Dental health and access to dental treatment: a comparison of drug users and non-drug users attending community pharmacies.

OBJECTIVE: To investigate the self-reported oral health, access to dental treatment and recent use of dental services among a group of drug users attending community pharmacies and to make a comparison with a group of age and gender matched community non-drug users/patients not using services for drug users. METHOD: Review instrument completed by pharmacist interviewing drug users and other pharmacy users. SETTING: Community pharmacists SAMPLING: All known drug users attending participating pharmacies plus an equivalent number of age and gender matched non-drug using pharmacy customers. Final sample size drug users N = 125; non-drug users N = 129. KEY FINDINGS: The data show that drug users self-report considerably more difficulty in accessing dental treatment, are less likely to have visited the dentist in the last 12 months and have a significantly higher level of self-assessed oral health problems, with less use of treatment services than non drug users. CONCLUSIONS: Drug users need to be encouraged to access free dental treatment available to them on the NHS. Closer collaboration between the dental profession and others in contact with drug users, such as community pharmacists, may enhance uptake of dental services.     

Oral lichenoid drug eruptions: their recognition and management

Lichen planus is a relatively common, often clinically distinctive, mucocutaneous condition with an uncertain aetiology. One variant of lichen planus is the so-called 'lichenoid drug eruption'. In contrast to idiopathic lichen planus, lichenoid drug eruptions, where practicable, may be managed by substitution of the offending drug. The dental clinician is in a prime position to identify these lesions and liaise with medical colleagues regarding their management. This article reviews oral lichenoid drug eruptions, emphasizing those aspects of relevance to the general dental practitioner.     

Drug users: oral health-related attitudes and behaviours

AIM: Explore oral health-related attitudes and behaviours of drug users. DESIGN: Qualitative study using focus groups and semi-structured interviews. SETTING: Facilities for treatment and recovery of drug users in South London. PARTICIPANTS: Twenty-six male and 14 female recovering drug users. RESULTS: Participants described many changes in lifestyle associated with drug use including the physical effects of drugs, dietary habits, organisational and time constraints and unfavourable social conditions, which were not conducive to oral health. There was considerable health consciousness. They associated general health problems and problems with teeth, gums and oral soft tissues to both direct and indirect effects of drug use. Use of dental services was inhibited by low priority for oral health relative to the need to obtain and use drugs, experientially induced fear of dentists, the acceptability of dental services, needle-phobia, ability to self-medicate and organisational factors in their lifestyles. CONCLUSIONS: The lifestyles of drug users may contribute to oral health problems and low use of services. Drug users therefore comprise a group with special dental needs and need greater access to dental care than most people. Much of this care could be provided in general practice where appropriate dental care can contribute to recovery from drug use.     

Impact of drug abuse/dependence on dentists

Drug abuse and dependence are important and complex health problems, and understanding these issues is important for dental patient management. At the same time, dentists, like their patients, could abuse alcohol and other illicit drugs, which would jeopardize their ability to provide optimum dental care. This article reviews important aspects of drug abuse and dependence, risk factors for dentists, the impact of drug abuse on the dental profession, and various treatment options.     

Drug addiction and dental care.

Patients who are addicted to drugs, or are being treated for drug addiction, present a variety of management issues when they attend for dental care. A number of factors are related to the treatment planning and clinical management. Dentists should be aware of these factors in order to manage these patients sensitively and effectively. Important management issues include medical problems associated with drug abuse, dental problems and how drug abuse and its subsequent treatment affect the dentition, behavioural disorders, pain management, and control of cross-infection. People who have recovered from chemical dependency to opiates have special needs, especially in pain management. Establishing a good pre-treatment rapport with the patient will assist the dentist in reducing the need for postoperative analgesics, and will encourage this group of patients to return and obtain needed dental care. The more dental practitioners know about types and patterns of drug abuse and recovery programmes, the more safely this group of patients with special needs can be managed.     

Documenting medication use in adult dental patients: 1987-1991.

The authors surveyed 5,002 dental outpatients to determine the prevalence and patterns of drug use. They found that drug use increased significantly with age and that a significant number of patients took medications that had potential for adverse dental effects. Thus, dentists should be aware of patient medications and the effects those drugs have on dental treatment.     

Adverse drug interactions in dental practice: interactions associated with local anesthetics, sedatives and anxiolytics. Part IV of a series

BACKGROUND: This article is the fourth in a five-part series based on a 1998 International Association for Dental Research symposium entitled "Adverse Drug Interactions in Dentistry: Separating the Myths From the Facts." The symposium evaluated the significance of various drug interactions associated with dental therapeutics. METHODS: Local anesthesia and preoperative oral sedative/anxiolytic therapy often are indicated for routine oral surgery and restorative dentistry. The author conducted a literature review of the drug interactions associated with the use of local anesthetics and sedatives. The quality of the information used to document these interactions and the severity of the possible adverse outcome were assessed using a significance rating scale for dental drug interactions. RESULTS: Many of the frequently described drug interactions were found to be poorly documented in the dental and medical literature. Others were determined not to be relevant to current dental practice. The use of local anesthetics, sedatives or anxiolytic agents in combination with other central nervous system depressant agents or in combination with drugs that inhibit their metabolism was associated with a few serious adverse drug interactions or complications. CONCLUSIONS: The adverse drug interactions associated with the use of local anesthetics and oral sedative/anxiolytic agents in general practice vary in significance. An understanding of possible adverse drug interactions in dentistry may help practitioners avoid and prevent these complications.     

Five-year evaluation of a dental care delivery system for drug addicts in Denmark

The present study describes the experiences and results of the first 5-year period of a municipal dental clinic offering free dental care to drug addicts. One of the many problems was the instability of this socially deprived group whose erratic life style made it impossible to maintain regular dental care. The DMFS level of the drug addicts was 50.2 and mean caries increment per yr was 2.5 (1.3 new surfaces and 1.2 surfaces with recurrent decay). The caries increments among the present drug abusers and the individuals on methadone maintenance were higher than among the previous drug addicts, 3.1 and 1.3 surfaces per yr respectively, but this difference was not statistically significant. Only slight improvement in oral hygiene (VPI) could be demonstrated whereas gingivitis (BI) remained unaltered. Traumatic injuries of the orofacial region were frequent. The mean time expenditure concerning dental treatment was 5 hr per individual in the initial treatment phase but decreased to 1-2 h per individual per yr. Broken appointments and last minute cancellations were as a rule related to drug/alcohol abuse. The mean number of fillings was 8.2 per individual in the initial treatment phase and 1.7 per yr for individuals in a maintenance phase. The poor dental health of the drug addicts seems closely related to their life style habits and the clue to an improvement would probably follow the cure of the drug abuse and a concurrent resocialization.     

Dentition of addiction in Queensland: poor dental status and major contributing drugs

BACKGROUND: Although it is said that drug addiction is associated with poor dental health, there is little research in this area. In particular, there is little work comparing the effects of the different drugs of addiction. METHODS: A cross-sectional patient survey of dental health was undertaken in a family practice comparing opiate and other drug addicts (DA) with non-addicts (NA). The age range was restricted to 19-45 years. Damaged teeth were counted and a semi-quantitative score applied to severity to allow the calculation of an overall dental index. A medical review only was undertaken; recognized dental diagnostic criteria were not applied. RESULTS: There were 233 and 47 respondents in the DA and NA groups, respectively. The mean ages and gender ratios were similar in both groups. DA used more addictive drugs than NA (all P < 0.001). DA had more absent, traumatized, major cavitated and extracted teeth (all P < 0.05). Addicts had a worse severity index (P < 0.02) and dental index (13.13 + 24.00 vs. 4.74 +/- 16.03; P < 0.005). Furthermore, dental pathology developed in DA at younger ages than in NA with 56.8% vs. 5.4% of patients younger than 38 years having dental indices more than 10 respectively (OR = 22.98, 95% CI = 5.57-200.65, P < 0.0000001). At multivariate analysis age, gender, and dose and/or duration of tobacco, methadone, morphine, and alcohol were significantly associated with these pathologies. CONCLUSION: These data are consistent with published dental reports and basic science information that drug addiction has a deleterious effect on dental health, that in addiction this effect is rapid and severe, and that tobacco, methadone, morphine and alcohol contribute importantly to these changes.     

Oral health status of drug addicts in the Czech Republic

Over the last decade, illicit drug use has become a very pronounced problem in the Czech Republic. Some branches of medicine such as psychiatry, internal medicine and neurology have tried to confront the situation by joint treatment of addicted patients. Dentistry has so far remained outside this multi-disciplinary care despite the fact that the status of dental and other tissues in the oral cavity influences general health and vice versa. The aim of the survey on the oral health of drug addicts that was conducted in the Czech Republic from 2000 to 2002 was to collect data to help dental professionals contribute to the complex care of drug addicts. The number of addicted persons examined was 400 and the subgroup of drug addicts consisted of 217 subjects (mean age 23.87 yrs, SD 6.70), all being treated in long term hospitals. Among other oral health features observed, the DMFT and CPITN indices are presented in this paper. The results show severe dental and periodontal tissue destruction in young addicts and two case reports are included. The above survey indicates that dental treatment should become a part of standard care for addicted patients in long-term hospitals. Furthermore, if severe oral tissue impairment in young persons whether in dental practice or during autopsy is encountered a drug addiction should be suspected. If so, the treatment of the person or examination of the dead body should accordingly be adjusted.     

人工种植牙全身给药系统的设计

本文提出一种能够全身给药的人工种植牙装置的设计,设计由网状种植体、储药囊和封盖螺丝组成。期望通过研究,这种装置能够为全身给药提供一种新途径。要研究的内容包括:(1)人工种植给药装置的设计与定制。(2)人工种植给药系统植入后的调控。(3)人工种植牙全身给药的药物吸收及其影响。(4)人工种植给药的筛选。(5)人工种植给药药物剂型的制备。     

Strategic protein target analysis for developing drugs to stop dental caries

Dental caries is the most common disease to cause irreversible damage in humans. Several therapeutic agents are available to treat or prevent dental caries, but none besides fluoride has significantly influenced the disease burden globally. Etiologic mechanisms of the mutans group streptococci and specific Lactobacillus species have been characterized to various degrees of detail, from identification of physiologic processes to specific proteins. Here, we analyze the entire Streptococcus mutans proteome for potential drug targets by investigating their uniqueness with respect to non-cariogenic dental plaque bacteria, quality of protein structure models, and the likelihood of finding a drug for the active site. Our results suggest specific targets for rational drug discovery, including 15 known virulence factors, 16 proteins for which crystallographic structures are available, and 84 previously uncharacterized proteins, with various levels of similarity to homologs in dental plaque bacteria. This analysis provides a map to streamline the process of clinical development of effective multispecies pharmacologic interventions for dental caries.     

Survey of drug used and medical history among dental out-patients

Information about drug used and medical history among dental patients would be useful for dental practice and teaching of clinical pharmacology. Therefore, 541 consecutive adult outpatients of Mahidol dental school were studied in 1987. The names of drug used and medical problems were obtained by direct questioning. Out of patients surveyed, 307 (56.7%) were taking drugs and the most commonly drug used was non-narcotic analgesics. 300 patients (55.4%) had medical problems and allergy was the most common disease. The frequency of patients who taking drugs and having medical problems varied between age groups. The highest frequency of medication intake was found in patients with age above thirty. The highest frequency of significant medical conditions was found in patients with age above fifty. The data from this investigation revealed that the medical problems of patients which affect dental treatment were very common. Consequently, the dental personnel should study more about the pharmacology of systemic drugs and the nature of systemic diseases.     

Drug therapy for the pregnant dental patient

Providing needed dental treatment, managing oral infection, and controlling pain are essential functions of dentists for helping patients maintain overall health during pregnancy. Medications commonly required for dental care consist of local anesthetics and associated vasoconstrictors, centrally and peripherally acting analgesics, sedative and anxiolytic agents, and antibiotics. Therapeutic drugs routinely used in dental practice are selected because of their known safety and effectiveness. However, for a pregnant patient requiring dental care, the agents routinely prescribed should be reevaluated for potential risks to the mother and/or fetus. The decision to administer a specific drug requires that the benefits outweigh the potential risks of the drug therapy. This article reviews and updates the recommendations for using dental therapeutic agents, thereby enabling general practitioners to select the safest drugs when treating pregnant dental patients.     

Managing patients on warfarin therapy: a case report

Coagulotherapy is a common therapeutic regimen most frequently utilizing warfarin. This therapy may have important dental ramifications. An understanding of the mechanisms of action and drug interactions may help avoid problems. Questions commonly arise as to what dental procedures may be safely considered when a patient is on anticoagulant therapy. The coagutherapy level is measured in values of the International Normalized Ratio (INR). Any question about the appropriateness of dental procedures should be referred to the physician prescriber of the anticoagulant therapy. Generally, controlling bleeding is less of a problem than the management of thrombi and vascular occlusion from decreased coagutherapy. A case is presented in which the INR reached a critical value as the result of drug interactions and miscommunication.     

妊娠期药物动力学及口腔感染性疾病的安全用药

妊娠期妇女因其所处生理阶段的特殊性,各项生理指标会有所变化,发生口腔疾病的风险急剧增加,对口腔感染性疾病不及时治疗或不合理用药可能会导致胎儿畸形甚至流产。本文对妊娠期药物动力学改变、妊娠期用药原则及治疗口腔感染性疾病常用药物进行综述,为口腔科医生对处于妊娠期口腔感染性疾病患者安全用药提供参考。     

Methotrexate and oral ulceration

Methotrexate is well established in the drug treatment of various neoplastic diseases. More recently it has become increasingly used as a once-weekly, low-dose treatment of disorders such as psoriasis and rheumatoid arthritis. Clinical trials have shown its effectiveness in these conditions and it is likely that dentists will encounter patients taking this drug in general dental practice. Oral ulceration can occur as a side effect of methotrexate therapy. This may be due to lack of folic acid supplementation or overdosage due to confusion regarding its once-weekly regime. Illustrations of these problems, which have initially presented in a dental setting, are given. Important drug interactions of methotrexate relevant to dentistry are discussed.     

Dental referral of drug addicts

Reasons for drug addicts' non-compliance to dental referral were investigated. Sixty-eight out of 83 addicts referred to the dentist were interviewed. Eighty-one percent intended to go, but only 42% did show up for their first appointment. Mean dental anxiety score (SDAI) was 23.6. An active referral of a non-anxious patient who visited the dentist in the past if in pain appeared least likely to fail. Dental care as an integral part of care for drug addicts is advocated.     

Analgesic update: tapentadol hydrochloride

Tapentadol HCI is an opioid (narcotic) analgesic, which also inhibits norepinephrine reuptake. While it appears to display a somewhat lower incidence of nausea and constipation than oxycodone 10 mg to 15 mg, its analgesic efficacy in acute postsurgical dental pain is inferior to ibuprofen 400 mg. Like other single-entity opioids, tapentadol should not be used as a first-line agent for postsurgical dental pain but can be employed as an add-on drug for breakthrough pain in patients already using a regimen of a non-steroidal anti-inflammatory drug and/or acetaminophen.