SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Dental pain needs recognising not ignoring (Jan 2009)

I was sitting in my consulting room when I heard singing and guitar playing coming from outside. Going out to investigate I found Billy sitting entertaining the packed waiting room. He gave me an enormous grin proudly showing off his new dentures!

When he began into treatment about six months earlier his primary goal had been to get his teeth fixed so he could sing again. For him being homeless, having infected groin injecting sites and not receiving any benefits, were all secondary to getting his teeth done.

It was a struggle to support Billy in his primary goal as many dentists in the area refused to register him and many others had left the NHS. But eventually with "a little persuasion" from us and his supportive church (another largely unrecognised and underused resource) Billy started the process of having his few remaining teeth removed and preparing for dentures.

Drug-using patients frequently in and out of treatment have a high level of oral disease and on the whole a low uptake of dental treatment. Although users and workers alike blame methadone mixture as the cause, research shows that dental caries manifest themselves much earlier and is a complex condition. A number of factors may play a part, including exposure to sugar, poor diet and poor dental hygiene, whilst the complex nature of dental pain may be masked by the analgesic effect of opioids prior to engagement in treatment. Dental pain may only appear when starting substitute medication and if not treated can lead to relapse.

As Ruth Gray, dentist extraordinaire who did most of the research in this area states, it is "...vital that dental health is taken into consideration in the primary assessment of a new client and dental treatment made accessible". Her research undertaken in Dublin showed that 99% of subjects required some form of dental treatment and 30% needed dentures. Ruth also found dental health (and hepatitis) were identified as main concerns for drug user support groups.

Dentistry has an important but largely unrecognised role to play in the recovery of people who use drugs, not only in the treatment of pain and disease, but also in enhancing people's appearance and self-esteem. Take care the need for dental treatment concurrent with drug treatment isn't a reason for people to drop out of treatment and its importance needs to be acknowledged and included in planning.

Billy understood this and re-taught me an important lesson. I'm now off to listen to his CD of Christmas carols, two of which are his own compositions!

- Dr Chris Ford