Alcoholism
Patient: Oliver
Age: 31
Gender: Male
Race: Caucasian
Weight: 195
Hometown: Margaritaville, CA
Physical Assessment: 6'0 tall, moderately active lifestyle
Mental Assessment: Extrovert, outgoing personality, high tempered
Social Assessment: Bartender at Elephant Bar and nightclub promoter
Medical Assessment: Does not make time for the doctor unless in pain, smokes socially with friends while drinking
Dental History: Generalized amalgam and composite restorations, impacted third molars, crown and root canal on tooth #30
EO/IO: Generalized pink, firm tissue with localized erythematous margins. Bilateral petechia from grinding at night.
Communication:
Communication with alcoholics must be done in a manner that is non-judgmental. A standardized questionnaire called CAGE or CUGE may be used. Here is an example:
C: Have you ever felt the need to cut down on your drinking?
- "Sometimes, but that's only the next day when I have a massive hangover."
A: Have you ever felt annoyed by criticism of your drinking?
- "Only when my boss tells me I shouldn't be drinking while bartending, but I can't help when my regulars that sit at the bar by me a few rounds."
U: Have you often been under the influence of alcohol in a situation where it increased your chances of getting hurt?
- "I guess I shouldn't be drinking on the job because sometimes towards the end of the night I have to be the bouncer and kick out some uncooperative patrons."
G: Have you ever felt guilty about your drinking?
- "Not really, but with these questions I really thinking about my drinking habits now."
E: Have you ever taken a drink (eye-opener) first thing in the morning?
- "Of course, it's what helps me get through those hangovers, but to put all jokes aside I do appreciate your concerns. I should be more responsible with my job and myself."
I think that's wonderful that you see the need for taking more responsibility. If you are interested in finding ways to cut back Alcoholics Anonymous has a good website, but only if you are ready.
Appointment planning:
Appointments for alcoholics need to be kept short. Afternoon appointments are usually better since they may not be feeling well in the morning. Two to three month recare appointments are recommended due to poor homecare. If a patient fails their dental appointment or cancels multiple times, their behavior should not be allowed.
Client positioning:
Seat the patient in a comfortable position
Dental Hygiene Procedures:
We need to avoid alcohol-based mouth rinses like Listerine
Safety Precautions:
- There may be mood swings with alcoholics and there may be a need for mood altering drugs to sit through a dental visit.
- Contact the physician for a prescription and they should only have the dose necessary without any refills.
- Local anesthetics are metabolized in the liver so they need to be used with caution.
- Sever liver dysfunction is a contraindication of amide local anesthetics.
OHI:
- offer alcohol free rinses
- saliva substitutes
- Bass method
- C-shaped flossing
- Caries risk management/education
Personal Reflection:
I recently learned about alcoholism in my Special Needs course and I can see the importance to be knowledgeable in this condition. It is important for us not to assume an alcoholic is not just one who smells of alcohol and is physically dependent on it. I learned that the different levels of alcoholism (type 1 through 5) vary greatly. The example given of the fictitious patient above is a common patient we may meet in practice so it is important to know how to modify our appointments. Also, those who may be a higher level of alcoholism may be on medications that we need to be aware of. While on these medications they can experience withdrawal symptoms and we need to educate our patients on receiving adequate nutrition and plenty of rest.
Fortunately, I have never known an alcoholic, but it is a serious condition. As healthcare providers it is important for us to educate our patients on the effects of alcohol abuse on our bodies.
Additional information:
Age: 31
Gender: Male
Race: Caucasian
Weight: 195
Hometown: Margaritaville, CA
Physical Assessment: 6'0 tall, moderately active lifestyle
Mental Assessment: Extrovert, outgoing personality, high tempered
Social Assessment: Bartender at Elephant Bar and nightclub promoter
Medical Assessment: Does not make time for the doctor unless in pain, smokes socially with friends while drinking
Dental History: Generalized amalgam and composite restorations, impacted third molars, crown and root canal on tooth #30
EO/IO: Generalized pink, firm tissue with localized erythematous margins. Bilateral petechia from grinding at night.
Communication:
Communication with alcoholics must be done in a manner that is non-judgmental. A standardized questionnaire called CAGE or CUGE may be used. Here is an example:
C: Have you ever felt the need to cut down on your drinking?
- "Sometimes, but that's only the next day when I have a massive hangover."
A: Have you ever felt annoyed by criticism of your drinking?
- "Only when my boss tells me I shouldn't be drinking while bartending, but I can't help when my regulars that sit at the bar by me a few rounds."
U: Have you often been under the influence of alcohol in a situation where it increased your chances of getting hurt?
- "I guess I shouldn't be drinking on the job because sometimes towards the end of the night I have to be the bouncer and kick out some uncooperative patrons."
G: Have you ever felt guilty about your drinking?
- "Not really, but with these questions I really thinking about my drinking habits now."
E: Have you ever taken a drink (eye-opener) first thing in the morning?
- "Of course, it's what helps me get through those hangovers, but to put all jokes aside I do appreciate your concerns. I should be more responsible with my job and myself."
I think that's wonderful that you see the need for taking more responsibility. If you are interested in finding ways to cut back Alcoholics Anonymous has a good website, but only if you are ready.
Appointment planning:
Appointments for alcoholics need to be kept short. Afternoon appointments are usually better since they may not be feeling well in the morning. Two to three month recare appointments are recommended due to poor homecare. If a patient fails their dental appointment or cancels multiple times, their behavior should not be allowed.
Client positioning:
Seat the patient in a comfortable position
Dental Hygiene Procedures:
We need to avoid alcohol-based mouth rinses like Listerine
Safety Precautions:
- There may be mood swings with alcoholics and there may be a need for mood altering drugs to sit through a dental visit.
- Contact the physician for a prescription and they should only have the dose necessary without any refills.
- Local anesthetics are metabolized in the liver so they need to be used with caution.
- Sever liver dysfunction is a contraindication of amide local anesthetics.
OHI:
- offer alcohol free rinses
- saliva substitutes
- Bass method
- C-shaped flossing
- Caries risk management/education
Personal Reflection:
I recently learned about alcoholism in my Special Needs course and I can see the importance to be knowledgeable in this condition. It is important for us not to assume an alcoholic is not just one who smells of alcohol and is physically dependent on it. I learned that the different levels of alcoholism (type 1 through 5) vary greatly. The example given of the fictitious patient above is a common patient we may meet in practice so it is important to know how to modify our appointments. Also, those who may be a higher level of alcoholism may be on medications that we need to be aware of. While on these medications they can experience withdrawal symptoms and we need to educate our patients on receiving adequate nutrition and plenty of rest.
Fortunately, I have never known an alcoholic, but it is a serious condition. As healthcare providers it is important for us to educate our patients on the effects of alcohol abuse on our bodies.
Additional information: