Hazards of Cocaine Misuse PDF

UPFRONT Human factors clearer guidance on and provision of PPE. Cocaine is one of the most commonly As a Faculty, we are committed to working used narcotics and is a...

UPFRONT Human factors clearer guidance on and provision of PPE. Cocaine is one of the most commonly As a Faculty, we are committed to working used narcotics and is a central nervous A wealth of accessible information with the rest of the sector to ensure the best stimulant resulting in a short term increase Sir, I was pleased to see the launch of Human possible outcomes for dentists and patients, in dopamine release.1,2 Well known for Factors and Patient Safety in Dentistry and I’d like to make it clear that everyone in its uses of anaesthetic and pain relief its publicised in the BDJ (2020; 229: 11). Prior dentistry is welcome to join. chemical structure has been altered to to my retirement in December 2019 I was P. Taylor, Dean Elect, Royal College of Surgeons produce commonly used preparations such Vice Chair of the Board which developed of Edinburgh, Edinburgh, UK as lidocaine, one of the most frequently used this resource. Written ‘by dental team https://doi.org/10.1038/s41415-020-2241-z topical and injectable local anaesthetics. members for dental teams’ it contains a There are three common routes of cocaine wealth of accessible information. Teams may Oral health administration: intravenous, insufflation and find it helpful to identify a lead member to smoke inhalation.3 Prolonged misuse of cocaine promote use of the resource and to ensure Hazards of cocaine misuse can lead to a myriad of complications which the principles are embedded in the team’s Sir, you published a highly insightful article can vary based on the route of administration. systems and processes. The resource can be Cocaine and oral health in 2008 (BDJ 2008; Nasal septal perforation is an uncommon accessed at www.humanfactors.dental and 204: 365–369). We detail a case of this unusual presentation and is more commonly associated can additionally contribute to individual presentation here with a brief literature with trauma and previous septal surgery.4 development and understanding. review. A 48-year-old female presented with Upon presentation of ulcerative lesions of the L. Howells, Caerbryn, Wales both nasal septal and hard palate perforation face, differential diagnoses must be considered https://doi.org/10.1038/s41415-020-2240-0 secondary to cocaine misuse (Fig. 1). Her including trauma, infection and neoplastic history consisted of nasal congestion and disease. Ulceration secondary to substance Royal Colleges obstruction which had deteriorated. She misuse is an uncommon occurrence but sadly also developed facial pain, foul odour and the trend is on the rise. Orofacial lesions and Not entirely accurate sensation of food debris and fluids in her nasal destructive midline perforation is not exclusive Sir, I am writing in response to the recent cavity. Clinical examination demonstrated to abusers of cocaine and physicians who are interview with Dr Shelagh Farrell (BDJ 2020; an obvious saddle nose deformity due to involved in the diagnosis and treatment of 229: 164) which includes the claim there is no loss of nasal structural support. Intra-oral these lesions should be aware that a number of royal college for dentists. I too hold the MGDS examination revealed partial anterior hard agents and pathophysiological causes can be qualification and was also part of the Advisory palate destruction leading to an oro-nasal associated with this appearance. Committee for the inception of the FGDP, and fistula. On further questioning the patient H. Chaudhry, J. Stansfield, A. Camilleri, indeed continue to support its evolution to a admitted to a ten-year history of daily nasal Manchester, UK College. However, to claim there is currently no cocaine use in addition to alcohol misuse. royal college for dentists is not entirely accurate. Due to raised inflammatory markers and References In fact, all four Royal College of Surgeons severe facial pain the patient was admitted 1. Brownlow H A, Pappachan J. Pathophysiology of cocaine abuse. Eur J Anaesthesiol 2002; 19: 395. (Edinburgh, England, Glasgow and Ireland) to the ENT/maxillo-facial inpatient ward. 2. Nestler E J. The neurobiology of cocaine addiction. Sci have dedicated Faculties of Dental Surgery. She received a course of IV antibiotics and Pract Perspect 2005; 3: 4–10. In particular, that of the Royal College of nasal douching. She was reviewed by the 3. Jeffcoat A R, Perez-Reyes M, Hill J M, Sadler B M, Cook C E. Cocaine disposition in humans after intravenous Surgeons of Edinburgh has been around for maxillofacial team and fitted with a cover injection, nasal insufflation (snorting), or smoking. Drug over 70 years and represents over 7,000 dentists plate to prevent passage through the oro- Metab Dispos 1989; 17: 153–159. 4. Metzinger S. Diagnosing and treating nasal septal from all over the world, ranging from general nasal fistula. The GP was asked to arrange perforations. Aesthet Surg J 2005; 25: 524–529. dental practitioners to specialist level. We are substance misuse support for the patient https://doi.org/10.1038/s41415-020-2242-y continually trying to broaden our reach and to to help with cocaine/alcohol cessation. The encourage more dental professionals to join, patient failed to engage with rehabilitation Eco-brushing including DCPs, through targeted advertising services and surgery was not advised due to Sir, as consumers are becoming and stakeholder partnerships. the high risk of recurrence. environmentally conscious and the toll of RCSEd’s Faculty of Dental Surgery offers a greenhouse gases are apparent, people are range of quality assured diplomas, membership understandably looking to reduce their carbon and fellowship qualifications, advocates on footprint. Currently the majority of toothpaste behalf of the industry and facilitates high tubes are not recyclable with an estimated 260 levels of education for members to promote million tubes contributing to landfill annually excellence in patient care. with biodegradation taking 500 years.1 In particular, the Faculty has played a While Colgate offers a nationwide crucial role in supporting its members recycling programme of toothpaste tubes, over the last five months, by helping them this is not commonly accepted by local understand the ever-changing regulations councils.2 Therefore, for those keen to reduce imposed as a result of COVID-19, and Fig. 1 Oro-nasal fistula showing a defect in the waste, alternatives are sought but these often anterior hard palate extending to the nasal septum lobbying on their behalf on issues such as do not contain fluoride, which as we know, BRITISH DENTAL JOURNAL | VOLUME 229 NO. 7 | October 9 2020 399 © 2020 British Dental Association. All rights reserved.