In recent years more and more dentists have had to deal with patients with substance use disorders. Wisdom teeth extractions are sometimes said to be a potential cause of a later substance use disorder, see for example http://blog.teethremoval.com/painkiller-overdose-in-michigan-are-wisdom-teeth-extractions-contributing/. Even though dentists and oral surgeons have taken steps in recent years to reduce the amount of drugs they prescribe to their patients that would possibly be used for non-medical purposes this may not entirely solve the problem. If through the course of a patient evaluation, a dentist becomes aware of a possible drug or alcohol problem, they should be prepared to refer their patient to a counselor, psychologist or psychiatrist. As such they should have several possibilities available for the referral. The American Dental Association (ADA) had a webinar series several years ago titled “Interviewing and Counseling of patients with substance use disorders and drug seeking behaviors” that provides useful information for dentists to review.
The webinar slides suggest dentists use The Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, the Drug Abuse Screening Test (DAST), and the Alcohol use disorders identification test (AUDIT). The slides suggest that less than than 5% of all patients are likely to have a positive screen. Numerous red flags a patient may show that could indicate a drug problem are presented including
- Unusual behavior in the waiting room
- Unusual appearance
- Assertive personality, often demanding immediate attention
- Unusual knowledge of controlled substances
- Reluctant or unwilling to provide reference information
- Request of a specific controlled substance
- No interest in diagnosis
- Exaggerate medical problems
- Signs of drug abuse such as skin tracks and scars
- Comes in after regular office hours
- States only a certain drug works
- Threatens dentist or staff
It also suggested dentists use a Prescription Drug Monitor Program (PDMP) to help them initiate a conversation with a patient. By using such a tool a dentist can determine if the patient has had any prescription medications for pain prescribed recently for pain or anxiety. A dentist can also determine if the patient is actively taking any prescription medications.
While a dentist may not typically encounter a patient with drug-seeking behavior, they should be educated in ways to determine this and what to do when it occurs. For some dentists in more rural areas or even in large cities with heavy traffic it may be more convenient for their patients to be referred to a online psychiatrist or other form of a counselor that does not require an in person office visit. Of course at some point an in person visit may be preferred, but the potential benefit with a virtual visit is the convenience which may allow for intervention sooner.