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2/20/2004
Dental professionals may be the first to recognize drug use -- and should also be aware of patients' substance use histories, including whether someone is in recovery. As such, they may be good allies in a community-wide screening program.
Experts recommend that dental professionals be familiar with every aspect of patients' health that could impact on dental treatment. For example, cocaine, methamphetamine, and ecstasy can have dangerous interactions with anesthetics. Use of acetaminophen, an over-the-counter pain killer, exacerbates liver problems. To avoid relapse, people in recovery need to be cautious of mouthwashes, anesthesia, and prescription painkillers.
Of course, in some cases, dentists may not even need to ask if someone is using drugs. Methamphetamine causes massive, sudden onset of tooth decay, gum disease, and worn-down teeth. Other drug use causes decreased saliva production, another important clue.
In an article in ADG Impact, Harold Crossley, DDS, an associate professor of pharmacology at the University of Maryland Dental School, recommends that dentists maintain a current medical history. Dr. Crossley recommends questions such as, "Do you have a history of chemical dependency? Do you drink or use recreational drugs? Have you taken cocaine, ecstasy, or methamphetamine in the past 24 hours? Are you in recovery? How long have you been in recovery?"
In the same article, Michael Fishman, MD, addiction specialist, recommends speaking with the person's physician, psychologist, or sponsor before delivering care.
"What makes me crazy is when I hear that patients tell their dentists that they are addicts, and the dentist gives them Ultram or uses nitrous without taking precautions," said Dr. Fishman. "They don't understand that it doesn't matter if it's one or a dozen; it can trigger a relapse in a recovering addict that could have disastrous consequences."
"This is our job. We're dentists. We're part of the community," said Dr. Crossley.
Recommendations for Dentists, from the Academy of General Dentistry - Include questions on substance use and recovery on medical history forms.
- If you suspect drug use, take precautions and avoid prescribing narcotics.
- Maintain a resource list of recovery resources for patients who admit to a substance use problem. Be gentle: Counsel, don't castigate.
- Avoid prescribing narcotic pain relievers whenever possible. Document all discussions regarding narcotic prescriptions.
- Familiarize yourself with the contraindications of illicit drugs and pharmaceuticals used in dentistry.
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