Comics explore links between drug use and oral health

Artists, dentists, public health experts and addiction workers have collaborated with people with lived experience of drugs to create a series of comics that examine the impact of substance use on oral health.

The University of Dundee, NHS Fife and the Scottish Drugs Forum came together for the Oral Health Improvement for People with Experience of Drugs (OHIPED) project. The comics they produced form part of a series of resources that will be used to deliver oral health mentor training to addiction workers and to raise awareness of the issues highlighted to improve access to services

The involvement of people with a history of drug and alcohol use was central to the project and they related their experiences with the help of the University-based Scottish Centre for Comics Studies.  

Drug use affects oral health through direct physiological routes but the lifestyle that often accompanies problematic drug use also affects oral health through high-sugar diets, malnutrition, poor oral hygiene, and lack of regular professional dental care. 

Research from the University’s School of Dentistry has previously shown an increased prevalence of decayed and extracted teeth among people with substance use problems, who also reported increased embarrassment and stress regarding their appearance leading to poor self-esteem. They recounted poor experiences of accessing dental services and preventive dental care, with the stigma of past drug use increased significantly by poor oral health. 

The project also addressed the fact that, rather than visiting their dentist to receive safe pain relief, individuals might choose to deal with toothache by self-medicating when they may already be taking a variety of other substances.

“The participants told us that when they were using drugs they were not thinking about their oral health,” said Dr Niall McGoldrick of the University and NHS Fife. “In addition to the aesthetic impact of this, it obviously makes them more susceptible to infections and other oral health problems. 

“A major concern is that when dealing with significant toothache or other problems, individuals may be tempted to take more drugs to deal with the pain. This is more likely to happen when people are disconnected from services and could increase the risk of overdose.

“This is one of the first studies to look at this issue, but we have substantial anecdotal evidence about the effects of prolonged or problematic drug use on an individual’s oral health.

“Participants told us that a passer-by might smile at them, but they didn’t feel they could smile back because they were embarrassed by the state of their teeth. They also felt uncomfortable accessing dental services because they felt they were being judged by clinicians, so we are also seeking to educate those working in the dental profession about how stigma prevents people from accessing treatment.

“We saw the comics as a novel way to communicate these messages as an adjunct to a wider oral health improvement programme. The stories are based on lived experience and each comic is designed around a particular theme. We need to engage more with this group and let them know about safe pain relief, how to access treatment and how to look after their family’s oral health.”

The comics cover safe pain relief, addressing dental anxiety, how to access dental services, and risk reduction. They are just one of several
resources that volunteers with the SDF helped produce to share how their experiences with drugs and/or alcohol has impacted on their oral health.

All resources produced as part of the project will be used as part of a training programme to enable addiction workers to be advocates for oral health. Training was delivered to trainee addiction workers who provide care in recovery hubs, justice settings and homelessness support centres. The project partners also sought to develop the capacity of volunteers with a history of drug and/or alcohol use to undertake research. 

Katy MacLeod, Peer Research and Engagement Programme Manager at SDF, said, “This project has offered a good opportunity for organisations to bring their expertise together and co-produce materials with peopled with lived and living experience of problematic drug and alcohol use.

“By communicating these messages through the voices of those who have living experience, the project aimed to produce innovative resources for groups who may not typically access dental health services.

“Scottish Drugs Forum volunteers involved in the project have offered a crucial insight into the experiences and barriers around accessing
dental health services. The volunteers involved shared that they identified with the stories, characters and animations that were produced and felt such health messages in this kind of format work, as it would be something that they would read and understand.

“We hope that these creative and accessible resources will have a positive impact on raising awareness and increasing uptake of dental health care services amongst people who use substances.”

Previous public education comics created by writers and artists at the Scottish Centre for Comics Studies have helped raise awareness of a range of conditions and issues including heart disease, coeliac disease, grief, and organ donation. 

The OHIPED project involved Professor Christopher Murray, of the School of Humanities and Director of SCCS, and comics artists Dr Damon Herd, Rebecca Horner, Andrew Strachan, Olivia Hicks and Katie Quinn. The comics they co-designed explore interrelated and complex issues, including oral health, drug use, and social attitudes to visualise the experiences of the participants.