Question

Bill S. is a longtime patient in your practice and has been in and out of rehabilitative treatment centers for the past 10 years for alcoholism. He tells you that he has been “on the wagon” for the past 3 months, and he is taking Antabuse. He also tells you that he is smoking more to deal with the stress of giving up alcohol. When you perform the intraoral and extraoral examinations, you notice that his parotid glands seem enlarged and that he has a red, beefy tongue with an ulcerated area on the lateral border of the left side. Once you start periodontal probing, the bleeding is excessive and continues long after it should have stopped.

2. Which factors could be responsible for the excessive bleeding?

a. Adverse reaction to the Antabuse

b. Poor oral hygiene

c. Liver failure caused by alcohol abuse

d. Squamous cell carcinoma

3. Which is the most likely cause of the ulcerated area on the lateral border of Bill’s tongue?

a. Trauma

b. Aphthous ulcer

c. Adverse reaction to the Antabuse

d. Squamous cell carcinoma

4. Noting that Bill is taking Antabuse, you use an alcohol-free pre-procedural rinse. Which would explain this use?

a. Fear of triggering alcohol cravings

b. Better efficacy than alcohol-based rinses

c. Adverse reaction to the Antabuse

d. Drying of oral mucosa with alcohol mouth rinses

5. Which modifications to the dose level of local anesthetic should be made for Bill’s dental treatment?

a. The dose should be reduced.

b. The dose should be increased.

c. No modification to the dose is necessary.

d. Local anesthetic is contraindicated completely.

Answer 1

2.C. Bleeding gums is found as a symptom in the patients having the Alcohol Related Liver Disease(ARLD).

Other ARLD related symptoms in the patient are:

• Loss of apetite
• Jaundice
• Nausea
• Weight loss
• red hands and feet
• Abdominal discomfort
• Increased thirst
• Fainting
• Confusion
• Enlarged breast in men.
• Mood swings

3.B

Since Bill is passing through a serious stress due to giving up of alcohol, and depends on cigarette to get rid of the stress, The ulcer found on the lateral aspect of the tongue most commonly may be the Aphthous ulcer. Because Stress is one of the triggering factor for Aphthous ulcer. aphthous ulcer is an autoimmune self healing immune response of the body.

4.C

Combining alcohol with the antabuse, will cause fatal reaction. Thats why the clinician prefer to give alcohol free mouth rinse before the clinical procedure.

5.A

The alcohol content in the body will slow down the efficacy of action of the local anaesthetici.e. In a chronic alcoholic, it is needed to increase the dose of the LA to compensate for this.Since the patient is under the antabuse usage,this will be reversed. i.e. Less dosage is required.