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Other Considerations
Alcohol and tobacco are known risk factors for head and neck cancers, including oral cancer. A complete extensive extra- and intraoral exam should be included in this group of high-risk patients' treatment.
Non-alcohol containing rinses and topical agents should be used as a part of daily patient home care regimens when treating chemically dependent patients.
Pain control methods should be carefully considered and discussed with the alcoholic's primary care physician or substance abuse therapist before use.
Even one drink during pregnancy may result in Fetal Alcohol Syndrome, which produces facial abnormalities and is the leading cause of mental retardation in our country.
Anxiety and Pain Management: Nitrous oxide should not be used when treating chemically dependent, addicted or recovering individuals without permission of the patient's addiction medicine physician's recommendation. An open dialog between the recovering patient and the dental practitioner is used to relieve anxiety surrounding dental treatment. Methods used for pain control should be discussed thoroughly before treatment begins. NSAIDS are a good choice except for individuals with hemostatic problems. Local anesthetics are not contraindicated.
Narcotics prescription should be written for a limited number of the medication and a responsible party should administer it to the alcoholic patients. Because chronic and acute episodes of alcohol intake affect drug metabolism, the dentist should consider avoiding prescribing acetaminophen in large amounts for extended time as concomitant alcohol and acetaminophen use increases the risk of hepatotoxicity.
All members of the oral health team should be educated about chemical dependency and drug seeking behavior. Individuals may falsely claim to experience dental pain in order to get a prescription for a narcotic. You should be wary of a patient claiming an allergy to a weaker pain reliever, requesting specific drugs or asking for more than a normal amount of drug to be prescribed.
Keep prescription forms away from areas where patients have access to them and never pre-sign prescription forms. Drugs should be stocked in a locked cabinet away from treatment areas and only in quantities that are sufficient for immediate use. Disposal of unused drugs and spent carpules and needles should be handled according to OSHA guidelines. Drug users often search trash receptacles outside medical and dental offices looking for drugs or drug paraphernalia.
Patients who abuse alcohol and drugs often do not attend scheduled dental appointments and neglect to pay for services. This can cause emotional and financial strain on any dental practice.
Health care professionals have a responsibility to ensure the safety of their patients and those who may be affected by their behavior. Legal responsibility in reporting drug or alcohol abuse is cloudy. Certain patient confidentiality laws prevent the health care provider from reporting patients' substance abuse problem. This becomes a bigger issue if the abuse problem is an immediate threat to public safety (e.g., airline pilot, health professional). You should contact your state dental association and legal council regarding your obligations under state and federal laws.
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