Abstract
Substance abuse is an issue that has been widely recognised both in the medical and dental professions. Many different recreational drugs exist and their use can have important consequences in relation to conscious sedation. As the use of illicit drugs is growing, it is important to have an understanding of the impact of substance abuse on determining if a patient is a suitable candidate for conscious sedation. It is important to appreciate that while human studies in this area are limited, animal studies and observation of the reactions of substance abusers to sedative agents demonstrate a potential link between illicit drug use and conscious sedation through drug interaction. This paper aims to discuss the importance of understanding substance abuse, the potential effects such substances can have in relation to conscious sedation and appropriate management techniques for substance abusers in order to provide optimum safe care when undergoing conscious sedation techniques.
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References
Farnfield G. Conscious sedation. In The Provision of Dental Care Report of an Expert Group on Sedation for Dentistry. Commissioned by the Department of Health 2003. Available online at https://www.rqia.org.uk/RQIA/files/bc/bcb0650d-8660-4d5f-940f-ea3b60ecf5f6.pdf (accessed 7 November 2019).
Conscious Sedation in Dentistry Dental Clinical Guidance. 2017. Available online at http://www.sdcep.org.uk/wp-content/uploads/2018/07/SDCEP-Conscious-Sedation-Guidance.pdf (accessed 7 November 2019).
Haridas R P. Horace Wells' demonstration of nitrous oxide in boston. Anaesthesiology 2013; 119: 1014-1022.
Hayden J. The Jorgensen Philosophy of Intravenous Sedation. Available online at http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2516413&blobtype=pdf (accessed 9 February 2019).
NHS Digital. Adult Dental Health Survey. Available online at http://content.digital.nhs.uk/article/3894/Adult-DentalHealth-Survey (accessed 14 January 2019).
Yoshida H, Ayuse T, Ishizaka S, Ishitobi S, Nogami T, Oi K. Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med 2007; 212: 373-378.
Conscious sedation. Available online at http://www.baos.org.uk/resources/BDAGuidanceconscious_sedation_-_nov_11.pdf (accessed 12 January 2018).
Mennini T, Caccia S, Garattini S. Mechanism of action of anxiolytic drugs. In Progress in drug research/Fortschritte der arzneimittelforschung/Progrès des recherches pharmaceutiques. pp 315-347. Basel: Birkhäuser Basel, 1987.
Klockgether-Radke A P, Pawlowski P, Neumann P, Hellige G. Mechanisms involved in the relaxing effect of midazolam on coronary arteries. Eur J Anaesthesiol 2018; 22: 135-139.
Nadin G, Coulthard P. Memory and midazolam conscious sedation. Br Dent J 1997; 183: 399-407.
World Health Organisation. Substance abuse. WHO 2017. Available online at http://www.who.int/topics/substance_abuse/en/ (accessed 24 January 2018).
Recreational drug definition and meaning. Collins English Dictionary. Available online at https://www.collinsdictionary.com/dictionary/english/recreational-drug (accessed 14 January 2019).
Statistics on Drugs Misuse: England, 2017 - NHS Digital. 2017. Available online at http://digital.nhs.uk/catalogue/PUB23442 (accessed 12 January 2019).
Ho. 2017 Drug Strategy. Available online at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/628148/Drug_strategy_2017.PDF (accessed 12 January 2019).
World Drug Report 2016. Available online at http://www.unodc.org/wdr2016/ (accessed 9 March 2019).
Versteeg P, Slot D, Van Der Velden U et al. Effect of cannabis usage on the oral environment: a review. Int J Dent Hyg 2008; 6: 315-320.
Joshi S, Ashley M. Cannabis: A joint problem for patients and the dental profession. Br Dent J 2016; 220: 597-601.
Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales Second edition. 2015. Available online at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/462885/drug-misuse-1415.pdf (accessed 12 Jan 2019).
Choices N. Alcohol units - Live Well - NHS Choices. Available online at https://www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx (accessed 12 January 2019).
NHS Digital (Great Britain). Statistics on alcohol: England, 2017. Available online at https://www.gov.uk/government/statistics/statistics-on-alcohol-england-2017 (accessed 12 January 2018).
Cruz-Pamplona M, Margaix-Muñoz M, Sarrión-Pérez M G. Dental considerations in patients with liver disease. J Clin Exp Dent 2011; 3: 127-134.
FRANK. Honest information about drugs. Available online at https://www.talktofrank.com/ (accessed 8 July 2019).
Patel R, Clayton S, Quintero E, Gill J. Chronic opioid users are more difficult to sedate than alcoholics and controls. South Med J 2015; 108: 744-747.
Coulthard P. The indicator of sedation need (IOSN). Dent Update; 40: 466-468, 470-471.
Greenwood M, Meechan J G. General medicine and surgery for dental practitioners Part 5: Liver disease. Br Dent J 2003; 195: 71-73.
Lu D P, Lu G P, Hersh E V. Augmenting sedation with hypnosis in drug-dependent patients. Anesth Prog 1995; 42: 139-143.
Flisberg P, Paech M, Shah T, Ledowski T, Kurowski I, Parsons R. Induction dose of propofol in patients using cannabis. Eur J Anaesthesiol 2009; 26: 192-195.
Hernandez M, Birnbach D J, Van Zundert AA, to Professor AAJ van Zundert C. Anaesthetic management of the illicitsubstanceusing patient. Curr Opin Anaesthesiol Curr Opin Anaesthesiol 2005; 18. Available online at https://pdfs.semanticscholar.org/8e60/770e0556ac3d2bd385823127a7d80b99346b.pdf (accessed 7 November 2019).
Ashton C H. Adverse effects of cannabis and cannabinoids. Br J Anaesth 1999; 83: 637-649.
Kuczkowski K. Marijuana in pregnancy. Available online at https://pdfs.semanticscholar.org/cb57/83436af1ba9bb9514cb3ae19368d6ced3991.pdf (accessed 17 January 2019).
Dickerson S J, Flint B. Cannabis and its effect on anaesthesia. Available online at https://pdfs.semanticscholar.org/da3e/6bf11bccca7530c9a1d88f3a932627d4938c.pdf (accessed 26 June 2019).
Public Health Profiles. Liver disease. Available online at https://fingertips.phe.org.uk/profile/liver-disease/data#page/0/gid/8000063/pat/6/par/E12000004/ati/102/are/E06000015/iid/90861/age/163/sex/4 (accessed 17 January 2019).
Grotenhermen F. Die Wirkungen von Cannabis und THC. Complement Med Res 1999; 6: 7-11.
Milosevic A, Agrawal N, Redfearn P, Mair L. The occurrence of toothwear in users of Ecstasy (3,4-methylenedioxymethamphetamine). Community Dent Oral Epidemiol 1999; 27: 283-287.
Chapple I L C, Mealey B L, Van Dyke T E et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; 45: S68-S77.
Nozad-Mojaver Y, Mirzaee M, Jafarzadeh A. Synergistic effects of cigarette smoke and saliva. Med Oral Patol Oral Cir Bucal 2009; 14: E217-E221. Available online at http://www.medicinaoral.com/medoralfree01/v14i5/medoralv14i5p217.pdf (accessed 28 May 2019).
Robinson P G, Acquah S, Gibson B. Drug users: oral health-related attitudes and behaviours. Br Dent J 2005; 198: 219-224.
Bullock K. Dental care of patients with substance abuse. Dent Clin North Am 1999; 43: 513-526.
Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: time for a sense of proportion? Br Dent J 2012; 213: 271-274. DOI: 10.1038/sj.bdj.2012.830.
Appukuttan D P. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016; 8: 35.
Atzori B, Lauro Grotto R, Giugni A, Calabrò M, Alhalabi W, Hoffman H G. Virtual reality analgesia for paediatric dental patients. Front Psychol 2018; 9: 2265.
Pickrell J E, Heima M, Weinstein P et al. Using memory restructuring strategy to enhance dental behaviour. Int J Paediatr Dent 2007; 17: 439-448.
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Hasan, A., Sharma, V. Substance abuse and conscious sedation: theoretical and practical considerations. Br Dent J 227, 923–927 (2019). https://doi.org/10.1038/s41415-019-0897-z
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DOI: https://doi.org/10.1038/s41415-019-0897-z
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