According to the National Institute on Drug Abuse (NIDA), more than 70,000 Americans died of drug abuse in 2017, a lethal manifestation of one of the nation’s most prevalent health problems. One in 12 Americans needs some form of drug abuse treatment, yet only about 11 percent of those individuals receive the help they need, an unfortunate situation considering that drug addiction is a highly treatable condition. Poor oral health, one of the most common comorbidities associated with drug addiction, is also highly treatable, and important to recovery efforts as well as the patient’s overall health.
This guide focuses on the connection between drug addiction and dental health, provides information on the impact of drug use on teeth and gums, considers the implications of inadequate oral health care for drug abusers and on their efforts to recover, and offers advice on how dentists can positively — and hopefully, successfully — intervene.
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Dental effects of drug abuse
Drug abuse causes a litany of serious dental problems, including frequent cavities, periodontal diseases, dysplasia, teeth grinding, tooth wear and tooth loss. Crack cocaine, meth, heroin and amphetamines are all damaging to oral health, leaving users vulnerable to rotting teeth and related problems such as acid reflux and dry mouth, which damage tooth enamel and soft tissue. Drug abusers also frequently suffer from painful infected sores or mouth ulcers, and tend to ingest food and beverages high in sugar and low in nutrition — which also contributes to bad dental health.
Extended health consequences of inadequate oral care
Medical science has raised awareness of the close connection between oral health and other parts of the body. People who neglect their teeth and gums are at higher risk for cardiovascular disease, kidney disease and diabetes. There’s a connection between oral and gut health, and dental neglect can result in chronic inflammation, and bacteraemia (bacteria in the bloodstream) may also result. Clearly, where drug abuse is concerned, there’s more going on than damaged and discolored teeth and bad breath. Oral neglect and lack of access to adequate dental care during the rehabilitation process not only makes recovery from drug addiction more difficult, but can place a patient’s life at risk.
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Oral health care has been shown to have a positive impact on people seeking recovery from abuse and addiction. Patients who receive dental care aren’t as likely to seek illicit means of controlling pain, and they aren’t faced with the humiliation and stigmatization that often comes with visibly poor dental health. Unfortunately, drug users and addicts are more likely to struggle with dental problems due to a lack of access to oral health services and a tendency among drug users to neglect oral self-care. Failure to address these factors makes treatment especially difficult.
Despite the positive impact that good oral health can have on addiction recovery, many people consider a refusal to undergo dental care a precaution against aggravating their condition, avoiding anything they perceive as placing their recovery at risk even if it can improve their health situation in the long term.
Oral care and drug rehabilitation
Oral health is important to drug abusers, both during rehab and afterward. However, patients who suffer from pain and feel ashamed of bad teeth and gums caused by years of drug abuse often avoid seeking care, fearing ridicule and judgment. Ideally, dentists should screen patients for signs of substance abuse, taking note of any advanced dental and/or periodontal disease inconsistent with a patient’s age, and considering a referral plan to medical professionals for treatment management of their addiction. For example, a patient with bad teeth and gums who exhibits an unusually high resistance to anesthesia and painkillers would indicate a need for medical attention and treatment.
However, dentists sometimes lack the knowledge about how to intervene with patients who exhibit signs of addiction, while some dental practitioners are nervous about treating a drug-addicted individual for personal reasons (i.e. fear of disease transmission). Offering dedicated dental services in addiction rehabilitation centers would improve access, but these resources are often unavailable.
Obstacles to treatment
Unfortunately, dental management of patients who habitually abuse drugs can be problematic for many reasons:
- Dentists are often skeptical of the medical need and advisability of using opiates to treat pain in drug abusers, and as a result, the patient fears the possibility of pain during treatment.
- Traditionally, there has been no standard approach for verifying the need for using pain management drugs with abusers.
- Dentists are often uncomfortable addressing issues when they suspect deception in a patient, and consequently, are hesitant when it comes to intervention.
- Abusers sometimes mistake delayed care or a provider’s lack of understanding about intervention and treatment protocols as evidence of a biased attitude against them.
Trust is an important element in any dentist-patient relationship, particularly when the patient is struggling with drug abuse and its oral consequences. Patience and sensitivity are vital if a patient’s dental crisis is to be confronted and dealt with effectively. There are several ways in which dentists can help drug abusers take control of their oral health and encourage them to seek help for their addiction:
- Offer oral health education and prevention services for addicts and their families
- Provide informational materials (booklets, posters, brochures, etc.) about how drug use contributes to poor oral health, and how to prevent tooth decay and periodontal disease
- Incorporate dental strategies into prevention protocols, which tend to be limited to preventing overdoses and overlook whole-patient care
- Impress upon patients the fact that dental care is as important as other aspects of their recovery
- Emphasize patient-centered, affordable care for patients dealing with a drug dependency
- Incorporate dental care in rehabilitation centers, where dentists could be equipped to
- diagnose oral problems and help manage systemic disorders related to addiction during treatment
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How dentists can help you get back on track
According to the American Dental Association (ADA), dentists should have a familiarity with a patient’s substance abuse history and take it into account when planning treatment and prescribing medications. An overall knowledge of substance use disorders is important for the safe administration of prescription medications. Dental practitioners should also be familiar with their community’s substance abuse treatment resources and be prepared to consult with a patient’s doctor when a history of drug abuse is indicated. The ADA also urges its members to stay current in their knowledge of pharmacology, including recognizing contraindications to the application of adrenaline-containing local anesthetics.
Dentists are in a good position to suggest and provide information about different treatment options available to individuals who exhibit the dental signs of addiction, including:
- Behavioral counseling (preparing the individual for life without drugs after rehab)
- Evaluation and treatment for mental health issues that could trigger a relapse
- Ongoing appointments with counselors and addiction specialists
Good oral health care is important for the maintenance of overall medical well-being. For individuals suffering the ravages of drug addiction, dental care is essential, because it can have an immensely positive impact on addiction recovery. Dental professionals do more than provide oral health care — they interact with patients in formal and informal ways that allow them to be aware of the larger context of patients’ health problems. Sensitive, patient and knowledgeable dentists are in a good position to have an encouraging effect on drug abusers who are reluctant to seek help for their addiction and its impact on their oral health.