HEROIN

Case study 37 year 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 RRs that require removal he was obviously anxious about any treatment of any sort .HEROINalso known as diamorphineH,smack

-is anopioidanalgesic

-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 viasubcutaneous,intramuscular , intrathecalorintravenousroute

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 treatmentSequence of the dental treatment-Drain the abscessExtract the retained rootsFill the decayed teeth

Treatment of the dental abscessDrain the dental abscessAntibiotics (when?)

Draining of the dental abscess

IncisionTrephination

Antibiotics & Pain killers

AmoxicillinMetronidazole

IbuprofenAspirinParacetamol (Not favorable)

Xerostomia

WaterInduce saliva ( gum or tooth pick )Artificial Saliva (Mouth Kote, Biotene mouth wash )

NoteHeroin and methadone have no significant interaction with the antibiotics and pain killers specified aboveAvoid antianxiety drugs like diazepam as it will interact with the methadone and cause side effectsPreferable to go for general anesthesia and finishing the whole treatment in one appointment