Substance abuse and the dental patient … What's the connection?

Dental Assistant, The, Jan-Feb, 2003 by Carolyn C. Newman, L. Worth Bolton

Dental Team Alerts

The dental receptionist is a key person for alerting the dentist and staff to potential problems. Receptionist observations can include noticing the general appearance of patients when they check in for a visit, noticing a history of broken appointments, dramatic unexpected complaints, or repeated requests for unusual prescriptions. The dental auxiliary observations should include reviewing the patient's general health, reviewing the medical history to include the use of prescription, over-the-counter, and illicit drugs and observing clinical or unusual behavioral signs. Common patient management issues of substance abusers may include irregular attendance or compliance with treatment, anxiety, fear, cravings for sweets, increased hazards of cross-infection with the hepatitis virus, HIV and increasing occurrence of tuberculosis. The common oral problems are oral neglect, increased caries, periodontal disease, smoker's keratoses, gingival or buccal ulcerations or pigmentations, and the feigning of oral diseases, such as pain or even self-inflicted injuries to obtain narcotic prescriptions. (5) Be aware of someone walking in near closing time claiming severe pain and hoping the dentist will provide a quick pain prescription until the patient can return for a next day appointment. The patient may request specific drugs or make a self-diagnosis, or have no interest in discussing the diagnosis, investigations or a second opinion. (5) Remember, prescription pads should be stored out of sight in the patient area.

Clinical Interview

All office visits should begin with updating the original health history. Patients may be reluctant to share information, as shame and guilt are primary issues with substance abusers. Be empathetic, neutral, and nonjudgemental in determining if a patient has a problem with alcohol, tobacco, or other drugs. The patient could also be recovering from the recent use of alcohol or other drugs. Confidentiality is a must for all patients and when requesting information reinforce the concept that this information is used to improve dental health. Remember to ask if there is a family history of alcohol or other drug dependence or if a patient has a past history of treatment or is currently under treatment. The name of the treatment facility, attending physician, length of abstinence, and current status, should be established and recorded in the medical history. (4) Remember, there is no stereotypical profile, and substance abuse can affect all age groups, the young, middle aged, and the older adult.

Alcoholism

What is the definition of alcoholism? The consumption of alcohol in a manner that it causes deterioration in social behavior and physical/psychological dependence where withdrawal is difficult, causes adverse effects, and can be life threatening.

Signs of alcoholism include the smell of alcohol on the patient's breath, signs of self-neglect of mouth, clinical signs of acute necrotizing ulcerative gingivitis, poor personal hygiene, and over-boisterous or facetious manners. Patients may complain of indigestion, anxiety, tremor of hands, malnutrition, and slurred speech. They may have a history of liver disease, and social difficulties.