Comprehensive oral care improves treatment outcomes in male and female patients with high-severity and chronic substance use disorders

Abstract

Background-Using data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre-and posttreatment assessments of highseverity and chronic substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes. Methods-After 1 through 2 months of treatment at a SUD treatment facility, 158 male selfselected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility-influenced outcomes were determined with multivariate analyses. Results-The dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval [CI]) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes. Conclusions and Practical Implications-Improvement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.

Illicit drug use and oral health

“…They may also interfere with vital functions such as breathing, food selection eating, swallowing and speaking, and with activities of daily living such as work, school, and family interactions.' (cited in [86]). Therefore, the oral health problems among PWDUD clearly extend beyond the oral cavity and need to be considered also by primary and specialized health and care services.…”

“…Almost half of those referred, had completed or remained in a course of treatment (75). Another example is from a program (FLOSS) in the USA, which offered comprehensive oral health care to a sample of patients who were in DUD treatment and had significant dental needs (86).…”

“…Restorative treatment of severe dental decay can for instance include endodontic treatment, comprehensive fillings or/and prosthodontic treatment with crowns or bridges, all of which are time consuming and expensive, and they usually require use of analgesics and several, sometimes lengthy, treatment appointments (e.g. [86]). Often PWDUD miss their dental appointments or come late [88].…”

“…According to the United States surgeon general, oral disease can ‘… undermine self‐image and self‐esteem, discourage normal social interaction and cause other health problems and lead to chronic stress and depression as well as incur great financial cost. They may also interfere with vital functions such as breathing, food selection eating, swallowing and speaking, and with activities of daily living such as work, school, and family interactions.’ (cited in [86]). Therefore, the oral health problems among PWDUD clearly extend beyond the oral cavity and need to be considered also by primary and specialized health and care services.…”

“…Compared to others in DUD treatment, those in the FLOSS program had improved treatment outcomes with regard to drug abstinence, completion of DUD treatment, and employment (86). The authors speculated that these beneficial outcomes could be explained by improved overall wellbeing and quality of life.…”