The dental management of a patient with a cocaine‐induced maxillofacial defect: a case report

Abstract

There are several dental complications associated with cocaine abuse, including adverse reactions to dental anesthetics, post-operative bleeding, and cellulitis, which can lead to necrosis of orbital, nasal, and palatal bones. Following is a report of the initial treatment rendered to a patient who had destroyed most of her hard palate over a ten-year period of cocaine abuse. There are no classic socio-economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients in any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.

Cocaine and oral health

“…12,15,26,35,37,40 Surgical reconstruction of the pal ate failed in five out of ten reported patients. 19,20,26,30,41 In three other patients, the final outcome of the surgical recon struction was unknown because they were lost to follow up within three weeks. 12,32,40 In another patient, two 1.5 mm fistulas remained after an anterior based tongue fl ap procedure.…”

“…44 described by five patients as comfortable or at least acceptable. 15,18,19,23,38 Consider ing the relatively poor outcome from surgical repair of cocaine-induced pala tal defects, the non-surgical conserva tive approach seems the better option.…”

“…This process can be exacerbated by chemical irrita tion from adulterants in 'cut' cocaine such as quinine, caffeine, talc, plaster of Paris or amphetamines. 19,20 Addition of lidocaine and procaine can cause facial numbness. 20 Some patients use instruments such as pens and pencils to remove intranasal crusting, which increases the risk of nasal perforation.…”

“…12,18,28,33,38,39 In addition, eating and drinking is dif ficult due to oronasal refl ux of both solids and liquids. 18,20,38 Some patients had resorted to obturating the defect by inserting chewing gum, 17 a piece of white bread 19 or a plug of tissue paper into the palatal defect. 14 The initial treatment of a cocaine induced palatal defect is complete absti nence from the drug, and the exclusion of other potential causes of midline pala tal necrosis such as a tumour, Wegener's granulomatosis, trauma, chronic (fun gal) infection and tertiary syphilis.…”

Palatal perforations: past and present. Two case reports and a literature review

“…6 The consequence to the dental profession is that practitioners are increasingly likely to encounter such patients. However they do not fit a classic profile 7 and so to identify them the health professional would need to recognise common signs and symptoms.…”