FAQ About Intoxicated Patients

Frequently Asked Questions About Substance Use and Dentistry

Question: Am I allowed to reschedule a patient who appears to be using marijuana?

Answer: If a patient shows signs of visible impairment due to any substance, TDIC recommends rescheduling the appointment and asking the patient to return when they are not impaired. Explain to them that for ethical and safety reasons, you cannot provide treatment to intoxicated patients.

It is important to realize that the smell of marijuana in and of itself is not an indication that the patient actively uses the drug or is currently under the influence. Be careful not to discriminate against any individual you suspect may use or abuse a substance. Ask questions to access knowledge that will help you make an informed decision about provision of care. Objectively document observations that lead you to believe the patient is impaired.

You can inquire about the individual’s use of marijuana and whether the use is for medicinal purposes (then consult with their physician) or recreational use. Request — as with someone who drinks alcohol — that they not use/consume prior to treatment as an altered state may impair their ability to provide informed consent for treatment. Initiate this dialogue with patients by requesting they update their health history at every visit. If recreational marijuana is legal in your state and the patient admits to occasional use, note this in the treatment record and advise the patient of your office policy accordingly.

If you have determined that a patient is under the influence, staff should encourage the patient to remain on-site and make alternative transportation arrangements, such as calling a taxi or ride-share service or notify the emergency contact listed on the health history form and ask them to pick up the patient. Should the patient become belligerent or abusive, notify security or law enforcement.

Question: My pediatric patient’s parent appears to be intoxicated. Should I still treat the patient?

Answer: This is an unfortunate and difficult scenario in which the safety and well-being of the patient must take precedence in your response. Generally, a minor should not be treated when their adult caregiver is chemically impaired. The adult in question is authorized to make treatment decisions and consent on behalf of the patient. Therefore, the same risks that exist in treating intoxicated adults apply to when a minor patient is accompanied by an intoxicated adult caregiver: they cannot provide accurate medical history, their decision-making is questionable, they are unlikely to remember care instructions and they cannot fully participate in informed consent discussions.

Many states do have laws that allow healthcare providers to proceed without parental consent in case

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of emergency. The step to provide emergency treatment without the parent’s informed consent should only go forward in the rare situation that delaying dental treatment could endanger the child’s health.

By law, dentists are mandated reporters, obligating them to notify the appropriate authorities when they feel the adult accompanying a minor patient may be a danger to themselves or others. This includes intoxicated adults who insist on leaving the office with children in a vehicle. Report all physical signs of child abuse, child neglect, elder abuse, elder neglect and domestic violence that are observable in the normal course of a dental visit. Document what you observed in the patient’s chart, along with information detailing how, when, and to whom you reported the abuse.

Question: I am concerned that a minor patient is showing signs of drug abuse. What is my responsibility?

Answer: If during a dental exam you find signs that would indicate a minor is abusing drugs or alcohol, do not hesitate to discuss your observations with your patient and their parents. You may be the first to discover tangible evidence of a problem that parents have not even begun to suspect.

Dentists sometimes wonder if it is a violation of patient privacy laws to discuss potential drug use with a minor patient’s parents. Abuse of alcohol or drugs is not a protected class as it would be in pregnancy, abortion and birth control. Therefore, the parent or legal guardian can be advised of the dentists’ reasonable suspicions. It is also important to note that dentists and other licensed dental care providers are mandated reporters for evidence of child, disabled or elder abuse. In a case where impairment of a minor is due to drugs or alcohol, both of which are illegal for a minor to consume, that may be evidence of child abuse. Depending on the source of the drugs or alcohol, this observation may be an event reportable to child protective services.

Early detection and intervention of substance use disorders, like most medical conditions, leads to better treatment outcomes. Your intervention may very well save a life. Discuss the drug use, its effects on the body, its impact on a healthy smile, and its risk of death. Suggest to the parent and patient that they seek treatment and support and offer to refer them to trusted specialists.

Unfortunately, there is the possibility that you will discover signs of drug use in a patient and either they or their adult caregiver will deny it. In this situation, it’s best to respectfully acknowledge that you are there for your patient and their parents as part of their healthcare support system. Assure them that if they need assistance, you will be happy to direct them to helpful resources and check on their oral condition. In the meantime, remind them of oral health tips that are important for all patients, but especially those at greater risk of injury, disease or decay due to drug use: • Avoid sodas and soft drinks • Cut back on sticky and sugary foods • Chew sugar-free gum to promote salivary flow • Stick to a consistent daily oral hygiene routine • Keep regular dental hygiene appointments

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Liability Lifeline is published by: The Dentists Insurance Company 1201 K Street, 14th Floor Sacramento, California 95814

©2022, The Dentists Insurance Company

Endorsed by: Alaska Dental Society

California Dental Association

Hawaii Dental Association

Idaho State Dental Association

Illinois State Dental Society

Nevada Dental Association

New Jersey Dental Association

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Washington State Dental Association

Also in: Arizona, Minnesota, Montana, North Dakota, Pennsylvania and Tennessee

TDIC reports information from sources considered reliable but cannot guarantee its accuracy.

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