Professional Documents
Culture Documents
Substance abuse is the regular use of a drug other than its accepted medical purpose or in
dosages greater than those that are considered appropriate
The most common drugs of abuse are alcohol and prescription drugs
There is no classic cultural, socioeconomic, or educational profile for a substance abuser
Alcohol
Clinical Pattern of Alcohol Use
Genetics: GABRA2 & CHRM2 are the 2 genes involved in the predisposition. ALDH2
substantially, but not completely, protects carrier from developing alcoholism by making
them ill after consuming.
Biopsychosocial: Parent-child influences
Environmental: psychological stress, family, peers, and social forces. Lifestyle, culture,
and advertisements
Signs of Alcoholism
Recreational Drugs
A recreational drug is used without medical justification for its psychoactive effects often in
the belief that occasional use of such a substance is not habit-forming or addictive
Most commonly abused are marijuana, cocaine, heroin, and ecstasy.
Treatment
Drug addiction is a treatable disorder, however, there is no single treatment appropriate for
all individuals
Medical detoxification is only the first stage of treatment
Treatment is tailored to the individual needs and may involve behavioral changes and
medications. No single treatment is appropriate for all individuals. Treatment does not have
to be voluntary to be effective and remaining in treatment for an adequate period of time is
essential.
Effective treatment includes:
Individual, group counseling, and behavioral therapies
Use of treatment medications
Integration treatment for any coexisting mental disorders
Infectious disease assessment and counseling (HIV/AIDS/Hepatitis)
Monitoring of possible drug use during treatment
Medical, social, vocational, legal, and family counseling
Recovery can be a long-term process and relapses can occur
Medications are used to suppress craving for drugs and withdrawal symptoms
Medications include: Methadone, LAAM, Naltrexone, Phenobarbital or Diazepam,
Disulfiram
Dental professionals often have the first opportunity to treat early signs and symptoms of oral
complications for the substance abuser. It is very important to recognize the characteristics of each
patient before treatment as it is rare that a patient will disclose information about an addiction.
Assess the patient by gathering a thorough medical history, keeping in mind that it may
be less reliable because many patients with drug abuse problems are in denial.
Interview the patient and be motivational, empathetic, and non-judgmental. Patient's need to
understand the importance of the information as a health-safety measure and that all
information will remain confidential.
Screen the patient using the CAGE questionnaire & 5 A's – Ask, Advise, Assess, Assist, Arrange
– used in tobacco intervention but may also be used with substance abusers.
Vital signs are important because high blood pressure and fluctuations are common in
substance abusers
Durning the Extraoral Exam, look for signs of substance abuse such as: red puffy eyes, dilated
or constricted pupils, needle track marks, slurred speech, drowsiness
Intraoral exam looking for drug induced xerostomia, generalized poor oral hygiene,
chipped or fractured teeth, rampant carries
Dental Hygiene Diagnosis: this consists of making your decision of patient care based on
the patient's oral condition and abuse habits.
Develop a treatment plan to meet the induvial needs of the patient as identified by the
dental hygiene diagnosis. Priorities and goals are determined by the severity of the
problem.
Implement – The clinical procedures are greatly influenced by the many health
problems that can result from drug use
Evaluate by developing a continuing care plan to prevent progression or reoccurrence of disease
Dental Implications
Xerostomia is often a side effect of opiates, amphetamines, barbiturates, hallucinogens, marijuana, and
alcohol. The resulting decreased salivary flow makes users much more susceptible to dental caries and
periodontal diseases. Chemically dependent patients often crave sugar, which leads to the consumption
of large quantities of sweetened carbonated beverages, thereby increasing enamel erosion. Drug addicts
may also be at a higher risk of bruxism, dentin hypersensitivity, and NUG.
Dental Considerations
Treatment
Review Questions
True/False: The most common drugs of abuse are alcohol and prescription drugs
A) Opiates
B) Amphetamines
C) Barbiturates
D) Marijana
Haveles, Elena B. Applied pharmacology for the dental hygienist. 7th ed., Elsevier Mosby, 2016.
McFarland, Kim K., and Eric Y.K. Fung. “The Complexity of Addition .” Dimensions of
Dental Hygiene, Dimensions of Dental Hygiene , 2011,
www.dimensionsofdentalhygiene.com/ddhright.aspx?id=10816.
Wilkins, Esther M. Clinical practice of the dental hygienist. 12th ed., Lippincott Williams &
Wilkins, 2017.