
magic mushroom
cannabis

Question 6

what drugs are legal?

Answer 6

nicotine/ tobacco
alcohol
POMs (prescription only medicines)

Question 7

how many deaths a year are there from drug abuse?

Answer 7

approx 500/ year

Question 8

how many deaths a year are there from alcohol?

Answer 8

approx 5-25,000 deaths/ year

Question 9

how many deaths per year are there from smoking?

Answer 9

approx 100,000

Question 10

what are the 2 main statutes relating to drugs in the UK?

Answer 10

The Medicines Act 1968
The Misuse of Drugs Act 1971

Question 11

what does the misuse of drug act 1971 divide drugs into?

Answer 11

class A, B and C

Question 12

what are class A drugs?

Answer 12

heroin
cocaine
methamphetamine
ecstasy
methadone

Question 13

what are the class B drugs?

Answer 13

amphetamines
cannabis

Question 14

what are the class C drugs?

Answer 14

benzodiazepines
ketamine
anabolic steroids

Question 15

what are the positive effects of opiates?

Answer 15

initial euphoria
removal of tension
tranquility
sense of control
detachment from worries, fears
analgesia

Question 16

what are the negative effects of opiates?

Answer 16

itching
flushing
myosis
appetite suppression
slurred speech
slow gait
depression
constipation

Question 17

what are the health problems associated with injecting?

Answer 17

BBVs
DVT
abscesses
amputation
collapsed veins

Question 18

what mental health problems may arise due to drug misuse?

Answer 18

paranoia
schizophrenia
depression
bulimia/ anorexia
bipolar

Question 19

what are the classification systems for mental illness?

Answer 19

ICD 10 (international statistical classification of diseases and related health problems)
DSM V (diagnostic and statistical manual of mental disorders)

Ffoulds classification

Question 20

what is neurosis?

Answer 20

contact retained with reality
functional mental disorder, without delusions or hallucinations
behaviour is not out with socially acceptable forms

• anxiety
• phobic
• obsessional
• hypochondriacal
• depressive

Question 21

what is psychosis?

Answer 21

contact lost with reality
delusions and hallucinations are common
patients may show changes in personality, thought disorder and may exhibit strange behaviour
likely to have difficulty in carrying out daily activities

Question 22

what is schizophrenia ?

Answer 22

most severe form of functional psychosis
thought and emotion disorder
characteristic delusions - often bizarre
auditory hallucinations - often threatening or derogatory

Question 23

what are types of eating disorders?

Answer 23

anorexia nervosa
bulimia nervosa
pica

Question 24

what is anorexia?

Answer 24

altered perception of body image

Question 25

dental effects of anorexia?

Answer 25

oral effects of malnutrition: - ulcers - dry mouth - infections - bleeding - NCTSL from vomitting

Question 26

what is bulimia?

Answer 26

normal weight - binge/ vomit 'comfort eating' - stress reaction?

Question 27

what are dental effects of bulimia?

Answer 27

dental erosion oesophageal stricture

Question 28

what is PICA?

Answer 28

persistent and compulsive cravings non foodstuffs

Question 29

dental effects of pica?

Answer 29

teeth dentures braces

Question 30

why do drug misusers have such poor oral health?

Answer 30

drug related - dry mouth - bruxism/ habits - sugar cravings - sugar in medication lifestyle - smoking is common - sugar craving - trauma common - dental anxiety common and poor attendance

Question 31

how is the cycle of drug misuse broken?

Answer 31

harm reduction substitution prison

Question 32

reasons for homelessness?

Answer 32

relationship breakdown prison loss of employment

Question 33

what is methadone?

Answer 33

methadone hydrochloride - synthetic opiate analgesic white powder mixed with syrup

Question 34

methadone trade name?

Answer 34

dolophine

Question 35

how does methadone work?

Answer 35

action on the CNS absorbed from buccal mucosa and stomach continuous occupancy of Mu opiod receptors stabilised neurochemistry, previously chaotic from repeated 'highs' and 'lows' of heroin use

Question 36

what are the types of methadone programme?

Answer 36

pts may stay on the methadone maintenance programme for years a few mat access short duration detoc programmes

Question 37

why is methadone so bad for teeth?

Answer 37

'normal' preparation contains 50% sugar in the syrup often methadone is 'held' in mouth to increase absorption from buccal mucosa opiate analgesic decreases salivary flow

Question 38

oral findings for amphetamine use?

Answer 38

xerostomia therefore increase caires and perio disease bruxism, grinding therefore TMD attrition/ erosion

Question 39

oral findings of ecstasy users?

Answer 39

bruxism, grinding therefore TMD occlusal wear on posterior teeth xerostomia attrition and erosion mucosal burns

Question 40

oral findings of cocaine users?

Answer 40

xerostomia caries in unusual surfaces bruxism and TMD erosion gingival and tongue erosions ulceration of palate cluster headaches may mimic atypical facial pain

Question 41

oral findings of heroin users?

Answer 41

dependent on route of administration - general oral neglect - advanced caries - advanced perio disease

Question 42

oral findings of cannabis users?

Answer 42

- decreased resp rate - impaired memory - soft tissue disease - increased HR following adrenaline in LA

Question 43

what must we ensure regarding a MH of a drug user?

Answer 43

up to date and accurate often difficult to obtain concurrent systemic disease concurrent medication

Question 44

what are drug users behaviours?

Answer 44

poor attenders poor time keepers have short attention span lack understanding

Question 45

can you put a drug user under GA?

Answer 45

sedation should be used with caution potential for damage to heart, liver and kidneys GA may not be feasible - resistance to GA IV access?

Question 46

what is KISS philosophy?

Answer 46

keep it simple, stupid

Question 47

what interactions in drug users should you be aware of?

Answer 47

disulfiram (antabuse) and alcohol

Question 48

what should your simple OH advice be to a pt?

Answer 48

brush 2 times a day am and pm decrease number and frequency of sugars in diet limit number of snacks per day importance of regular dental check ups

Question 49

what is methadone specific advice regarding OH?

Answer 49

drink methadone with a straw try take near a mealtime swallow it immediately - dont hold in mouth rinse with water afterwards chew sugar free chewing gum to increase saliva brush teeth BEFORE taking it! or leave for a few hours after

Question 50

what are barriers to care regarding drug users?

Answer 50

attitudes to oral health attitudes to patient group lack of education cost manpower access to (specialist) services