Consumption of addictive substances is more widespread than is often assumed: According to the Federal Ministry of Health, 12 million people smoke, 1.6 million people are addicted to alcohol and about 2.3 million people are addicted to drugs – and that in Germany alone. About 600,000 people also have a problem with the consumption of cannabis and other illegal drugs.1 But everyday stimulants like coffee or soda also affect the teeth. Practice teams should therefore have relevant knowledge about the consequences of consumption, possible interactions and how to deal with these particular patients.
# 1: Intoxicants
Heroin and methadone are opioids, the latter being prescribed therapeutically, among other things, as painkillers for rehabilitation after injuries or operations. Because of their sometimes euphoric effect, they have also has some potential for addiction and can be abused by drug use will.2 Orally administered methadone has high sugar levels that can cause widespread cavities in the teeth. Heroin, on the other hand, like amphetamines and ecstasy, can cause thrombocytopenia – with possible consequences for hemostasis.3
Due to the high consumption of methamphetamine (“crystal meth”), the so-called meth mouth is known in everyday speech.4 A meth mouth describes the combination of several symptoms that can occur in the same way with cocaine abuse:5, 6
- widespread caries
- gingivitis and periodontitis
- bruxism and
LSD (lysergic acid diethylamide) is a hallucinogenic substance that can increase the incidence of bruxism and has been linked to TMJ dysfunction. Dentists should also be aware that stressful situations can trigger panic attacks in these patients.3
Even with regular use of cocaine is an increased risk of ischamie and an increased incidence of caries.3 In addition to LSD and cannabis, cocaine also has a sympathomimetic effect and may potentiate the systemic effects of adrenaline in local dental anesthetics.8 For this reason, adrenaline supplementation should be reduced in these patients.3 Since these are illegal drugs, these are Wecheffects in specialist information such as eg with ultracain® DS 1: 200,000 not listed. For example, cocaine primarily inhibits norepinephrine, but also adrenaline breakdown.9 This can lead to life-threatening highlightspressure crises are coming. It should also be noted that in these patients it is often difficult to achieve adequate anesthesia depth.10
Misuse of solvents has also made headlines in recent years. This increases the risk of seizures. A reduction in the dose of adrenaline-containing local anesthetics is recommended for these patients because solvents may sensitize the myocardium to catecholamines.3 There may be contraindications to adrenaline in patients with underlying cardiovascular disease. Dentists can use local anesthesia without a vasoconstrictor, e.g. B. Ultracaine® D without adrenaline.11 The systemic effect of adrenaline can also be increased with anabolic steroids and blood coagulation can also be disrupted. The consumption of performance-enhancing drugs should therefore be questioned.3
# 2: Alcohol
Numerous studies have already shown that excessive alcoholConsumption is associated with an increased risk of periodontitis. alcoholics Compared to healthy people, patients show poor oral hygiene. In combination with smoking, the overall oral health significantly deteriorates compared to non-smokers.13 From a dental point of view, therefore, all alcoholic patients should be encouraged to optimize basic oral hygiene and access be promoted to professional dental care, to reduce diseases of the oral cavity.13
When should the training team pay attention? An alcohol misscustom should then be suspected if it after Alsmells kohl or has a tremor due to withdrawalcould be delivered.3 It should also be noted the time of day because people with alcohol dependence often start at an early age drink in the morning to overcome any withdrawal symptoms that may occur. For example, the CAGE questionnaire is a simple and useful screening tool for detection (≥ 2 yes answers: high probability of an existing drinking problem).3, 14
# 3: Tobacco
Cigarettes harm the body in many ways. Tobacco causes discoloration of teeth and bad breath and increases the risk of cavities and tumors in the mouth and throat (such as squamous cell carcinoma).15 The toxic components of cigarette smoke accumulate in the saliva and are a permanent danger to teeth and gums. For example, nicotine causes vasoconstriction. The gums and the entire mucous membrane are less supplied with blood. As a result, the gums of smokers often appear pale and gray.16 Wound healing is often delayed in smokers. Depending on the number of cigarettes smoked per day, the risk of developing periodontitis increases by about ten percent.16, 17 Studies show a higher severity and faster progression of periodontitis in smokers. They lose more teeth and respond less well to periodontal treatment than non-smokers.18 However, evidence has shown that some of the harmful effects of smoking on periodontal tissue are reversible. It is therefore important to advise smokers to quit smoking as a matter of urgency.18
In recent years, more and more of one has also come Trend away from cigarettes towards e-cigarettes (vaporizers). AkStudies show that compared to conventional cigarettes, e-cigarettes can be thought to have a less harmful effect on the oral mucosa – but it is still a risk.19
# 4: Caffeine and sugary stimulants
Teeth are especially attacked by drinks with a high sugar and acid content – especially if they are ingested again and again. The consequences may include increased caries, especially approximate caries, as well as erosive damage to the hard tooth structure.20 Tooth erosion in particular is a growing problem, especially in industrialized countries.21, 22 But not only soft drinks and energy drinks are a challenge for the teeth, but also coffee. The frequent consumption of coffee, but also of tea, red wine and other luxury foods and foods, leaves color particles on the tooth surface. Some of it penetrates into the enamel over time. The result is brownish-yellow discolored teeth. To counteract such external tooth discoloration, which is usually only an aesthetic problem, the prophylaxis team should recommend regular professional tooth cleaning.
Dentists should also pay attention to the recommendation that patients should avoid coffee on the day of surgery. This serves to avoid secondary bleeding, which may be caused by the stimulating effect of caffeine on the cardiovascular system (including hypertension, tachycardia) and vasodilation.23 Anesthesia failure or premature loss of anesthesia may also be due to an increased amount of caffeine in the blood.24
Long-term side effects of coffee on the orofacial system have been and are repeatedly raised, but often lack an accurate scientific basis. With a statistically average consumption, no increased bruxism, no iatrogenically induced gingivitis and periodontitis could be observed, but also no positive antibacterial effects. In terms of bone metabolism, various studies have indicated possibleSignificant adverse effects on cell activity and mineralization.23
Interested parties can find out more about special patients at: www.dental.sanofi.de/besondere-patients
Author: Isabel Becker
The article was published in ZWP Dental Economics Practice.
The corresponding bibliography can be downloaded here.