As a teenager, John was diagnosed as a chronic cocaine abuser. As a result, he has suffered from different oral, systemic, and mental behavioral problems. John is a 42 year old male. He smokes ½ pack of cigarettes per day and drinks around eight alcoholic beverages per day. John also works for an industrial company in Sioux City, IA. He enjoys hunting, watching television, movies, playing video games, watching baseball, and college basketball. He also enjoys the company of his four year old on the weekend, which he no longer has full custody of. Some of his dislikes include: hockey, family reunions, reality television, and ethnic foods. John has not been able to hold a steady job, steady relationship, or a healthy connection with his family. An unexpected pregnancy from an ex-girlfriend forces him to pay child support every month. He is a High school drop-out (working on his GED) with no college degree in mind. Money is spent that he does not have on cigarettes and beer. Numerous bills plague his mind as he cannot keep up with them. His current living situation entails living in a two bedroom apartment with a 23 year old cocaine addict as a roommate.
The medical condition as described is from complications of chronic cocaine addiction whose chronic cocaine intake resulted in erosion of mid-facial anatomy and recurrent sinus infections (Myers, 2009). The physical anomalies that are visual include a broad, flat nose and a saddle nose deformity. This is from perforation of the nasal septum reducing the nasal support and results in a broad flat nose, or the so-called saddle nose deformity (Myers, 2009). Swollen lymph nodes and intraoral swelling are also apparent. Tooth number three was deeply decayed and # 11 had erupted palatally. A 10 x 12 mm oval palatal hole was evident, just left of the midline, in the second premolar area. No drainage or lesions are observable.
John first noticed a small pin sized opening when liquids from his mouth would leak up and into his nose. Patient said he enclosed the hole with orthodontic wax to keep liquid flow from there. The hole progressively grew bigger throughout the year. Brushing his teeth excessively has caused recession on almost all posteriors; this is also from physically applying cocaine on the mucosa and teeth.
Nearly 22 million Americans have abused or tired cocaine at one point or another in his/her life (Myers, 2009).
Cocaine as been labeled the drug of the 80s and 90s because of its popularity. “Age-specific incidence rates generally have mirrored the overall incidence rate. The number of new users aged 18 to 25 reached a peak of 0.9 million in 1983, while the most recent low point for this group was 0.3 million from 1991 to 1994. Incidence among 12 to 17 year olds has not varied as greatly over the years, but peaked in 1980 at 0.3 million new users and reached a recent low point in 1991 with 90,000 new users (Trends…, 2008).
A family history of heart attack and stroke encourages John to take one aspirin per day. He does not take any other prescription medications or over the counter drugs. He has not had a heart attack nor stoke since taking aspirin every day. The dental consideration for aspirin is increased risk of bleeding during treatment or surgery (Myers, 2009).
Patients with combined cocaine and alcohol addiction tend to exhibit the most severe oral disease conditions and symptoms, such as severe xerostomia, advanced periodontitis, many decayed and missing teeth, and severe tooth attrition from bruxism or grinding (Myers, 2009). Extreme xerostomia leads to carious lesions. It also contributes to a higher risk of developing anorexia. Many may exhibit angular cheilitis, cracking or inflammation at corner of mouth can be the cause of malnutrition from a fungal or bacterial infection (Myers, 2009). Oral candidiasis can occur which is a pain or burning sensation which is associated with poor nutrition most commonly with anorexics. Glossodynia or burning mouth syndrome of the lips, tongues, or entire mouth, cervical abrasion, and gingival lacerations can also transpire. Dental enamel and dentin can be easily damaged throughout time because a chronic user hardly ever has neutral pH level due to the constant harbor of it in oral and nasal cavity (Myers, 2009).
A reduced healing process is present because of small vessel vasoconstriction is a contributing factor to progression of periodontal disease (Myers, 2009). Continuous stress and a poor diet can result in necrotizing gingivitis, a progressive painful infection with ulceration, swelling and sloughing off of dead tissue from the mouth and throat due to the spread of infection from the gums (Myers, 2009). Even if the patient chooses to excessively brush may still have halitosis, the odor resembles alcohol (Myers, 2009). Abusers who draw drug into nasopharynx can experience a form of dental erosion that occurs when cocaine in oral cavity for an extended time – because of nasal insufflations or breathing directly through the nasal cavity (Myers, 2009). Gingival hyperplasia, erosive lichen planus and herpetic gingivostomatitis are three common pathological conditions of chronic users. Herpetic gingivostomatitis can derive of the mouth and lips caused by a virus with redness and inflammation of the oral mucosa. Gingival hyperplasia is overgrowth of the gingiva characterized by firm, non-painful swellings. Erosive lichen planus can emerge on lining of mouth, this looks like lacy white patches (Myers, 2009).
This patient brushes his teeth excessively. He states his teeth always have a gritty feeling that will not go away. The bristles on his toothbrush wear out after a few weeks of use. John needs frequent recall appointments, his teeth are more apt to decay. Mid-afternoon appointments are better since he most always works the nightshift at his job and sleeps during the day. The only dental consideration from OTC medications is additional bleeding from the daily aspirin. This patient at all time should avoid vasoconstrictor drugs, any use of this drug could result in sudden death, myocardial infarction, or stroke (Yagiela, 1999).
As a preventative measure treatment should be suspend for 24 hours if known of use of cocaine is ingested or injected (Yagiela, 1999). Operator would manage a situation of a heart attack by position patient upright, provide nitroglycerin under the tongue. No more than three nitroglycerin pills in ten minutes should be administered, activate 9-1-1, and give 100% oxygen, order aspirin to chew from emergency kit, check vitals every 5 minutes and be prepared to provide CPR. Everything must be documented at the end of the medical emergency. If suspecting a stroke operator should ask the patient to raise his/her arms, repeat a short phrase, and smile. The patient should be positioned more upright during the appointment and give them an aspirin to chew. John is considered an ASA III.
