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Flashcards in Substance misuse Deck (19)
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1

Dependence divided into .....

psychological and physical.

2

Physical dependence

Physical; or neuroadaptation, is characterised by physical disturbances when the drug is suspended, or when its actions are antagonized

3

Psychological dependence

Psychological; Feeling of satisfaction or psychic drive requiring periodic or continuous administration of the drug to produce pleasure, or avoid discomfort.
PSYCHOLOGICAL DEPENDENCE OFTEN OUTLASTS PHYSICAL DEPENDENCE AND IS THE MAJOR CAUSE OF RELAPSE IN TREATED ADDICTS.

4

Drug tolerance

• Tolerance is the reduction in the effect of the drug due to prior exposure and is dependant on the dose and frequency of the exposure.
• The physiological basis for tolerance can be due to the decrease in the number of drug receptors, depletion of essential mediators, or a decrease in the plasma concentration with prolonged usage.
Tolerance may be overcome by increasing the dose of the drug.

5

Challenges in the dental management of substance abusers:

Pain control and management
Should use local without vasoconstrictor/ not treat patients that appear high/ not treat patients that are high on meth amphetamine/ dental professionals should be knowledgable about substance abuse/ longer acting drugs such as bupivicaine could be used for procedures requiring longer anaesthesia, therfore cutting down on the quanitity of drugs used/ drug abusers may claim an allergy to codeine in order to receive stronger drug such as morphine or hydrocodone (not really applicable to general practice in the UK)

6

Xerostomia

Unkown mechanism but: quality and quanitity of saliva affected
Elevation of metabolism, leading to dehydration
Lack of general self regulation of hydration levels, (abusers don't eat or drink regularly)
The risk of dental caries, tooth substance loss/wear and periodontal disease is considerably increased by xerostomia

7

Soft tissue/ mucosal/ cutaneous damage

Very common in cocaine users/ some user snot coke, leads to damage of nasal tissue and can perforate/ some rub on to gingival tissues, leads to recession and possible buccal caries, if mixed with icing sugar-corn flour/ cocaine has a vasocontrictive effect leading to ulceration and atrophy of the tissues/ morphine experts an inhibitory effect on the phagocytosis of candida by macrophages, so together with reduces saliva formation/function can lead to oral candidosis/ smoking cannabis, cocaine, spice can lead to tissue dysplasia

8

Temperomandibular joint disorders, including bruxism, clenching and grinding

Very common in chronic substance abusers
One research paper showed 75% of people ' felt like chewing something' after taking such drugs
Can lead to early tooth loss
Aggreviates the effects of periodontal disease

9

Diet

Substance abusers usually have unhealthy diets as a consequence of their chaotic lifestyle
Often have poor or suppressed appetites, altered taste and smell sensations
Often crave for sugar, of which they consume huge amounts
Priority is not to maintain good dietary habits, but to secure next hit

10

Tips on talking with patients about substance abuse

Communicate your concern
Offer support
Avoid shaming
Ask non-judgemental questions
Develop trust and offer hope

11

Acetaldehyde is the cause


Metronidazole inhibits aldehyde dehydrogenase

Acetaldehyde is the cause of majority of the unpleasant affects of alcohol hangover
Eg flushing, sweating, nausea
Metronidazole inhibits aldehyde dehydrogenase leading to acetaldehyde accumulation in tissue
30% of hospital admissions alcohol related, need to establish if other drugs involved or whether methanol the cause of intoxication

12

process of alcohol through the body:

Alcohol passes cell membrane very readily
Alcohol dehydrogenase breaks alcohol into acetaldehyde
Aldehyde dehydrogenase to acetyl co-enzyme A then into krebs cycle, finally produceing carbon dixoide and water

13

Define Alcoholism

Alcoholism is psychiatric condition which oral health care providers must treat as a specific disease without moral implications
Often occurs in individuals who are financially solvent and try to lead reasonably normal lives
Many patients try to mask their addiction with perfumes or after shave, and mints or chewing gum

14

Alcoholism affect on general health

Gerenal health:
Malnutrition
Vit deficiences especially vit B complex
Jaundice
Neurological disorders eg tremor
Liver dysfunction
Aggravated cardiovascular disease
Drug interactions
Imparied coordination
Personality changes
Immunosupression
Memory loss

15

Alcoholism affect on oral health

Oral health
Poor oral hygiene
Uvulitis
Increased decayed, missing or filled teeth
Periodontal disease
Oral mucosal changes
Changes in appearance of tongue
Enlarged parotid glands
Xerostomia
Predisposition to oral cancer

16

Methaphetamin long term effects may include:

Long-term effects may include:
Addiction
Psychosis including: paranoia, hallucinations
Repetitive motor activity
Changes in brain structure and function
Deflicits in thinking and motor skills
Increased distractibility
Memory loss
Aggressive or violent behaviour
Mood disturbance
Severe dental problems- due to clenching, dry mouth, poor oh, poor nutrition and gross neglect
Weight loss

17

Methamphetamine is:

Potent CNS stimulator
Can be smoked, swallowed, snorted or injetced during drug use, with varying rapidity of onset
High addictive and cheap and readily available when compared to some other illicit drugs

18

Opiods
Oral facial mainfestations

Xerostomia
Poor oral hygiene
Increased DMF teeth
Chronic malnutrition
Increased susceptibility to periodontal disease

19

Marijuana oral facial manifestation

Acid erosion of enamel
Dental caries
Inflammation
Stomatitis with leukedaemia (buccal mucosa)
Hyperkeratosis
Ginigval hyperplasia-risk factor for perio disease
Uvulitis
Leukoplakia
Oropharyngeal cancer risk
Lowered anti-tumour immunity
Poor oral hygiene
Alveolar bone loss
xerostomia