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

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

Occupational risk factors for alcohol abuse include: workers in the alcohol industry, entertainers, commercial travelers, bored housewives, bachelors over the age of 40, armed forces personnel, and health care professionals. Social problems may include absenteeism, frequent job changes, and marital disharmony. There could be an increase in accidents, assaults, violence, or occurrence of cirrhosis. A family history of alcoholism is also a contributing factor. (5)

A positive screening for alcoholism would be for men who drink 15 or more drinks per week (180 grams of alcohol) or women who drink 12 or more drinks per week (144 grams of alcohol). Persons who drink more than five drinks per occasion one or more times per week are at risk. Use of the CAGE screening process can aid the dental professional by asking the patient the following questions for alcohol or other drug abuse:

* Have you felt you ought to Cut down or Control your drinking or drug use?

* Do you get Annoyed or Angry when people ask you about you alcohol or drug use?

* Have you felt bad or Guilty about your drinking or drug use?

* Have you ever had a drink or used drugs first thing in the morning (Eye opener) to steady your nerves, or get rid of a hangover, or get the day started?

A score of two or more positive answers indicate a need for more in-depth assessment. (4,6,7) Remember, it is not unusual for patients to become defensive or even a bit upset when you ask these questions. Remain calm and reinforce that this is designed to help the dental team provide effective dental care.

Nicotine and Other Drugs

Statistics reveal that more than 400,000 deaths in the United States each year may be attributed to cigarette smoking, making it the nation's leading preventable cause of premature mortality. Half of the cases of adult periodontitis, in this country may also be attributable to cigarette smoking. Tobacco use is responsible for more than 75% of the cases of oral and pharyngeal cancer in the United States. (8) Nicotine and tobacco use present dental management problems in patients, which may include chronic obstructive airway disease, ischemic heart disease, resistance to sedation, and associated disorders such as alcoholism or peptic ulcer. The affects of tobacco affects decrease success rates of periodontal therapy and dental implants. It impairs oral wound healing, and increases the risk for a wide range of oral soft tissue changes. This includes gingival recession and dental caries on tooth roots and crowns with the use of smokeless tobacco. Smokeless tobacco users should be aware that both chew and snuff are addictive substances and can cause oral disease. (9)

What are some clinical signs of nicotine abuse? Oral cancers, smoker's keratosis or pigmentation changes, predisposes to periodontal disease, ie acute necrotizing gingivitis, candidosis, and xerostomia.

Extrinic staining of the teeth is also present. Screening questions about nicotine and illicit drugs should include:

* Have you used any tobacco products, such as cigarettes, cigars, or smokeless tobacco in the past three months? If yes, what and how much and how often?