Problems of the state of the oral cavity and anesthetic care in users of various forms of cocaine (scientific and literary review)

The prevalence of cocaine among the narcotic substances used by the population of Europe and America is second only to cannabinoids. Cocaine and crack use can cause various types of damage to the oral cavity, ranging from bad breath (halitosis) and gingivitis to cancer. These lesions are due to the anesthetic, vasoconstrictor, local prothrombotic properties of cocaine and its components in combination with cytotoxic effects and tissue damage associated with the method of use. Dentists quite often and treat cocaine users unknowingly, and they should be aware of the significant risks of possible problems and complications and be prepared to deal with them. Consuming this narcotic immediately before or after tooth extraction can cause excessive bleeding. Active cocaine users had significantly more complications related to anesthesia. Anesthesiologists should know the specifics of managing such patients, regardless of whether they are acutely intoxicated or suffering from the effects of chronic drug use. Monoamine oxidase inhibitors, class I antiarrhythmic drugs, and methadone in combination with cocaine lead to arrhythmias. The prescription of β-blockers should be avoided. The use of atropine and adrenaline can cause dangerous tachycardia in cocaine addicts. With general anesthesia during intubation, uncontrolled hypertension, arrhythmia and myocardial infarction, difficulty in mask ventilation and tracheal intubation due to inflammation, mucosal edema, defects of the palate, nasal membrane, pulmonary hypertension, which can complicate oxygenation or ventilation, may occur. Sympathomimetics are contraindicated if cocaine has been used within the last 24 hours. This must be explained to the patient (who must ensure that the drug was not used during this period), if local anesthesia with vasoconstrictors is indicated to reduce periodontal bleeding, since the use of a local anesthetic alone may not provide the necessary duration of anesthesia or the degree of hemostasis. Planned intervention using general anesthesia is possible at least 48 hours after the last use of cocaine (with certain risks), and optimally — after a week.