Extraction of Mandibular Second Molar In A Former Drug Users, Alcohol Consumers, and Active Smokers

Pipiet Okti Kusumastiwi, Syifa’ Ardlina

Abstract


Background: Extraction of Mandibular Second Molar Extraction in Former Drug Users, Alcohol Consumers, and Active Smoker has a high risk of complications. Case report and case treatment: A 34-year-old male presented with a non-restorable carious lesion on the lower right second molar (tooth 47) and requested extraction. The patient reported poor oral hygiene, active smoking, alcohol consumption, and a prior history of chlorpromazine abuse. The extraction was performed under Inferior Alveolar Nerve Block (IANB) using Lidocaine. Anesthesia lasted approximately one hour, after which pain resumed. Post-extraction healing was monitored over two months, during which the socket of tooth 47 showed delayed epithelial closure. Discussions: Alpha-adrenergic receptor blockade from chlorpromazine, hepatic cytochrome P450 enzyme alterations due to alcohol, systemic acidosis, and post-operative smoking are known to influence the efficacy of local anesthesia and impair healing. Nicotine-induced vasoconstriction and xerostomia further disrupt tissue regeneration. Despite the absence of acute complications, socket healing remained incomplete at 8 weeks post-extraction. Conclusion: This case emphasizes the importance of evaluating systemic and behavioral risk factors before extraction.


Keywords


Active Smoker; Alcohol Consumers; Delayed Wound Healing; Drug Users; Mandibular Molar Extraction

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References


Bonanthaya K, Panneerselvam E, Manuel S, Kumar VK, Rai A, Oral and Maxillofacial Surgery for the Clinician, 1st ed, Singapore: Springer Nature; 2021, p 1965-1966

Costa GM, Almeida T, Martins N, Sousa R, Silva AC, Comparative efficacy of local anesthetics and adjuvants for inferior alveolar nerve block: A systematic review and meta-analysis. Clin Oral Investig. 2021;25(11):6417–6431

Gaither KA, Yue G, Singh DK, Trudeau J, Ponraj K, Davydova NY, et al. Effects of Chronic Alcohol Intake on the Composition of the Ensemble of Drug-Metabolizing Enzymes and Transporters in the Human Liver. J Xenobiotics. 2025;15(1):20.

Taha AA, Bahammam LA, Hassan AM, Alanazi MS, Paresthesia and nerve-related complications following dental local anesthesia: a systematic review. J Stomatol Oral Maxillofac Surg. 2023;124(4):101–108.

Rood JP, Coulthard P, Seymour RA, Current advances in dental local anesthesia. Br J Oral Maxillofac Surg.2021;59(8):927–935.

Iqbal MR, Samad R, Ullah M, Nazir R, Khan S, Pharmacodynamic interactions between local anesthetics and psychotropic medications: implications for dental practice. J Clin Pharm Ther. 2020;45(6):1242–1250.

Jaber D, Salameh Z, Hjeij A, et al, Variations in mandibular foramen location: A review and meta-analysis. Anat Cell Biol. 2020;53(3):230–9.

Khoswanto C, Dewi IK, The role of Wnt signaling on tooth extraction wound healing: narrative review. Saudi Dent J.2024;36(4):516–20.

Kuśnierek W, Brzezińska K, Nijakowski K, Surdacka A, Smoking as a risk factor for dry socket: a systematic review. Dent J. 2022;10(7):121.

Malamed SF, Handbook of Local Anesthesia. 7th ed. St. Louis: Elsevier; 2024; 145-152

Meechan JG, Local anaesthesia—recent advances and clinical implications. Br Dent J. 2022;233(3):123–129.

Meechan JG, Effective use of local anesthetics in dentistry. Dent Update. 2020;47(4):308–14.

Meurman JH, Murtomaa H, Oral discomfort and health behavior of patients with typical vs. atypical antipsychotic drugs. Front Psychiatry. 2024;15:1420010.

Hillerup S, Jensen RH, Nerve injury associated with inferior alveolar nerve block anesthesia: a 10-year update. J Dent Res. 2019;98(3):266–272.

Shaikh AH, Askarey SH, Shaikh AC, Zaidi SJA, Memon R, Lari FR, Iqbal S, Evaluation of post-extraction healing after atraumatic extraction in gutka chewers and non-gutka chewers using the modified inflammation proliferation remodeling scale. BMC Oral Health. 2024;24(1):1412-1413

Tandon S, Sahoo SK, Mohanty L, Jain N, Hittalamani V, Kamble SS, et al. Dry socket prevalence and risk factors in third molar extractions: a prospective observational study. J Oral Maxillofac Surg. 2024; 16(3): 56721

Taylor A, McLeod G, Basic pharmacology of local anaesthetics. BJA Educ. 2020;20(2):34–41.

Trevejo-Nunez G, Kolls JK, De Wit M, Alcohol use as a risk factor in infections and healing: a clinician’s perspective. Alcohol Res Curr Rev. 2020;37(2):177.

Udeabor SE, Heselich A, Al-Maawi S, Alqahtani AF, Sader R, Ghanaati S, Current knowledge on the healing of the extraction socket: A narrative review. Bioengineering. 2023;10(10):1145.

Kämmerer PW, Schneider D, Ettl T, et al. Clinical factors influencing local anaesthesia success in oral surgery: a systematic review. Int J Oral Maxillofac Surg. 2021;50(5):650–660.

Fox PC, et al. Anticholinergic drug effects on salivary function. J Am Geriatr Soc. 2018;66(6):1103–1111.

Villa A, et al. Oral candidiasis and hyposalivation: Clinical associations. Oral Dis. 2020;26(3):569–576.

Jagger RG, et al. Microbiome shifts associated with drug-induced xerostomia. Front Oral Health. 2023;4:1120567.

Johansson I, et al. Nutritional deficiencies and oral mucosal healing. Nutrients. 2021;13(8):2786.

Raittio E, et al. Interdisciplinary oral health management in substance use disorders. Community Dent Oral Epidemiol. 2022;50(4):275–284.

Seagroatt V, et al. ASA and anticholinergic burden as predictors of surgical outcomes. Br J Anaesth.2023;130(1):124–132.

Aframian DJ, et al. Sialogogues and salivary substitutes in oral rehabilitation. J Dent Res. 2019;98(13):1469–1477.

Yamalik N, et al. Substance use and oral health: Towards integrated dental care guidelines. Int Dent J.2024;74(2):123–133.




DOI: https://doi.org/10.32509/jitekgi.v21i2.6011

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