Sir, it seems there is often reluctance within our profession to ask patients about recreational drug use. Whilst undertaking dental core training, it became apparent asking about recreational drug use was the norm, especially in patients undergoing treatment under IV sedation or general anaesthetic (GA).

The oral impacts of cocaine, for example, are well documented and include gingival lesions, palatal perforations and bruxism.1 More importantly, cocaine blocks nerve conduction similar in action to lidocaine and articaine, therefore enhancing the body's response to epinephrine (often used as a vasoconstrictor in local anaesthetics),2 meaning administration of a local anaesthetic after recent cocaine use may induce an acute increase in blood pressure. Cocaine users may also present with an increased risk if undergoing treatment under GA,particularly if ketamine (a reuptake inhibitor of endogenously released norepinephrine) is included in the anaesthetic technique.3,4 Cannabis (one of the most commonly abused drugs in the UK) can manifest intraorally (increased caries and oral cancer risk).5 Although there are few studies regarding the interaction between cannabis and sedative agents, it has been noted cannabis may compound the effects of anaesthetic agents, thus affecting arterial pressure and heart rate to possibly life-threatening levels. Refraining from using cannabis for 72 hours before treatment under conscious sedation may be advised to reduce the likelihood of drug interactions.6 Additionally, those who use MDMA may complain of ongoing temporomandibular pain due to jaw clenching.7

We may find it difficult to discuss drug use with patients, often due to the illegal nature of the subject. However, it is crucial that drug habits are discussed and reviewed such that risk mitigation can be put in place prior to treatment and so patients can be directed to appropriate support groups if required.