Cocaine abuse: orofacial manifestations and implications for dental treatment

Millions of individuals in Europe and the United States use cocaine regularly. Use of cocaine may have several orofacial effects such as perforation of nasal septum and palate, gingival lesions and erosion of tooth surfaces. Recent use of cocaine may also increase medical risks during dental treatment, especially when local anaesthetics with epinephrine or epinephrine-impregnated retraction cords are used. Therefore, it is recommended to postpone dental treatment at least 6 to 24 hours after the use of cocaine.     

Effects of cocaine use on oral health and implications for dental treatment

In The Netherlands, an increasing number of people use cocaine frequently, which may induce orofacial complications such as perforation of the nasal septum and palate, gingival lesions and dental erosion. In addition, recent use of cocaine increases the risk of cardiovascular complications during dental treatment, especially when local anaesthetics or adrenaline-impregnated retraction cords are used. Therefore, dental treatment should be postponed at least 6 to 24 hours after the use of cocaine.     

Child abuse and neglect: implications for the dental profession.

Dentists, as a group, have participated in the recognition and reporting of child maltreatment to a lesser degree than other health professionals, being either unaware of their legal responsibility to report or, when abuse or neglect is suspected, reluctant to do so.     

Alcohol abuse and dependence: psychopathology,medical management and dental implications

BACKGROUND: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism. LITERATURE REVIEWED: The authors conducted a MEDLINE search for 1995 through 2001 using the key terms of alcoholism, epidemiology, pathophysiology, treatment and dentistry. Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials. CONCLUSIONS: Alcoholism is a chronic and progressive psychiatric illness that afflicts more than 14 million Americans. It is characterized by a loss of control over the use of alcohol, resulting in impaired social functioning, and the consequent development of medical illnesses. The disease arises in genetically vulnerable people when they are overwhelmed by their cravings for the alcohol-associated euphoria that results from the actions of several neurotransmitter systems in the brain's pleasure center. New medications to counteract alcohol-induced neurotransmission imbalance may assist patients in reducing their craving. CLINICAL IMPLICATIONS: The prevalence of dental disease usually is extensive because of a disinterest in performing appropriate oral hygiene techniques and diminished salivary flow. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of the alcohol-abusing patient, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Special precautions must be taken when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol or psychiatric medications.     

Aggressive destructive midfacial lesion from cocaine abuse

Since the first reported case in 1912 of cocaine-induced perforation of the palate, an additional 7 cases have been reported describing extensive palatal destruction. The clinical presentation shares similarities with nasal-type natural killer/T-cell lymphoma, Wegener's granulomatosis, and infectious diseases. We describe a 50-year-old woman with a progressively destructive midfacial process that initially appeared as a small, localized palatal defect. Over time, the lesion caused bilateral deformity of the ala, extensive loss of the palate, maxillary and sinonasal complexes, ethmoids, and ulceration of adjacent tissue. Clinical laboratory tests showed elevated cytoplasmic-antineutrophil cytoplasmic antibodies, but the histopathology did not support the diagnosis of Wegener's granulomatosis. Special stains and cultures were negative for infectious organisms. Flow cytometry and T-cell gene rearrangement studies ruled out lymphoma. Because of the inability to diagnose this worrisome process, the presence of polarizable foreign material in the original biopsy, and the patient's admission to past cocaine use, a urine drug screen was performed, which was positive for cocaine and marijuana.     

Alcohol abuse in dental patients

Alcohol abuse is an important problem in Britain and is imposing increasing burdens both in general practice and in the hospital service. In the absence of previous investigations of the prevalence of intoxication and dependence in dental patients, 225 consecutive patients who attended the University of Bristol Dental Hospital were interviewed and examined: 75 attended for primary care, 75 for consultation at an oral surgery clinic, and 75 for elective minor oral surgery. A group of 50 consecutive dermatology out-patients were used as controls. All patients were breath analysed to determine blood alcohol concentrations. Dependence was assessed with the CAGE self-administered questionnaire. Eleven per cent of patients showed evidence of alcohol dependence, a similar proportion to that which has been demonstrated in the population of England and Wales overall. Dependent patients attended more often in the morning (71%) than in the afternoon (29%). Only four (1%) of all 275 patients showed evidence of blood alcohol (range 5-90 mg/100 ml): three who attended in the afternoon and one who attended at 9 am. No patient reported recent alcohol intake to allay anxiety. There were no significant differences between groups of patients with regard either to intoxication of dependence.     

Methamphetamine abuse: medical and dental considerations

Amphetamines are central nervous system stimulants with high abuse potential and intense physiological and psychological effects. Abuse of methamphetamine--a methyl derivative of amphetamine--has grown to epidemic proportions across the United States. Due to the characteristic signs of methamphetamine abuse that appear in the oral cavity dentists should have a heightened awareness of the medical and dental issues surrounding this dangerous behavior. Moreover, recognition and proper referral to treatment should be a part of every provider's plan for preventing the devastating psychological, oral, and overall systemic effects of methamphetamine abuse.     

Prosthetic and surgical management of oronasal communications secondary to cocaine abuse

Oronasal communications are serious sequelae of chronic cocaine abuse. If left untreated, these communications can severely limit a patient's quality of life. The defects can be rehabilitated successfully utilizing either maxillofacial prosthetics or various surgical techniques. Considerations in deciding between prosthetic and surgical approaches are discussed, as well as the basics of maxillofacial prosthetic rehabilitation and the different surgical techniques available. Photographic documentation of both maxillofacial prosthetic and surgical treatments performed by the authors is shown.     

The significance of cocaine use to dental practice

Patients who use cocaine illicitly present obstacles and potential challenges for the treating dental professional. There are many manifestations--both systemic and oral--that the dentist needs to be aware of to treat known abusers and to identify those who are not forthcoming about their cocaine use. Certain modifications to treatment, or even a delay in treatment, may be indicated in cocaine abusers.     

Prescription opioid abuse: dental perspectives

Drug abuse and diversion of controlled substances prescribed by dentists will continue to be an important issue in the overall management of dental pain, and must be recognized by the dentist. If suggested guidelines, regulations, and laws are observed, the associated problems for the dentist and the entire dental team and their patients can be minimized. Pain control is an essential service and duty for dentists, and the appropriate selection and use of analgesics affords this service with the best safety and efficacy.     

Child abuse and neglect: dental and dental hygiene students' educational experiences and knowledge

The objective of this study was to explore dental and dental hygiene students' educational experiences and knowledge concerning child abuse/neglect. Questionnaire data were collected from 233 dental (116 male/117 female; response rate=54.82 percent) and seventy-six dental hygiene students (all female; response rate=76.77 percent). Of those surveyed, 94.7 percent of the dental hygiene and 70.5 percent of the dental students reported having learned about child abuse/neglect in classroom settings, and 15.8 percent of the dental hygiene and 29.3 percent of the dental students reported having learned about it in clinical settings. Dental students reported more minutes of instruction about this topic than dental hygiene students (184.48 vs. 112.90 minutes; p=.006). Only 5.5 percent of the dental and 16.7 percent of the dental hygiene students defined child abuse correctly; 32.2 percent of the dental and 13.2 percent of the dental hygiene students did not know their legal responsibility concerning reporting child abuse; and 82.4 percent of the dental and 78.9 percent of the dental hygiene students did not know where to report child abuse. Dental care providers are likely to encounter child abuse and neglect in their professional lives and are legally required to respond to these matters. Dental and dental hygiene curricula should be revisited to ensure that students are adequately prepared for this professional task.     

Child abuse and dental neglect: the dental team's role in identification and prevention

Abstract:  Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases.
The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect.
Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.