Medically Compromised Patient (substance related disorder)

Pg. 1086-10923

Substance-related Disorder

o Substance-related disorders are diagnosed when use of any substance, whether

recreational or prescribed, becomes excessive and leads to significant impairment
or distress.

Most Common Addictive Drugs

o Cannabinoids
o Opioids and morphine derivatives
o Stimulants
o Dissociative Anesthetics
o Depressants
o Hallucinogens
o Steroids
o Inhalants
o Alcohol

Treatments for Drug Abuse

o Individual and group counseling

o Treatment medications
o Inpatient and residential treatment
o Partial hospital program
o Case or care management
o Intensive outpatient treatment
o Recovery support services
o 12-Step fellowship
o Peer support

Oral Aspects of Drug Abuse

o Dry mouth
o Tooth decay
o Chronic gingivitis
o Ulcerations of gums
o Periodontal diseases
o Tooth loss
Medications Used for Drug Abuse

o Methadone
o Levo-Alpha-Acetyl-Methadol
o Naltrexone
o Phenobarbital
o Diazepam

Management of Patient Before Treatment

o Screening of patient
o Medical history
o Verbal interview
o Extraoral examination
o Vital signs

Management of Patient During Treatment

o Oral examination
o Knowledge of oral health conditions/drug abuse
o Pain management
o Risk of relapse
o Behavioral disorders
o Infection control
o Comfort of patient

Management of Patient After Treatment

o Diagnosis
o Strategies to meet individual needs
o Educating patient about their oral health
o Make decisions as to frequency of appointments
o Recall intervals
o Referral to treatment programs
o Sharing decisions

Contraindications for Treatment

o Never treat a patient under drug influence

o Vasoconstrictors
o Medication interactions
o Nitrous oxide and oral or intravenous sedation should be used with caution for drug
dependent patients and only if there is no other alternative.
Indications for Treatment

o Caries
o Malocclusion
o Multiple restorations
o Periodontal disease
o Ulcerated gums
o High calculus amount due to poor plaque control

Test Questions

1.The primary medically assisted withdrawal method for narcotic addition is....
a. Allow patient to handle the addiction on their own.
b. Switch patient to comparable drug with milder withdrawal symptoms and then gradually taper
off.
c. Have patient wean off drug by using only every other day for a specified time, then every three
days and so on.

2. Which of the following are commonly used addictive drugs?

a. Stimulants, Marijuana, Opioids
b. Aspirin
c. Ciprofloxacin
d. All of the above

3. What form is considered the most important part of pre-examination of the dental patient?
a. Social Security Application
b. Financial Report
c. Medical History