Table 3.35.
Key considerations for dental management in cocaine abuse (see text)
Management modifications* | Comments/possible complications | |
---|---|---|
Risk assessment | 2 | Drug abusers recognition; abnormal behaviour; blood-borne infections; others (cardiac lesions, drug interactions, etc); appropriate analgesia; consent issues; escort |
Pain and anxiety control | ||
– Local anaesthesia | 2 | Avoid ester type and epinephrine |
– Conscious sedation | 3/4 | Avoid opioids |
– General anaesthesia | 3/4 | Avoid halothane, ketamine, suxamethonium, barbiturates and opioids; resistance to GA; hyperthermia |
Patient access and positioning | ||
– Access to dental office | 0 | |
– Timing of treatment | 1 | 6h after cocaine use; failed appointments |
– Patient positioning | 0 | |
Treatment modification | ||
– Oral surgery | 1 | |
– Implantology | 1/5 | Neglected oral hygiene; periodontitis; xerostomia; heavy smokers |
– Conservative/Endodontics | 1 | |
– Fixed prosthetics | 1/5 | Neglected oral hygiene; heavy smokers |
– Removable prosthetics | 1 | |
– Non-surgical periodontology | 1 | |
– Surgical periodontology | 1/5 | Neglected oral hygiene; heavy smokers |
Hazardous and contraindicated drugs | 1 | Avoid opioids |
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.