Drug Abuse in Dentistry

Co-Editor-in-Chief, Judy J. Johnson, DDS
Wednesday, June 17, 2009 – 07:01 PM
General Dentists:

Drug Abuse in Dentistry
Drug abuse is one of the most serious problems in the U.S. Because dentists can prescribe medications for their patients, addictive painkillers included, the dental field is a player in the role for stopping drug abuse.

Dentists prescribe narcotics for various reasons, such as post-extraction pain, cavity pain, and after any type of oral surgery. Sometimes patients abuse these medications and conjure up fake symptoms in order to obtain them. On the other hand, dentists are exposed to these painkillers and can prescribe such medications for themselves. This puts dentists along with their patients at risk for drug abuse.

Preventing Drug Abuse

Patients
Careful surveillance is the number one way to reduce prescription drug abuse. Patients will come in to the dentist repeatedly with excruciating mouth pain. If no evidence for it is discovered, this patient could be seeking painkillers and abusing them.

If a patient has been prescribed painkillers on several occasions in a short span of time, then the case should be reviewed to see if these prescriptions have been necessary. If a dentist thinks that a patient is seeking to abuse prescription drugs, then he or she should not give the patient another prescription.

With so much stress in today’s society, terrorism, natural disasters and economic insecurity, many have turned to drugs for comfort. Most do not want to buy them off the street, so they seek it legally in the form of prescriptions. Dentists must be able to recognize these types of patients and refer them to services for help.

Dentists can be educated through training or accessible information on recognizing drug abuse. This includes learning the definition of “substance abuse and dependency, prevention concepts, rationale for substance abuse screening, dental team alerts, clinical interview skills, awareness of medical and legal implications, and the referral process.” By knowing and understanding these important aspects of recognizing and preventing drug abuse, these patients will not undergo unnecessary procedures and will have better quality dental care, and the dentist may help them get onto the path to recovery.

By observing the behavior history of a patient, dental staff may recognize a potential problem and refer the patient to a recovery program. The first staff member who usually addresses a patient is the receptionist. By knowing the following signs, he or she may be able to tell whether a patient has a problem with drug abuse. Here are a few signs that give warning to a patient who abuses prescription drugs:
1. Poor general appearance
2. History of broken appointments
3. Dramatic unexpected complaints
4. Repeated requests for unusual prescriptions
5. Appearing at closing time looking for a prescription for oral pain and promising a next day appointment

Dentists
If a dentist is the one abusing drugs, or suspected of doing so, then the staff needs to step in and demand he or she check into a rehabilitation center. It’s important that the dentist want to seek treatment voluntarily. If not, then the staff must be severe and report the dentist. If abuse is taking place during office hours, the dentist could be risking a patient’s well-being or life by misdiagnosing.

Dentists are trusted to perform the privileged act of practicing medicine. When that trust is violated by drug use, the dentist is no longer deemed responsible enough to practice medicine and treat patients. By going untreated, a dentist is risking the practice itself, a patient’s life, and his or her own.

Methamphetamine Use (Meth Mouth)
A new epidemic in drug abuse is methamphetamine (meth) use. Many dentists have seen an increasing number of these cases. Meth users’ teeth are clear evidence that they abuse this drug. Meth use significantly decays teeth.

The teeth of a user are “blackened, stained, rotting, crumbling or falling apart” and usually cannot be saved and must be extracted. Meth is very acidic and dries out the tissues in the mouth. It also destroys the natural ability to chew. The “Meth Mouth Prevention and Community Recovery Act” sponsored by U.S. Representatives Rick Larsen (D-Wash.), John Sullivan (R-Okla.), Brian Baird (D-Wash.), and Mike Ross (D-Ark.) includes funding for dentists and educations to inform children about the dangers of meth. For the referenced resourced information, go to http://www.smilemd.com/general-dentist/drug-abuse-and-dentistry.aspx