Recreational Reluctance PDF

UPFRONT COMMENT Letters to the editor Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. Email [email protected]. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Ora...

UPFRONT COMMENT Letters to the editor Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. Email [email protected]. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space. Oral health References reduce the likelihood of drug interactions.6 1. Brand H, Dun S, Nieuw Amerongen A V. Ecstasy Additionally, those who use MDMA may MDMA and mouth ulcers (MDMA) and oral health. Br Dent J 2008; 204: 77–81. complain of ongoing temporomandibular 2. Brazier W, Dhariwal D, Patton D, Bishop K. Ecstasy Sir, 3,4-methylenedioxymethamphetamine related periodontitis and mucosal ulceration – a case pain due to jaw clenching.7 (MDMA), otherwise known as ecstasy, report. Br Dent J 2003; 194; 197–199. We may find it difficult to discuss is an illicit drug which is consumed for https://doi.org/10.1038/s41415-021-3778-1 drug use with patients, often due to the recreational use. In addition to systemic illegal nature of the subject. However, it complications, it can also present with Recreational reluctance is crucial that drug habits are discussed a variety of oral side effects. Patients Sir, it seems there is often reluctance and reviewed such that risk mitigation may first present to their primary care within our profession to ask patients about can be put in place prior to treatment and practitioners before being referred acutely recreational drug use. Whilst undertaking so patients can be directed to appropriate onwards to an oral and maxillofacial dental core training, it became apparent support groups if required. surgery or oral medicine department for asking about recreational drug use was the O. Mudhar, M. Agarwala, Essex, UK further investigations and management, norm, especially in patients undergoing which has been our experience here in a treatment under IV sedation or general References secondary care setting. I would like to raise anaesthetic (GA). 1. Brand H, Gonggrijp S, Blanksma C. Cocaine and oral health. Br Dent J 2008; 204: 365–369. awareness about these oral manifestations The oral impacts of cocaine, for example, 2. Yagiela J. Adverse drug interactions in and the management options that can be are well documented and include gingival dental practice: interactions associated with provided. lesions, palatal perforations and bruxism.1 vasoconstrictors. J Am Dent Assoc 1999; 130: 701–709. Xerostomia can occur which should More importantly, cocaine blocks nerve 3. Hill G, Ogunnaike B, Johnson E. General anaesthesia subside after approximately 48 hours.1 conduction similar in action to lidocaine for the cocaine abusing patient. Is it safe? Br J Anaesth 2006; 97: 654–657. Patients should be advised to stay hydrated and articaine, therefore enhancing the 4. Cheng D. The drug addicted patient. Can J Anaesth until normal salivary flow returns. Erosion body’s response to epinephrine (often used 1997; 44: R101–R111. 5. Joshi S, Ashley M. Cannabis: A joint problem for also occurs due to increased consumption as a vasoconstrictor in local anaesthetics),2 patients and the dental profession. Br Dent J 2016; of soft drinks and vomiting during the meaning administration of a local 220: 597–601. 6. Dickerson S J. Cannabis and its effect on anaesthesia. recreational use of MDMA. A fluoride anaesthetic after recent cocaine use may AANA J 1980; 48: 526–528. mouthwash and sugar-free chewing gum induce an acute increase in blood pressure. 7. Brand H, Dun S, Nieuw Amerongen A V. Ecstasy (MDMA) and oral health. Br Dent J 2008; 204: 77–81. is recommended to maintain salivary flow Cocaine users may also present with an and buffering capacity. Sugar-free chewing increased risk if undergoing treatment https://doi.org/10.1038/s41415-021-3781-6 gum is also recommended for alleviating under GA, particularly if ketamine (a the symptoms of bruxism which occurs reuptake inhibitor of endogenously Anaesthesia due to partial inhibition of the jaw opening released norepinephrine) is included in reflex.2 the anaesthetic technique.3,4 Cannabis Inhalation solutions Perhaps one of the most common (one of the most commonly abused Sir, I am writing to highlight the benefits manifestations for concern is severe, drugs in the UK) can manifest intraorally of offering inhalation sedation (IHS) to widespread oral ulceration. With these (increased caries and oral cancer risk).5 patients, particularly because of the effects cases, reassurance and a soft diet is advised Although there are few studies regarding of the COVID-19 pandemic on waiting as these ulcers tend to resolve after 14 the interaction between cannabis and times for general anaesthetic. days. Management options may include sedative agents, it has been noted cannabis In hospital, we are seeing general the use of benzydamine, chlorhexidine or may compound the effects of anaesthetic anaesthetic (GA) waiting lists getting corticosteroid mouthwash for symptomatic agents, thus affecting arterial pressure longer, with many patients suffering repeat relief.1 If there are any concerns for and heart rate to possibly life-threatening bouts of pain and infection, and increased infection, a course of antibiotics could be levels. Refraining from using cannabis treatment with antibiotics. For those prescribed. for 72 hours before treatment under old enough, IV sedation can be offered, Y. Lin, Plymouth, UK conscious sedation may be advised to but for younger children and patients 724 BRITISH DENTAL JOURNAL | VOLUME 231 NO. 12 | December 17 2021 © British Dental Association 2021.