The Patient With a SubstanceRelated Disorder

By: Sarah Neel

Carly Meriwether
Lam Tran

Two types of Patient of Substance

Disorder
Alcoholic Patient
Drug Abuse Patient
Patients who are alcohol dependent are

more likely to use other drugs, as are

patients with a drug dependence are more
likely to drink alcohol. For these reasons
drug and alcohol dependence are often
related to one another.

Alcoholic Patient
Alcohol use is common in a large percentage of the population

and varies from social drinking to alcoholism .

Physical dependence and tolerance are both present in an
individual suffering from alcoholism.
Alcoholism and its dependency develop after periods of
unhealthy alcohol use followed by abuse.
Behavioral changes from alcohol includes
Aggressiveness
Mood instability
Impaired judgment
Impaired attention and memory

Physical characteristics associated with alcohol use

Slurred speech
Lack of coordination
Unsteady gait

Etiology of Alcohol
Dependence
Genetics - GABRA2 and CHRM2 are two genes

identified to involved in the predisposition to alcohol

dependence.
Biopsychosocial - Children of alcohol-dependent
parents are exposed to a higher risk factors, leading
to alcohol dependence.
Environmental - Emotional (stress reduction, mood
enhancement) and cognitive (beliefs about alcohol)
motivational factors may play a role in an
individuals decision to drink.
Stress, family, peers, and social forces.
Current lifestyle, culture, advertisements, and

economics.

Alcohol and the Body

Alcohol is quickly absorbed from stomach

and small intestine upon intake and

diffused into the bloodstream.
The liver and its enzymes metabolize the
alcohol for excretion. More than 90% of
ingested alcohol converted into
acetaldehyde, then acetone, and finally
into CO2 and H20.
High level of acetaldehyde and chronic
alcohol consumption can impair liver
function leading to liver damage.
Less than 10% is excreted directly from
breathing, sweating, and urination.

Health Hazards
Tooth decay alcoholic beverages contain high amounts of sugar and

frequent consumption will demineralize tooth enamel.

Liver disease most frequent.
Immunity and infection alcohol abuse diminished immune response.
Digestive system alcohol alters stomach mucosa and stimulates unneeded
secretion of gastric acid.
Nutritional deficiencies alcohol abuse result to malabsorption of vitamins
and nutrients.
Wernicke-Korsakoffs syndrome Brain disorder of the cerebellum from thiamine

deficiency.
Cardiovascular diseases heavy consumption increases risk.
Neoplasm risk for many types of cancers increase with combined use of

tobacco.
Nervous system judgment and actions are affected. Long-term abuse can
lead to damage of CNS, PNS, and the brain.
Reproductive system alters endocrine hormones.
There is no safe amount of alcohol use during pregnancy.
Prenatal alcohol exposure is cited as the leading cause of birth defects.

Signs & Symptoms of Alcohol Abuse

Tremor of hands, tongue, and eyelids.
Nervousness and irritation.
Malaise, weakness, and headache.
Dry mouth.
Autonomic hyperactivity: sweating, rapid

pulse, and elevated blood pressure.

Insomnia.
Grand mal seizures.
Nausea or vomiting.

Treatment for Alcoholic

Patient
Early intervention counsel patients who are not yet dependent.
Detoxification management of acute intoxication and the withdrawal

syndrome.
Withdrawal occurs after an abrupt cessation of alcohol intake in the

alcohol-dependent person. Signs appear within few hours and can include
fatigue, depression, and anxiety.
Pharmacotherapy for withdrawal management.
Disulfiram (Antabuse) interferes with alcohol metabolism in the liver.
Naltrexone (ReVia) interferes with neurotransmitter system that produce

pleasure effects.
Acamprosate affects certain neurotransmitter.
Toirimate an anticonvulsant.
Rehabilitation
Counseling and Education
Group Therapy and Alcoholics Anonymous (AA)
Psychiatric Treatment
Aftercare Services

Drug Abuse Patient

Drug abuse: habitual use of drugs not

needed for therapeutic purposes.

Prescription drug abuse: taking prescription
medication that is not prescribed for that
person.
Drugs interfere with the function of the
brain and create long-term effects on brain
metabolism and activity.
Dependency develops after periods of drug
use followed by pathologic abuse.
There is no classic cultural, socioeconomic,
or educational profile for a substance

Most Common Drugs of

Abuse
Cannabinoids
Depressants
Dissociative anesthetics
Hallucinogens
Opioids
Stimulants
Steroids
Inhalants

Medical Effects of Drug

Abuse
Cardiovascular effects increase blood pressure, arrhythmias,

vasoconstriction, and induce angina.

Neurological effects memory lapses, attention problems, seizure,
intracerebral hemorrhage, and dementia.
Gastrointestinal effects many drugs of abuse have been known to
cause nausea and vomiting. Cocaine has been associated with GI
complications and life-threatening hemorrhage.
Kidney damage toxic effects of drug reduce and affect renal function.
Liver damage because liver detoxifies drugs, chemicals, and alcohol, it
can be damage from abuse.
Musculoskeletal effects steroid use during adolescence can result in a
short stature.
Respiratory effects smoking tobacco or marijuana damage sensitive
lung tissue.
Prenatal effects miscarriage, premature birth, and low birth weight.
Infections risk for acquiring infections are higher for drug users. HIV
from sharing needles.

Oral Effects of Drug Abuse

Lips & Tongue
Drug induced xerostomia and soft tissue abnormalities.
Tongue coated with bacteria.

Gingiva - Heavy biofilm, moderate-severe inflammation, periodontal

infections.
Palate - Perforation of palate due to chronic cocaine use.
Teeth - Chipped and fractured from falls and injuries, attrition due to
bruxism.
Dental Caries - Diet high in cariogenic substances, poor diet, lack of
dental care, xerostomia .
Stimulants like ecstasy, amphetamines and cocaine are known to cause
individuals to clench and grind their teeth when under the influence,
damaging roots and gum. Chronic dry mouth are also common.
Meth Mouth is a term to describe the discoloration, rotting and broken
teeth from chronic use of methamphetamine. Methamphetamine stop the
saliva glands from producing saliva, causing extreme xerostomia and
allowing increased acid attacks on the enamel.

Treatment Methods for Drug Abuse

Patient
Behavioral changes
Counseling
Support groups
Psychotherapy
Family therapy

Medications substitute with comparable drug with milder

withdrawal symptoms, and then gradually taper off the

medications.
Methadone associated with narcotic addiction.
LAAM (Levo-Alpha-Acetyl-Methadol) suppresses withdrawal

symptoms and drug cravings.

Naltrexone blocks the effects of heroin at the opioid receptor
sites, does not eliminate drug cravings.
Phenobarbital/Diazepam use to treat sedative withdrawal
symptoms.

Contraindication
Rinses, antibacterial agents, and oral

hygiene products that contain alcohol need

to be avoided for patients suffering from an
alcohol use problem.
Drug interactions, use of epinephrine, and
using nitrous oxide verses local anesthesia
needs to be reviewed with the patients
physician.
Consult with patients physician to
determine whether prophylactic antibiotic
premedication is indicated.
Patients are at an increased risk for
infection, use ultrasonic scalers and air

Dental Concerns and

Management
Medical and dental history of the patient does not always provide information

necessary to determine if the patient abuse alcohol or use substances.

Patient might be reluctant to reveal information about their substance-use;
many patients with drug abuse problem are in denial, which makes their
medical history less reliable.
It is the Dental Hygienists professional responsibility to be aware of signs and
symptoms of drug abuse, and to view chemical dependency as an illness.
Use effective communication and refrain from using comments that will place
the patient on the defensive. Be empathetic, respectful and nonjudgmental.
Motivate your patient!
Develop maintenance program to prevent progression of reoccurrence of
disease.
Evaluate treatment plans and goals with patient, and make changes
according to the patients progress.
Provide information about basic dietary needs.
Recall: 3 months.

References
www.ada.org/en/member-center/oral-healthtopics/drug-use#talking
www.alcoholrehab.com/drugaddiction/substance-abuse-and-oral-health
Wilkins, Esther M. Clinical Practice of the
dental Hygienist.
Philadelphia: Walters Kluwer Health/Lippincott Willams
& Wilkins, 2013. Print.