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BDS4 SCD > Substance abuse > Flashcards

Substance abuse Flashcards

1
Q

What are risk factors for drug abuse

A

Genetic
Environment
* socioeconomic factors
* surrounding by those who take drugs
* time of drug use (younger = higher risk)
* personality (low self esteem)
* availability of drugs
* coexisting mental help problems
* peer pressure
* physical and sexual abuse
* early exposure to drugs
* stress

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2
Q

What is the traditional theory on the pattern of addiction

A
  • intense initial intoxiciation
  • development of tolerance
  • escalation in intake
  • profound dysphoria, physical discomfort and somatic withdrawal
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3
Q

What is the ‘reward’ pathway

A
  • when activated by rewarding stimulus, informationt ravels from the VTA to the nucelus accumbens and then up to the prefrontal cortex
  • dopamine mediated transmission allows us to feel pleasure
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4
Q

How do drugs effect neurotransmitters

A

increased dopamina levels - euphoria
decreased levels of serotonin - decreased levels of contentment

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5
Q

Describe the psychodynamic theory

A

two critical elements - disordered emotions and disordered self care
two contributory elements - disordered self esteem and disordered relationships

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6
Q

What does prolonged exposure to drugs of abuse result in

A

addiction via reward pathway
chronic exposure reduces sensitivity of brain to reward system

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7
Q

What are features of drug dependance

A
  • psychological - taking the drug knowing its harmful
  • physical - symptoms if drug not taken
  • withdrawal syndrome - symptoms following sudden withdrawal
  • tolerance - repeated administration means they become less sensitive
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8
Q

What can drugs be divided into

A
  • behavioural classification
  • pharmacodynamic classification
  • legal classification
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9
Q

How can drugs be classed based on behavioural features

A
  • stimulants e.g cocaine
  • opiods
  • sedative
  • anypsychotics
  • antidepressants
  • psychedelics
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10
Q

What are the risks of illicit drug use

A
  • STI
  • BBV
  • TB
  • smoking/alcohol risks
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11
Q

How can drugs be administered

A
  • oral
  • transmucosal
  • inhalation
  • smoking
  • intramuscular
  • IV
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12
Q

What are injection related complications from drug use

A
  • cellulitis
  • abscess
  • thrombophlebitis
  • thrombosis
  • embolism
  • DVT
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13
Q

What are the effects of cannabis

A
  • euphoria
  • slowed thinking and reaction time
  • confusion
  • impaired balance and coordination
  • cough
  • frequent resp infections
  • impared memory and learning
  • increased HR
  • anxiety
  • panic
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14
Q

What are the effects of alcohol

A
  • CNS depressant
  • judgement, concentration and coordination
  • effects are dose related
  • eventually interfere with cerebellar function
  • cause ataxia and motor coordination
  • ultimately unconsciousness
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15
Q

What are signs of substance misuse

A
  • loss of reliability
  • mood and behaviour changes - defensive and angry
  • subjective symptoms
  • requesting specific drugs
  • progressive deterioration in personal appearance and hygiene
  • tremor
  • constricted pupils or dilated
  • puncture marks, scars or pigmentation over veins
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16
Q

What are barriers to accessing dental services for drug misusers

A
  • fear of judgement
  • low priority of OH
  • fear of dentists
  • self medication
  • chaotic lifestyle
  • poor attendance compliance
  • cost
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17
Q

What can help facilitate access for drug misusers

A
  • key workers may be assigned if enrolled in addiction programmes
  • key workers can encourage attendance and accompany px to appointments
18
Q

What are the medical implications of drug misuse

A
  • increased rates of infection
  • general health neglect
  • oral health neglect
  • chronic liver disease in alcohol abuse - impaired drug metabolism and bleeding risk
  • BBV
  • infective endocarditis
  • venous thromboses
19
Q

What are drug misusers at risk of

A
  • crime to fund addiction
  • maxfax injuries
  • sharing of needles - BBV
  • family disruption
  • no address
  • prison
  • risk of withdrawing
  • chaotic lifestyle
20
Q

Why may consent be an issue for this group

A
  • issue for dependent px
  • fluctuating capacity
  • capacity unlikely when under the influence
  • postpone tx
21
Q

What are examples of alcohol related brian damage

A

korsakoffs syndrome
similar to dementia

22
Q

How should we tx plan for these px

A
  • assess px expectation
  • stabilise mouth
  • diet and OHI
  • keep tx as simple as possible during active substance misuse - use ART and SDF
23
Q

How can LA be impacted in cannabis misusers

A

LA with adrenaline can prolong acute tacychardia

24
Q

What problems can LA pose for alcohol misusers

A
  • liver problems
  • lidocaine metabolzied in liver
  • keep doses to minimum
  • use articaine
  • avoid IDB
25
Q

Why can sedation pose a problem to this group

A
  • px may have developed tolerance to sedative drugs so larger doses required - refer to anaesthetist
  • alcohol and opiod have synergistic effect with sedative agents –> avoid if px actively using substance
  • GA and IV can trigger relapse
  • venous access –> collapsing veins
26
Q

What are general dental implications of substance misuse

A
  • rampant caries
  • periodontal disease
  • NCTSL
  • masseteric hypertrophy
  • hyposalivation
  • poor OH
  • opportunistic infections
  • trauma
  • oral cancer and mucosal lesions
27
Q

Why are px at risk of necrotizing periodontal diseases

A
  • impaired immune system
  • stress, BBV, smokers
28
Q

What appointment times should this group be given

A

morning as less likely to be under the influence
high chance of DNA however

29
Q

What are the effect of sedatives in alcohol users

A

risk of tolerance
have an addictive effect

30
Q

Why should GA be avoided in alcohol abusers

A
  • risk of vomiting
  • risk of inhalation of vomit
  • can be resistant to GA
31
Q

What drug to recoveirng alcoholics use and what problems does it pose

A

disulfiram
psychotic reaction seen with those who use this drug and metronidazole

32
Q

What are the oral effects of alcohol abuse

A
  • advanced caries
  • risk of leukoplakia and OC
  • glossitis
  • angular stomatitis
  • RAS
  • sialosis
  • rhinophyma
  • erosion
  • nocturnal brusism
  • xerostomia - dehydration
33
Q

What are the systemic manifestations of alcohol abuse

A
  • liver cirrhosis - drug metabolism and bleeding risk
  • bone marrow suppression: anaemia and thrombocytopenia
  • impaired wound healing: immunosuppression
  • avoid use of aspirin and NSAIDs due to gastric erosion
  • paracetamol safest
  • avoid metronidazole as inhibits breakdown of acetylaldehyde
34
Q

What are opiates

A

morphine
methadone
dihydrocodeine
heroin

35
Q

What are the effects of opiates

A
  • euphoria
  • followed by sedative state
  • dependant px may find analgesia ineffective in controlling dental pain
  • never prescribe opiates to this group
36
Q

What are the dental implications of opiate abusers

A
  • trauma
  • infective endocarditis
  • oral neglect
  • drug metabolism
37
Q

Why does methodone pose risk to oral health

A
  • often used long term
  • contains high sugar content
38
Q

What is dental advise for methodone users

A
  • use a straw
  • drink water after consumption to prevent regurgiation
  • dont brush teeth immediately after
  • engage with dental services
  • prevention
  • sugar free suspensions available however pose greater risks
39
Q

What are the risks of cannabis use

A
  • oral cancer
  • psychosis including schizophrenia
  • impaired memory
  • impared cognitive function
  • xerostomia
  • caries
40
Q

What are the dental implications of cocaine

A
  • may present with unusual ulceration on gingiva
  • NCTSL
  • orofacial pain
  • long term –> palatal adn nasal septum perforation
  • interaction with LA - delay tx ideally 24h after administration
41
Q

What is practical advise for tx drug abusers

A
  • dont use adrenaline containing for px taking cocaine, ecstasy and methamphetamines - risk of increasing BP
  • avoid adrenaline containing LA for cannabis user due to prolonged tachycardia risk
  • alcohol abusers –> liaise with GP prior to invasive tx . may want some tests

BDS4 SCD (5 decks)

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