Recreational reluctance | British Dental Journal

Sir, it seems there is often reluctance within our profession to ask patients about recreational drug use. Whilst undertaking dental core training, it became apparent asking about

recreational drug use was the norm, especially in patients undergoing treatment under IV sedation or general anaesthetic (GA). The oral impacts of cocaine, for example, are well documented

and include gingival lesions, palatal perforations and bruxism.1 More importantly, cocaine blocks nerve conduction similar in action to lidocaine and articaine, therefore enhancing the

body's response to epinephrine (often used as a vasoconstrictor in local anaesthetics),2 meaning administration of a local anaesthetic after recent cocaine use may induce an acute

increase in blood pressure. Cocaine users may also present with an increased risk if undergoing treatment under GA,particularly if ketamine (a reuptake inhibitor of endogenously released

norepinephrine) is included in the anaesthetic technique.3,4 Cannabis (one of the most commonly abused drugs in the UK) can manifest intraorally (increased caries and oral cancer risk).5

Although there are few studies regarding the interaction between cannabis and sedative agents, it has been noted cannabis may compound the effects of anaesthetic agents, thus affecting

arterial pressure and heart rate to possibly life-threatening levels. Refraining from using cannabis for 72 hours before treatment under conscious sedation may be advised to reduce the

likelihood of drug interactions.6 Additionally, those who use MDMA may complain of ongoing temporomandibular pain due to jaw clenching.7 We may find it difficult to discuss drug use with

patients, often due to the illegal nature of the subject. However, it is crucial that drug habits are discussed and reviewed such that risk mitigation can be put in place prior to treatment

and so patients can be directed to appropriate support groups if required. REFERENCES * Brand H, Gonggrijp S, Blanksma C. Cocaine and oral health. _Br Dent J_ 2008; 204: 365-369. * Yagiela

J. Adverse drug interactions in dental practice: interactions associated with vasoconstrictors. _J Am Dent Assoc_ 1999; 130: 701-709. * Hill G, Ogunnaike B, Johnson E. General anaesthesia

for the cocaine abusing patient. Is it safe? _Br J Anaesth_ 2006; 97: 654-657. * Cheng D. The drug addicted patient. _Can J Anaesth_ 1997; 44: R101-R111. * Joshi S, Ashley M. Cannabis: A

joint problem for patients and the dental profession. _Br Dent J_ 2016; 220: 597-601. * Dickerson S J. Cannabis and its effect on anaesthesia. _AANA J _1980; 48: 526-528. * Brand H, Dun S,

Nieuw Amerongen A V. Ecstasy (MDMA) and oral health. _Br Dent J_ 2008; 204: 77-81. Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * By email, Essex, UK O. Mudhar & M.

Agarwala Authors * O. Mudhar View author publications You can also search for this author inPubMed Google Scholar * M. Agarwala View author publications You can also search for this author

inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Mudhar, O., Agarwala, M. Recreational reluctance. _Br Dent J_ 231, 724 (2021).

https://doi.org/10.1038/s41415-021-3781-6 Download citation * Published: 17 December 2021 * Issue Date: 17 December 2021 * DOI: https://doi.org/10.1038/s41415-021-3781-6 SHARE THIS ARTICLE

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