Substance misuse Flashcards
(27 cards)
What is a drug?
a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body
What percentage of people in Scotland have alcohol dependence?
4%
what is an addiction?
chronic, primary neurobiological condition influenced by genetic psychosocial and environmental factors
risk factors for drug misuse and addiction
men 2x as likely
genetics
socioeconomic factors
environmental:
- home and family, friends and acquaintances that do drugs
personality
- low self esteem
- stress
availability
coexisting mental problems
peer pressure
physical and sexual abuse
early exposure to drugs
prolonged exposure to drugs - effect
results in addiction through the rewards pathway
chronic exposure reduces sensitivity of the brain to reward systems
as addiction evolves there appears to be a greater role of habituation and compulsion as a result of conditioning and environmental stimuli
drugs can be classified in 3 different ways - name them
behavioural
pharmacodynamic
legal
illicit drug use in healthcare professionals
between 10-15% misuse alcohol or drugs
decreases with age
effects of cannabis
euphoria
slowed thinking and reaction time
confusion
impaired balance and coordination
frequent respiratory infections
impaired memory and learning
increased heart rate
anxiety
panic
tolerance
addiction
signs of addiction
loss of reliability
mood changes
impaired driving
patient and staff complaints about deteriorating attitude and behaviour
sloppy record keeping
You have an addiction problem. What should you do?
put interest of your patient first
consult senior colleague to ask for advice and support
- document encounter if you are the colleague
are you safe to practice?
support groups
- British doctors and dentists group
engage with medical services
general dental implications of substance misuse
rampant caries
periodontal disease
NCTSL
masseteric hypotrophy
- bruxism
hyposalivation
- xerostomia associated to opiates and cannabis
poor OH
poor denture hygiene
opportunistic infections
trauma
oral cancer and mucosal lesions
one of your patient’s is an alcoholic, what considerations would you make in regards to treating them?
morning appointments
- least likely time to be under the influence
patient may have poly-substance misuse including smoking
sedatives have an addictive effect with alcohol
GA best avoided
- increased risk of vomiting and inhalation of vomit
- may be resistant to GA
many recovering addicts may be on disulfiram (Antabuse)
- psychoitic reaction with metronidazole
alcohol abuse potential dental implications
advanced caries, periodontal disease and NCTSL
angular stomatitis
RAS
increased risk of leukoplakia and oral cancer
dialysis
erosion
nocturnal bruxism
dry mouth secondary to dehydration and vomiting
LA to give alcoholic
care with la metabolised in the liver
- consider articaine
considerations to take prior to an extraction on an alcoholic
impaired wound healing
liver cirrhosis = bleeding risk
avoid use of aspirin and NSAIDs
- paracetamol safest analgesic
dental implications of opiate abuse
trauma
infective endocarditis
enhances sedation agents
impaired drug metabolism
oral neglect
methadone - dental implications
Hugh sugar content
- 5ml methadone = 2.5mg sugar
- sugar free prep available
caries rate higher in methadone users
dental advice for methadone users
use a straw
drink water after consumption
- prevents regurgitation
don’t brush teeth immediately after
engage with dental services
prevention
sugar free suspension available
opioids - dental considerations
suboptimal oral hygiene and self care
use leads to salivary hypofunction
- xerostomia
- caries
- burning mouth
- taste impairment
smooth surface, buccal and cervical caries often present prior to beginning methadone therapy
anxiety and opioid use can reduce effectivenesss of LA
injecting drug users at greater risk of BBV and endocarditis
can cause thrombocytopenia putting patients at risk of post op bleeding
- especially if liver function impaired
populations at risk of infective endocarditis
patients with previous IE = highest risk
patients with surgically implanted prosthetic valves
patients with congenital heart disease
patients with ventricular assist devices
patients at increased risk of infective endocarditis
acquired valvular heart disease with stenosis or regurgitaion
previous IE
structural congenital heart disease
valve replacement
cannabis - sedation considerations
patients should be advised to not use cannabis for at least 72 hours before treatment under conscious sedation in order to reduce the likelihood of drug interactions and unpredictable sedation quality
cannabis and local anaesthetic
la containing adrenaline may prolong tachycardia following an acute dose of cannabis
cocaine dental consequences
bruxism, clenching and NCTSL
gingival erosions, retraction and ulcerative lesions at the site of application - owing to rubbing of powder topically
- resolve upon abstaining from use within 2weeks to 18 months
chronic sinusitis
nasal crusting
epistaxis (nose bleeds)
higher periodontitis risk
use of powder intramurally = decrease in saliva pH
enhances body’s response to adrenaline
links between cocaine use and development of cluster headaches
