16- chemical dependency- drug addiction

Alcohol- does what, interferes with…acute vs later effects

Depresses CNS, interferes with cerebellum and higher centres

Main dental considerations of alcohol (5 imp)

Aggressive, neglect

Tooth loss from erosion

Attrition- bruxism

Bleeding (liver damage) + wound healing may be impaired

Osteomyelitis after jaw fracture

Leukoplakia

Folate deficiency or other anemia causing glossitis

Angular stomatitis, recurrent apthous lesions

Early morning appointments

In alcoholic patients avoid…

GA- risk of vomiting and inhalation of vomit

Sedatives or hypnotics- additive effect

Aspirin + NSAIDs- gastric erosion + bleeding

Alcohol containing mouthwash

Metronidazole- inhibits liver breakdown of acetaldehyde

Nicotine 5 dental considerations

Smoker keratosis

Leukoplakia

Erythroplakia

Melanosis

Candidiasis

Nicotine 4 difficulties in dental management

COPD

Ischemic heart disease

Peptic ulcer

Smokers Metabolise other drugs more rapidly (need higher dose of BZP)

7 Adverse effects of cannabis

- behavioural problems

- cardiovascular

- immune impairment

- psychological

- respiratory

- doubles and triples risk of lung cancer

- associated with oral cancers

5 dental considerations of cannabis

- hyposalivation → dry mouth- caries + candida

- increased candida carriage

- increased risk of oral cancer

- periodontitis

- caries

6 Effects of cocaine snorting- they are…

Immediate and profound

Palatal perforation

Nasal septum perforation

Chronic sinusitis

Changes in sense of smell

Bruxism

Nose bleed

3 Oral effects of cocaine

PD

Gingival lesions

Gingival recession

Facial lesions due to cocaine

Burns and sores on lip, face, oral cavity

More prone to infection diseases- increased risk of HIV

4 Dental considerations of cocaine

- pregnant mother using cocaine → child more prone to have ankyloglossia

- blood borne infections

- avoid epinephrine containing LA (at least 2h)

- defer treatment until 6h after last use of cocaine

Opioids/Heroin short (4) vs long term effects (2)

Euphoria, dry mouth, heavy limbs, drowsy (CNS depression)

Death- respiratory depression, addictive- converts to morphine

Dental considerations of opioids/heroin- avoid? 2 care?

- tooth extractions

- caries

- eating difficulties

- mucosal infections (candidiasis)

- periodontitis

- mucosal dysplasia

- bruxism

AVOID CODEINE!

Opioids may enhance sedation, non narcotic analgesics may be ineffective

Effect of amphetamine and methaphetamine, 3 dental considerations

Stimulate CNS and PNS, oral use

Xerostomia, rampant caries, bruxism

Hallucinogens- ecstasy + LSD- 5 dental considerations

- dry mouth

- bruxism

- malnutrition

- TMJ tenderness

- topical use → necrosis and mucosal fenestration

Strategies to identify addicts

Clinical exam- specific patterns (rampant caries, dry mouth, PD stage not common for age), appropriate dental indices, treatment protocol on oral condition

Questionnaire, interview

- self perceived oral health

- self perceived barriers against dental service utilization

- oral health behaviour

- quality of life

First level vs second level care

Provide education

Provide treatment

a. diagnose

b. management of systemic disorders

c. behavioural and psychological management

d. encourage dentist positive attitude

e. cross-infection control