Oral health an additional concern for providers to chew on

Among the many ways in which substance use disorder wreaks havoc on a person’s well-being, oral health often is an overlooked component. Nevertheless, the effects that illicit substances and misuse of prescribed medications can have on teeth, gums and the oral cavity can also lead to other health concerns, all of which greatly hinders recovery.

For that reason, Mark Calarco, MD, the national medical director for American Addiction Centers, says his aim for AAC facilities is to be true medical homes for clients, and not only places that directly treat addictions and co-occurring disorders.

“Sometimes, we think of oral health as being secondary behind those other issues in priority, but the research is showing it’s just as critical as any other aspect,” Calarco says.

“Meth mouth”—severe tooth decay and gum disease—is a commonly known result of methamphetamine use, as illustrated by a 2015 National Institute on Drug Abuse study in which 96% of methamphetamine users in were found to have cavities. But other substances, from opioids to cocaine to even marijuana, have been shown to cause damage to the mouth. A 2005 study appearing in the British Dental Journal found that 95% of all illicit drug users surveyed reported experiencing dry mouth, while 75% experienced a “chewing” sensation, 56% felt pain or tenderness in their jaw muscle or jaw joint, and 52% developed a habit of grinding their teeth.

Understanding the effects

Dry mouth in particular opens the door to a series of other oral health problems, says Harold Katz, DDS, founder of the California Breath Clinics.

“Healthy mouths are always in balance, which means you have plenty of saliva,” Katz says. “Saliva does a lot of beneficial things. Not only does it keep your breath fresh, it prevents tooth decay and gum disease because of the enzymes in saliva, as well as minerals and oxygen.” A lack of saliva can also eventually lead to the beginning of gingivitis, bleeding gums and the loss of teeth, Katz adds.

Oral health problems stemming from substance use put patients at an increased risk for other ailments as well. The oral cavity is its own microbiome with its own set of bacteria, says Calarco. Imbalances in that microbiome heighten the potential for heart attack, cardiovascular disease and Type II diabetes.

Both Katz and Calarco note that pregnant women face even more risks, including preterm labor and miscarriages. When patients have bleeding gums, the open wound sites created in the mouth allow toxins to enter the bloodstream and cross the placenta, affecting the baby, Katz says.

“It’s that whole continuum of drugs directly and indirectly leading to a domino effect in causing a lot of disease processes,” Calarco says.

Oral health in treatment

Self-neglect, particularly with regards to oral health, is a common theme among those with substance use disorders, making the re-establishment of good oral hygiene practices a key part of addiction treatment, Calarco says.

Katz recommends that patients brush their teeth twice per day and two minutes per brushing. He also recommends treatment centers to provide non-alcoholic mouthwash and toothpaste, and to also use a toothpaste with fluoride to remineralize the tooth enamel. Lastly, Katz recommends daily flossing to remove food particles, which promotes faster healing of gums.

Calarco, meanwhile, says that when addiction treatment patients are in detox, be prepared for patients to experience increased oral pain, including pain in the jaw and headaches, if they have underlying dental health issues.

“(Opioids) can mask a lot of underlying, serious dental issues,” he says. “When patients are going through the withdrawal process and treatment, all of the sudden, that pain will rise to the surface and be very acute. If you’ve ever had bad tooth pain, you know it can be excruciating.”

Opioid alternatives post-surgery

During many cases of addiction treatment, it is discovered clients will require extensive dental work to address damage incurred through substance use. Such surgery could cause intense pain for the client, but given their substance use history, prescribing opioids isn’t a safe and viable option. In these situations, Mark Calarco, MD, recommends the following alternative pain management modalities:

• Topical analgesics, such as lidocaine and clove oil
• Nonsteroidals (NSAIDS), such as ketorolac and naproxen
• Acupuncture
• Bridge, a neuro-stimulation device that attaches to the earlobe that targets withdrawal-related pain
• Auricular therapy
• Ice, heat, ultrasound or a battery-powered TENS (transcutaneous electrical nerve stimulation) unit, which uses a low-voltage electrical current to deliver pain relief through skin patches

Calarco also notes that many of these modalities can be combined or “stacked” to provide additional comfort.

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Oral health impacts by substance

Various illicit substances heighten the risk for different oral health ailments. The following is a list of oral health complications specific to different intoxicating substances:

• Opioids: Heroin causes sugary food/drink cravings. Other complications include: grinding teeth, oral fungus, viral infections, loss of sensitivity (which could lead user to ignore cavities or gum disease).
• Alcohol: Increased plaque buildup, rapid tooth decay, tooth stains.
• Amphetamines: Grinding teeth, jaw damage, dry mouth.
• Cocaine: Powdered form rubbed into the gums creates mouth sores and damages tooth enamel, while snorting damages upper palate tissues. Cocaine use can also lead to jaw and mouth-related muscle spasms and grinding teeth.
• Marijuana: Oral cancer, dry mouth, vomiting, tooth enamel damage
• Meth: Dry mouth, gum disease, grinding teeth, increased cravings for sugary foods and drinks.
• Tobacco: Smoking and chewing tobacco increases risk of oral/throat cancer. Other risks: gum disease, halitosis.

Source: https://americanaddictioncenters.org/how-does-drug-abuse-affect-teeth-health/

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Substance use spotted by dentists

While oral health issues often surface during addiction treatment, the inverse is common as well.

Harold Katz, DDS, founder of the California Breath Clinics, tells Addiction Professional that it is often dental professionals who are the first to identify a patient’s potential substance use disorder because individuals with SUDs tend to stay away from physicians.

“It’s pretty easy for a dental professional to look and see something isn’t quite right,” Katz says. “Today, if people can sneak around and are addicted to opiates and no one can tell, sometimes the dentist can tell by the constant dry mouth, increase in tooth decay and increase in gum disease.”