|
Introduction
It is important to recognize the signs and symptoms of substance abuse because patients are rarely truthful about their drug and alcohol use. Treatment modification is necessary for both the substance abuser and the recovering substance abuser. Patients, who have been through treatment and are in recovery, will be apprehensive about spending time in an environment that might cause relapse. Consultation with patient's physician or primary care provider is also advised.
Drug and alcohol interaction is common and should be considered when treating an individual with a substance abuse problem. Of the 20 most prescribed drugs, over 50% have at least one ingredient that will negatively react with alcohol. 22
Alcohol: Patients who abuse alcohol but do not suffer from alcoholic liver disease (ALD) are very different when considering dental treatment modifications. Often patients will self-medicate with alcohol to decrease anxiety related to dental treatment. The oral health team member's role is to discourage this practice by explaining how we are prepared to decrease anxiety through safer techniques such as use of behavior modifications, pharmacotherapy, or both.
The patient who has ALD presents a unique challenge during dental treatment. Elective dental treatment is not recommended if the ALD patient is not receiving medical treatment.
Bleeding Tendencies: Since the liver is a primary source for agents involved in clotting, ALD patients should have a complete blood count with differential, AST and ALT, prothrombin time and platelet count checked prior to treatment. If treatment will involve excessive bleeding, local hemostatic agents should be used, and treatment avoided if an acute drinking episode has occurred within the last 4 to 5 days. 23, 24
Unpredictable Metabolism: Unpredictable metabolism of certain medications: Increased amount of local anesthetic agents and sedatives may be necessary to achieve desired effects. Acetaminophen should be used with caution in both the ALD patient and patients who consume alcohol when fasting. Considering ALD patients who present with increased lab results related to liver function, ascites, and encephalopathy, and/or malnutrition, drug metabolism will most likely be impaired. 1
Alcohol acts to decrease or increase the effect of prescribed and non-prescribed drugs. Individuals who are abusing alcohol and have problems with gastric bleeding and other hemostatic problems should avoid aspirin and non-steroidal anti-inflammatory drugs (NSAIDS). These drugs could increase gastric bleeding.
Metronidazole, commonly used to treat periodontitis, can cause a profound reaction if used in combination with alcohol (similar to an alcohol/disufulram reaction). The combination of opioids (e.g. hydrocodone, oxycodone) and alcohol enhances the sedative effect of both and increases the risk of overdose.
Risk of spread of infection: ALD patients may require use of prophylactic antibiotics if ongoing infection is present. While policy does not require use, ALD patients often present with diminished immune response. Coupled with ongoing infection, use of antibiotics should be taken into account on an individual patient basis.
Cocaine and Methamphetamine: If you suspect a patient is under the influence of cocaine, methamphetamine, or other stimulant, do not treat the patient for at least 24 hours after the patient reports last using the drug. Vasoconstrictive drug interactions have been well documented when treating patients who are under the influence of cocaine. To insure patient safety, adrenergic vasoconstrictors be completely avoided.25
Continue on to
|
