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TREATING A PATIENT WITH

A COCAINE ADDICTION
By: Moriah Wallace, Christen Kennon, & Cecily Fontenot

INTRODUCTION
There are 2.4 million cocaine abusers in the U.S.
Most commonly used illicit drug
Cocaine is extracted from the leaf of Erythoxlum coca bush.
Our goal is to educate dental professionals on how to recognize the signs and
symptoms of cocaine use and how to give proper treatment to a patient with a
cocaine addiction.
Topics include: how cocaine effects the brain, the signs and symptoms of
cocaine use, and how to apply the dental hygiene process of care.

HOW COCAINE EFFECTS THE BRAIN


The normal communication process in
the brain

Neurons release dopamine


into the synapse
Binds to dopamine receptors
Acts as a chemical
messenger
Is removed from the synapse
by a transporter
Recycled

HOW COCAINE EFFECTS


THE BRAIN (CONTD.)
If cocaine is present

Attaches to the dopamine


transporter
Blocks the normal recycling
process
Causes an accumulation of
dopamine in the synapse
contributing to the
pleasurable effects of the
brain.
Addictive response in the
brain is enhanced

BEHAVIORAL SYMPTOMS

Anxiety
Irritation
Extremely talkative
Increased energy
Bizarre behaviors
Violence
Changes in habits, attitudes, and
efficiency
Irregular attendance at appointments by
one who was previously responsible.

DENTAL HYGIENE CONSIDERATIONS

Conduct a detailed medical and dental history.


Monitor the patients blood pressure and heart rate at each visit.
Perform an oral cancer screening.
Evaluate salivary flow.
Recommend anticaries agents as necessary.
Recommend non- alcoholic mouth rinses.

PATIENT HEALTH HISTORY

Increase blood pressure

Cause vasoconstriction

Alter electroactivity of the


heart

Promote a cardiac stimulant


effect
Induce angina; precipitate
myocardial infarction
Cause a variety of
arrhythmias and palpitations
including sudden cardiac
death

Liver Damage

Gastrointestinal Effects

Cardiovascular Effects

Gastrointestinal
complications

Abdominal pain

Possible life- threatening


hemorrhage

Severe bowel gangrene

Nausea

Vomiting

When combined with


alcohol, cocaethylene is
formed.

Cocaethylene intensifies the


euphoric effects of cocaine

Increased risk of sudden


death

ADDITIONAL INFORMATION TO OBTAIN


FROM THE PATIENT
Last recall of any drinking or drug use
Pattern of use
Medications being used
Taking or buying prescriptions intended for another

INTERVIEWING THE
PATIENT
Effective Communication
Keep the lines of communication open
the dental hygienist should remain empathetic, respectful, and nonjudgmental
Discuss the effects of drug use on the patients well being

Obtaining Patient Confidence


Patients could hesitate to disclose personal information
Information is required as a health safety measure. All personal information will
remain confidential.

DRUG
INTERACTIONS
Epinephrine- response is enhanced by the vasoconstrictor activities of cocaine
Administration of local anesthetic after recent use of cocaine may cause an acute rise in
blood pressure.
Convulsions are associated with the combination of lidocaine and cocaine potentiates
Dental treatment should be postponed 6 to 24 hours after the ingestion of cocaine.
Opioid analgesics should be avoided in patients recovering from substance abuse.
Vasoconstrictors should not be used in patients who are actively using cocaine.

APPLYING THE DENTAL HYGIENE


PROCESS OF CARE
Assessment- Collection and analysis of systemic and oral health data.
Dental Hygiene Diagnosis- Identification of a patients health, behaviors, attitudes, and oral
health care needs.
Planning- The establishment of realistic goals and the selection of dental hygiene interventions
that can move the patient closer to optimal oral health.
Implementation- The act of carrying out the dental hygiene care plan.
Evaluation- The measurement of the extent to which the patient has achieved the goals.
Documentation- Documentation to maintain continuity of care, provide communication, and
minimize the risk of exposure to malpractice claims

CLINICAL
EXAMINATION
EXTRAORAL
Vital Signs- Increase in blood pressure, cardiac arrhythmias, and increase in body temperature
Personal Appearance- Lack of interest in proper dress and personal hygiene, small blood stains on
clothes from previous injections, dramatic weight loss.
Eyes- Wears sunglasses to conceal dilated or constricted pupils and eye redness, or to avoid bright
light due to eye sensitivity.
Nose- Perforated nasal septum
Lips- Angular cheilitis
Arms- Needle marks may be noted when determining blood pressure. Patient may wear long sleeves
TMJ- Limitations or deviations of movement, limitation of opening, tenderness, sensitivity, noises,
discomfort, TMD

CLINICAL EXAMINATION
INTRAORAL
Mucosa, Lips, and Tongue- Xerostomia, soft tissue abnormalities, glossodynia, halitosis
Gingiva- Poor oral hygiene, heavy biofilm, generalized calculus deposits, moderate to
severe gingival inflammation, spontaneous bleeding or bleeding on probing, gingival
lesions, periodontal disease
Palate- Perforation of palate due to chronic cocaine snorting.
Teeth- Chipped and fractured from falls and injuries, abrasion, attrition, erosion, occlusal
wear, corrosion of gold restorations
Dental Caries- Diet high in cariogenic substances, root caries, rampant carious lesions,
tooth loss, increased risk factors: poor diet, lack of dental care, accumulation of biofilm, and
xerostomia.
Oral Manifestations- Saddlenose deformity, rapid gingival recession, mucosal
ulcerations, trismus, excessive hemorrhage after tooth extraction

SIGNS OF COCAINE USE

Perforated Septum
Rampant Caries

Attrition

Cleft Palate
Saddlenose

Angular Cheilitis

TREATING THE SYMPTOMS OF


COCAINE USE
Monitor vitals
Non-alcoholic mouth rinses and saliva substitutes
Fluoride treatments
Make necessary referrals to other healthcare providers
Chart attrition and suspicious areas for further evaluation by the dentist
Implement patient education

TREATMENT
SUMMARY
Review and confirm the dental hygiene care plan with the patient
Modify as necessary and obtain consent
Implement the plan
Monitor patient comfort
Provide post-treatment instruction
Implement self-care intervention
Confirm the plan for continuing care or maintenance
Maintain patient privacy and confidentiality
Follow up with the patient as necessary

FACTORS TO TEACH THE


PATIENT

Explain the risks of drug abuse


Routine oral cancer screenings and
regular dental exams
Setting goals to help the patient with
drug abuse and oral care
Proper home care

HOW TO GET
HELP

www.drugabuse.gov
www.samhsa.gov
1-800-662HELP (4357)

REFERENCES
Bassiouny, Mohamed. (2013). Dental Erosion Due to Abuse of Illicit Drugs and Acidic Carbonated Beverages. General Dentistry, 61(2),
38-44.
Cocaine Abuse & Addiction Signs, Effects & Symptoms. (n.d.). Retrieved August 02, 2016, from
http://www.acadianaaddiction.com/addiction/cocaine/symptoms-signs -effects#Signs-and-Symptoms

Hamilton, J. S., M.D. (2014). What Effect Does Cocaine Have on the Nose? Retrieved August 03, 2016, from http://www.ohniww.org/cocaine-nose-collapse-treatment/
Hofstede, Theresa M. & Jacob, Rhonda F. (2010). Diagnostic Considerations and Prosthetic Rehabilitation of a Cocaine-induced Midline
Destructive Lesion: A Clinical Report. The Journal of Prosthetic Dentistry, 103(1), 1-5. doi:10.1016/S0022-3913(09)00153-X
How does cocaine produce its effects? (n.d.). Retrieved August 02, 2016, from
https://www.drugabuse.gov/publications/research-reports/cocaine/how-does-cocaine -produce-its-effects
Maloney, William, J. (2010). The Significance of Cocaine Use to Dental Practice. New York State Dental Journal, 76(6), 36-39.
Shekarchizadeh, Hajar, Khami, Mohammad R., Mohebbi, Simon Z., Ekhtiari, Hamed, & Virtanen, Jorma I. (2013). Oral Health of Drug
Abusers: A Review of Health Effects and Care. Iranian Journal of Public Health, 42(9), 929-940.
Standards for Clinical Dental Hygiene Practice - adha.org. (n.d.). Retrieved August 2, 2016, from
https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental -Hygiene-Practice.pdf
Wilkins, E. M. (2009). Clinical practice of the dental hygienist (11th ed.). Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.