SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Teeth important for self-esteem (Oct 2011)

I went to get Bob from the waiting room. He had arrived over an hour early for his review appointment. When I called him he stood up with the most enormous smile on his face and kept it up as he walked in and talked. I asked him how he was and he answered very well still smiling at me with teeth showing. The penny didn't drop until he said "did you not notice my new teeth!?"

Since he started with us just over a year ago he had been trying to get his teeth fixed. The remains of his rotten teeth had been removed about 6 months ago and he was awaiting dentures since then. Bob felt that his rotten teeth seriously affected his self-esteem. He always kept his head down or his hand over his mouth when he spoke. It had been hard for Bob to find an NHS dentist but when he did, the dentist had been a complete star and made Bob feel that he was worth treating.

People who have or are using drugs, particularly opiates, have a high level of oral disease and poor access to dental treatment. Dental caries is a complex condition and a number of factors may play a part, including dry mouth caused by the opiates, 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 treatment, and if not treated, can lead to relapse. Methadone mixture is sometimes blamed for dental problems but it starts well before this and it has been shown that sugar or non-sugared formulas have no significant effect on dental health.

Like Bob, many people feel their poor dentition has an effect on self-esteem, consequently hindering recovery. It should always be included in the assessment and they should be given simple advice on dental hygiene (e.g. regular brushing, oral rinsing and the use of sugar-free gum to stimulate saliva production) and explicit advice on how to access dental services in their local area (Ref 1).

Don't forget dental health 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.

Bob has always worked as a labourer and with his wife has raised 3 children. He has long harboured a desire to go back to college but had felt too ashamed of his appearance. He finished his review and with a large grin on his face listed three goals: 1) now he could achieve his desire to become drug-free 2) he could sign on for that access course he had found and 3) he could look forward to walking his daughter down the aisle proudly.

- Dr Chris Ford
GP Lonsdale and Clinical Lead for SMMGP


1. Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care RCGP Substance Misuse Unit (SMU), RCGP Sex, Drugs and HIV Group (SDHIVG), Substance Misuse Management in General Practice (SMMGP), The Alliance.