Heroin

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Case study
37year old male attended for pain relieve of the acute dental abcess he experienced over the last 3 days . He has a history of heroin abuse and currently being treated with methadone . The examination showed multiple grossly decayed teeth and RR’s that require removal he was obviously anxious about any treatment of any sort.

HEROIN
also known as diamorphine H, smack -is an opioid analgesic - itself is an active drug, but it is also converted into morphine in the body -When used in medicine, it is typically used to treat severe pain The name "heroin" is only used when being discussed in its illegal form. When it is used in a medical environment, it is referred to as diamorphine it is given via subcutaneous, intramuscular , intrathecal or intravenous route

Heroin and dental abcess
• Heroin addicts, due to their impaired immunity and also due to the non hygienic heroin administration practices, are at an increased risk of contracting infections. IN A NORMAL PATIENT

The foreign organism is therefore destroyed and the infection contained. This response is augmented and supplemented by the use of antibiotics .

• IN A PATIENT ADMINESTRING HEROIN The host immune response was not able to counter the microorganisms causing the abscess.

Since the cell mediated and humoral immunity were both compromised, the organisms causing tooth abscess could not be combated by body and may lead to bacteremia sepsis and organ damage

Heroin and destructed teeth
• These drugs affect teeth indirectly. Actually these drugs rouse a carving for sugary items such as candies and soft drinks, which are harmful to teeth • It depletes your body of nutrients which weakens the tooth enamel.

• causes dry mouth and teeth grinding and since there is no saliva to combat the bacteria it will cause tooth decay and attrition

Dental treatment
• • • • Sequence of the dental treatmentDrain the abscess Extract the retained roots Fill the decayed teeth

Treatment of the dental abscess
• Drain the dental abscess • Antibiotics (when?)

Draining of the dental abscess
• Incision • Trephination

Antibiotics & Pain killers
• Amoxicillin • Metronidazole

• Ibuprofen • Aspirin • Paracetamol (Not favorable)

Xerostomia
• Water • Induce saliva ( gum or tooth pick ) • Artificial Saliva (Mouth Kote, Biotene mouth wash )

Note
• Heroin and methadone have no significant interaction with the antibiotics and pain killers specified above • Avoid antianxiety drugs like diazepam as it will interact with the methadone and cause side effects • Preferable to go for general anesthesia and finishing the whole treatment in one appointment

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