Table 3.71.

Key considerations for dental management in heroin or opioid 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 dental care	2	Control behaviour; appropriate analgesia; universal cross-infection barriers; possibly bacterial endocarditis prophylaxis; select drugs
Pain and anxiety control
– Local anaesthesia	2	Poor pain control
– Conscious sedation	3/4	Avoid opioids
– General anaesthesia	3/4	Avoid halothane, ketamine, suxamethonium, barbiturates and opioids; resistance to GA
Patient access and positioning
– Access to dental office	0
– Timing of treatment	1	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.