Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals’ experiences

Abstract

Background People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). Methods Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. Results Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients’ expectations and the services offered and perceived stigma. OMT patients’ lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs’ lack of knowledge and information of the OMT system and what they can offer patients. Conclusions OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.

Providing better access to oral health care for people receiving substance use treatment: A timely discussion

“…These oral health treatment plans should be simple, feasible, centred on client's needs and developed in collaboration with the client. Accessing dental services and regular attendance by AOD service clients have been identified in the literature as key challenges [2,3,11]. To address this, a multidisciplinary care approach is an essential factor in delivering quality dental treatment to priority populations [1,2] including AOD service clients [1].…”

“…There is little argument that poor oral health is a significant problem among clients of AOD services [1]; and that good oral health is an integral part of overall health, quality of life and wellbeing [2]. Studies have shown that people who use drugs are at increased risk of poor oral health [3] that impacts on their quality of life [2,[4][5][6]. As described in the scoping review, studies of people with substance use disorder (SUD) report high rates of caries, periodontal disease, xerostomia (dry mouth), bruxism, prostheses, toothache and tooth loss [7].…”

“…There are individual and/or structural barriers that might limit the use of oral health care by people with SUD [3]. Individual barriers include low self-esteem, dental phobia, difficulty in managing pain, trauma generated by previous dental experience, cognitive impairment, stigma, inadequate finances and continued use of substances [3,7].…”

“…There are individual and/or structural barriers that might limit the use of oral health care by people with SUD [3]. Individual barriers include low self-esteem, dental phobia, difficulty in managing pain, trauma generated by previous dental experience, cognitive impairment, stigma, inadequate finances and continued use of substances [3,7]. The cost of dental treatment, poor accessibility of services, general misconception in the community regarding accessibility, social background and lifestyle challenges are structural barriers for seeking oral health treatment [3].…”

“…Individual barriers include low self-esteem, dental phobia, difficulty in managing pain, trauma generated by previous dental experience, cognitive impairment, stigma, inadequate finances and continued use of substances [3,7]. The cost of dental treatment, poor accessibility of services, general misconception in the community regarding accessibility, social background and lifestyle challenges are structural barriers for seeking oral health treatment [3]. The higher prevalence and risk of trauma among people with SUD [8][9][10], in combination with these factors can create substantial challenges for people with SUD in following processes like making and attending appointments, thus amplifying the impact of structural barriers on accessing treatment [2].…”