SUBSTANCE

RELATED
DISORDERS
Lauren Morris
Emily Hunt
Whitney Rhodes

ALCOHOL ABUSE/
ALCOHOLISM
Alcoholism is a chronic

progressive behavioral disorder

characterized by a strong urge to
consume ethanol and the
inability to limit the amount
despite adverse consequences

Etiology: genetics,

biopsychosocial, and
environmental

Occurs in a large percentage of

the population and fluctuates

from social drinking to alcoholism

Characteristics:
Intra oral
Extra oral
Xerostomia
breath/ body odor of tobacco &
Glossitis
alcohol
Poor OH
tremor of hands, tongue, & eyelids
Chipped/ fractured teeth red skin
Attrition
jaundice of face
Erosion
eyes- red and puffy
Increased caries
angular cheilites
swollen parotid gland

TREATMENT & MEDICATIONS

Treatment:

-combination of medical and psychiatric

therapy
-to help the person achieve and maintain total
abstinence
-AA programs
Medications used:

-alcohol-sensitizing agents (Disulfiram)

-anti-craving agents (Naltrexone)
-amethystic agents

 Dental Hygiene Considerations:

-Consult doctor to determine if a

prophylactic is needed
-Avoid alcohol containing mouth rinses
and oral hygiene products

Contraindications
-local anesthetics with
vasoconstrictors (such as
epinephrine)
-nitrous oxide

-Impaired wound healing

-Increased susceptibility to infection
-use anesthetics without
vasoconstrictors
-use ultrasonic and air polishers with
caution to prevent inhalation of
microorganisms, high powered suction is
vital

Recall:
-Evaluate to determine how
frequent the patient should
come for maintenance
appointments

RECREATIONAL DRUGS
Recreational drug use is very common

around the world and it frequently leads to

disaster and crime
The 3 most popular recreational drugs are:
1. Marijuana (most common)
2. Heroin
3. Cocaine

MARIJUANA
Also called Cannabis, Grass, Hemp, Weed, Pot,

Hash, or Dope

When ingested or smoked, the effects are a

slightly drunken but euphoric sensation. It can

be mild or strong according to the method of
delivery and the strength and quantity of dose.

DH considerations and Treatment:

If your patient is smoking
marijuana, bring to their
New studies show significant associations
attention the dangers associated
between marijuana smoking and a variety of
with it:
respiratory diseases
Immediate effects are traffic
Smokers of marijuana are subject to:
accidents, difficulty thinking
Coughing and phlegm production on most days
and problem solving,
Wheezing and other chest sounds
impairment of memory and
Acute and chronic bronchitis
learning
Injury to airway tissue, including edema,
Chronic marijuana use is
increased vascularity, and increased mucus
correlated with greater
secretion
incidence of psychosis and
Impaired function of immune system
schizophrenia
components
Treatment is marijuana smoking

HEROIN

DH considerations and Treatment:

Morphine because it was thought to be less
The patient should know that heroin
addictive.
use leads to destruction of the brains
white matter, affecting the patients
Users experience exhilaration, euphoria and a sense
of well-being.
decisions and behaviors
Inform the patient that prolonged use
Can be smoked, sniffed, or injected
of heroin will lead to dependency and
After an intravenous injection of heroin, users report
the perceived need for more and
xerostomia, a warm flushing of the skin, heaviness
more of the drug at each use.
of the extremities, and clouded mental functioning
A range of treatments including
Heroin overdoses frequently involve suppression of
behavioral therapies and medications
breathing, which can cause hypoxia (not enough
are effective at helping patients stop
oxygen reaching the brain). This can result in a
coma and permanent brain damage.
using heroin and return to stable and
productive lives.

This drug was first used as an alternative to

COCAINE
This drug has been used in one form or another

for over a thousand years

It is a powerful stimulant, appetite suppressant

and anesthetic

It has been generally known as a rich mans

drug, although a modified version called Crack

Cocaine has brought its usage down to street
level

It produces short-term euphoria, energy, and

talkativeness in addition to dangerous effects

like raised heart rate and blood pressure

The powdered form is either snorted or injected

into the bloodstream, while the Crack form can

be smoked

People who use cocaine often take the drug

repeatedly within a short period of time, at

increasingly higher doses.

DH considerations and Treatment:

Inform the patient that repeated
cocaine use can lead to addiction and
uncontrollable drug-seeking, which
can significantly alter their life in a
negative way.
It can cause headaches, GI
complications, malnourishment,
irritability, restlessness, anxiety,
paranoia
Regular snorting of cocaine leads to
loss of sense of smell, nosebleeds,
problems swallowing, hoarseness,
and a chronically runny nose.
Most seriously, these people can
suffer heart attacks or strokes, which
may cause sudden death.
Depending on the person, treatment
options include pharmaceutical
approaches and behavioral
interventions

TOBACCO
21% of adult Americans smoke
Offspring more likely to smoke
90% of lung cancer deaths in

women attributed to smoking

Smokeless Tobacco:
Nicotine directly absorbed
through gingiva and
mucous membranes
3-4 times the amount of
nicotine absorbed than
that of a cigarette
Concentration declines
over 2 hours and is
insignificant within 24
hours

TOBACCO USE & DISEASE

CONSEQUENCES
Cancer
Respiratory Disease
Cardiovascular Diseases
Pregnancy/Infant Health
Other

ORAL EFFECTS OF TOBACCO

USE
Periodontal destruction
Bone loss, attachment loss, and

pocket depths

Pocketing greater and gingival

recession in anterior

Gingival blood flow and crevicular

fluid diminished

Increased tooth loss

Increased prevalence
Prevalence and
severity lessen with
cessation

TREATMENT
Self-help interventions
Counseling
Nicotine replacement therapy
Nicotine gum
Patch
Nasal spray
Pharmacotherapies
Welbutrin SR
Zyban
Chantix

CLINICAL TREATMENT PROCEDURES

WITH TOBACCO USER
Halitosis, yellow-brown nails, facial

wrinkling, precancerous lesions

Precaution with ultrasonic as many

tobacco users have pulmonary and

cardiovascular disease

Nutrition education
Longer, more frequent appointments
Nonalcoholic mouth rinses

1.) Which of the following is contraindicated for a recovering

alcoholic?
A. Air polisher
B. Local anesthesia without epinephrine
C. Ultrasonic
D. Nitrous oxide

2.) Regular smoking of marijuana can lead to loss of sense of

smell,
nose bleeds, problems swallowing, hoarseness, and a
chronically runny nose. When marijuana is ingested or
smoked,
the effects are a slightly drunken but euphoric
sensation.
A. Both statements are true
B. Both statements are false
C. The first statement is false, the second statement is true
D. The first statement is true, the second statement is false

3.) There is an association between smoking and which

of the following:
A. COPD
B. cancer
C. fetal death
D. all of the above

ANSWERS
1.) D
2.) C
3.) D

REFERENCES
Wilkins, E., & Wyche, C. (2013). Clinical practice of the dental hygienist (11th

ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

National Institute on Drug Abuse. Marijuana Smoking Is Associated With a

Spectrum Of Respiratory Disorders Retrieved from

http://www.drugabuse.gov/news-events/nida-notes/2006/10/marijuanasmoking-associated-spectrum-respiratory-disorders on November 30, 2015

National Institute on Drug Abuse. Heroin Retrieved from

http://www.drugabuse.gov/publications/drugfacts/heroin on November 30,

2015

National Institute on Drug Abuse. Cocaine Retrieved from

http://www.drugabuse.gov/publications/drugfacts/cocaine on November 30,

2015