An Introduction to Substance Use Disorders for Dental Professionals

This course will review the various signs, symptoms and other aspects that substance use disorders can have on our patients. We will limit our scope to the effects on the oral cavity and we will cover more commonly abused substances. Information will be provided for the clinician to make distinctions, begin safe dialogues, document patient comments and oral findings, and provide resources and follow-up support to patients with substance use disorders.

Drug abuse remains a significant epidemic in present day society. According to the 2019 National Survey on Drug Use and Health, 7.7% (19.3 million) of the United States population use illegal drugs. As contemporary dental professionals, it is important that we are educated on the current effects of commonly used and abused drugs or medications including alcohol and nicotine.

There are several reasons why today’s dental clinician needs to be observant when treating patients who may be using drugs, alcohol and/or nicotine. Medical emergencies during dental treatments spurred by health or drug interactions would be cause for concern. Long-term health of the oral cavity is another, but perhaps the most important consideration would be the quality of life and health that could be restored after abuse or addiction.

Focused chairside observation is essential considering that 50% of patients will reveal less about their lifestyles than they should. Unsubstantiated observations should not cause the clinician to assume the patient has a substance use disorder. Instead, careful questioning of the patient may reveal a substance use disorder. At the end of each section, we will review various approaches and acceptable means of guidance that a dental professional might employ with a patient regarding that particular substance. While this course is intended to encourage observation and detection of the signs and symptoms of various substance use disorders, sensitivity for the patient’s right to privacy should be respected. Providing gentle educational explanations about a particular oral condition and posing either straightforward or benign questions to the patient about how or why a particular condition might be arising is the best professional action. If dental professionals develop a dialog that promotes trust, we ensure the patient feels safe in our care. Approximately 50% of general dentists provide their patients with nicotine cessation information, but fewer provide information about alcohol or other substances. It is important for the dental professional to have broad-based knowledge regarding substance use disorders because a patient suspected of this disorder can be a challenge. Clinically, it is important to avoid drug treatment interactions or behavioral outbursts in the dental office and further support the patient as they attempt to become drug-free. Many times, the dental office can serve as a safe and non-threatening source of cessation assistance. Creating referral protocols may help our patients find appropriate professional treatment.

Most scientists consider addiction to be a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.¹ There are implications for oral health professionals in identifying and managing the patient who is abusing substances. Management issues relevant to delivery of oral care include:

1. Identifying potential drug interactions, during oral care, with substances used.
2. Offering drug abuse cessation information.
3. Dealing with the erratic behavior of a patient who arrives at the oral care appointment while under the influence of drugs or alcohol.¹⁹