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11/5/2018 |
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Drug Addiction: The Importance Of Patient Disclosure Before Dental Treatment |
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Drug Addiction: The Importance Of Patient Disclosure Before Dental Treatment
by Katie Melko, RDH, MSDH
Working for a Federal Qualified Health Center (FQHC) is rewarding, yet the variety of patients I serve can sometimes be overwhelming and stressful. Patients I see regularly range from drug and alcohol addicts, special needs, juvenile delinquents, patients who are starting over after being in prison, AIDS/HIV, and more. Each patient is unique and has a set of health issues, medications, or past, which makes their appointments challenging. Fear of being judged, mistreated, or feeling anxiety-ridden, also creates a different element in the dental operatory.
My outlook on patients is they’re in my chair to receive treatment and education, and I do this to the best of my ability. However, certain issues need to be taken into account before I can treat a patient. Some of those issues include patients arriving under the influence and intoxicated. I’m going to recount two cases; including the way the situations were handled and their outcome, in hopes you can gain some insight.
In my experience, the most common drugs patients take before a dental appointment are cocaine, marijuana, opioids, and alcohol. Some of these can have a potential interaction when administering local anesthesia.
Potential Drug Interactions when administering local anesthesia: - Nonselective beta-blockers and vasoconstrictors (Wilkens)
- Tricyclic antidepressants
- Phenothiazine
- Cocaine
- Cimetidine and lidocaine
- Ecstasy
- Methamphetamines
Case One
The patient was a 25-year-old male whose last visit dental visit was approximately 4-5 years ago due to lack of insurance. The patient presented for non-surgical periodontal therapy/SRP after an initial exam and FMX. Pocket depths were generalized 4-6mm with generalized, heavy bleeding. Medical history was reviewed and showed previous chemical dependency. An explanation of treatment was given allowing the patient to ask any questions about the procedure. Local anesthesia was required for treatment.
Read full article on Today's RDH.
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