Substance Use Disorder (SUD) in Adolescence: A Review for the Pediatric Dentist

Resident: J. Hencler
Date: 05/25/2011

Article title: Substance Use Disorder (SUD) in Adolescence: A Review for the Pediatric Dentist
Author(s): Marcio A. da Fonseca, DDS, MS
Journal: Journal of dentistry for Children-76:3, 2009

Major topic: Substance abuse in adolescents

Type of Article: Literature review

Main Purpose: Review for the pediatric dentist

Key points in the article discussion:
Drug addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use. SUDs are maladaptive patterns of use accompanied by clinically significant impairment or distress, causing reduced functioning in major areas of life, risk-taking behavior, exposure to hazardous situation, and an increase in the likelihood of legal problems due to possession. Adolescents are more vulnerable to the risks of neuropathology as a result of substance abuse b/c their brains are still developing. Neurobiological changes during puberty contribute to 3 behavioral factors that relate to SUD development: 1) increase in peer affiliation; 2) decreased parental monitoring; and 3) risk-taking behaviors. The pediatric dentist is in a good position to help prevent and detect suspicious cases of substance abuse. Patterns of behavior that should raise suspicion include recent/sudden drop in grades, mood changes, school disciplinary action, antisocial behavior, drinking b/f 15 yo, and associating with peers w/ SUD. A good first step is to use the CRAFFT screening tool questions: 1) Ever ridden in a car driven by someone using alcohol/drugs? 2) Do you take drug to relax? 3) Do you take drugs while alone? 4) Do you forget things while using drugs? 5) Do people tell you to cut down on alcohol/drugs? 6) Have you gotten in trouble b/c alcohol/drugs? Drug addiction appears to have fast, severe, and deleterious effects in the oral cavity. Factors that contribute to increased risk of dental disease include: lack of adequate diet, dry mouth induced by drugs, tobacco, alcohol, and medications, poor OH, increased acidity, vomiting, and impaired smell and taste sensation leading to intake of heavily sweetened foods.

Summary of conclusions:
Any substance abuse by young patients carries high-risk b/c the likelihood of progression to more dangerous drugs and their effect on physical, physiologic, neurological, and emotional development. The key to recognition of substance abuse is the professional’s willingness to ask parents and adolescents about it.