2. Anti-craving agents such as naltrexone (Revia): Decreases the
desire for alcohol by interfering with neurotransmitter systems
that produce pleasurable effects.
3. Acamprosate (Campral): Antagonizes the actions of alcohol
and reduces the desire to drink heavy alcohol.
11, 12 Has been
shown to double the likelihood of successful abstinence.
4. Anticonvulsants such as topiramate (Topamax, Qudexy),
carbamazepine (Tegretol, Carbatrol, Equetro), and valproic
acid (Depakote, Depakene, Stavzor):
11, 12 These drugs may be
beneficial for cocaine dependence as well.
The dental health professional should be able to provide education and referrals for patients with a suspected chemical dependency problem. Dental local anesthesia with vasoconstrictors
should be used with caution, especially for patients with a known
dependency to stimulants.
11 Larger doses of local anesthesia may
be necessary as they tend to quickly “wear-off” in this population.
5 This is due to the increase in liver enzyme systems that are
common in people who abuse chemical substances, which alters
12 These patients will metabolize and break down the
vasodilators and vasoconstrictors present in dental local anesthesia faster than what is considered normal.
Alcohol mouth rinses should be avoided in patients who
are in recovery for fear of relapse.
11 Complete abstinence from
substances is needed for successful long-term recovery.
patients with infections or altered immune responses, power
instruments (ultrasonics, air polishing, high-speed handpieces)
should be used with caution due to the creation of aerosols.
is also important for the dental health provider to remember that
this population may have impaired healing due to decreased immune functions.
11 Patient education should consist of nutritional
counseling, abuse risk to overall health status, oral cancer risk,
need for routine oral care, and fetal risk factors.
Chemical dependency is a growing public health concern globally. The economic burden of chemical dependency will continue to grow if nothing is done to change current prevalence
and relapse rates. Dental care providers are well positioned in
the health-care community to identify chemical dependency
problems. Appropriate, timely, and compassionate referrals will
increase a patient’s chance for a successful recovery.
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2013: Economic Consequences of Drug Abuse. Retrieved
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2008–2011. 2016; Retrieved from https://www.cdc.gov/
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