Typically, dentists ask their patients if they have been using illegal drugs before beginning a procedure. It’s a practical question, since intoxication and addiction can interfere with treatment. But researchers at Columbia University’s Mailman School of Public Health say these queries can do more to improve the lives of possible addicts — if more dentists embrace their benefits.
“There are a sizable number of people whose visit to a dentist represents their sole interaction with the healthcare system,” said Carrigan Parish, DMD, associate research scientist in the Department of Sociomedical Sciences. “However, our findings underscore a significant barrier in dentists’ attitudes that may limit the potential of the dental venue to play a role in screening for substance misuse.”
According to the researchers, 77% of those dentists surveyed ask patients about illicit drug use, though only 54% believe such screenings should be their responsibility. Drilling deeper, 86% of the dentists who agree that screening is part of their role ask about drug use on their health history forms. Of those who don’t agree, only 68% include these questions. Generally, agreement with the purpose and use of health history forms with substance misuse questions increased with the amount of prior training and knowledge regarding substance use.
Surveyed dentists under the median age of 53 were more apt to say that illicit drug use screening should be part of the dentist’s role than their older colleagues — 62% versus 47%. Also, more female dentists (61%) agreed that such screenings should be the dentist’s responsibility than male dentists (52%). The survey sampled 1,802 dentists in general practice in 2010 and 2011, achieving a 71% response rate.
Drug use can have a negative impact on oral health. Methamphetamine users, for example, see rampant tooth decay, accelerated tooth wear, unexplained advanced gum disease, missing multiple teeth, and overall rapid and severe detrimental dental effects. These patients also often seek cosmetic dental treatment such as veneers and whitening, giving dentists another opportunity to discuss suspected substance misuse, provide treatment referrals, and encourage cessation of drug misuse.
Furthermore, dentists are the second largest group of prescribers of opioid pain medication. Dentists, then, may encounter substance-seeking patients who describe pain that’s more severe than anticipated based on the nature of their dental condition. These patients also may report lost prescriptions for opioid pain medications or only seek dental treatment sporadically.
“In order for substance misuse screening to be compatible with the dental setting, two-way communication between patient and dentist needs to occur more openly,” Parish said. Patients already are amenable to HIV, heart disease, and diabetes screenings at the dental office, Parish added, though further studies addressing patient acceptance of substance misuse screenings are key in determining their acceptance of such services.
Dentists may need additional education to increase their awareness, comfort, and knowledge of substance misuse since they “are well situated to make appropriate referrals to treatment centers if instilled with the proper training and supports,” Parish said.
The full results of the survey are available from the Wiley Online Library.