Dental professionals can help reduce harms associated with drug use, according to a University of Dundee researcher who headed up a Scottish Government-funded project to help improve the oral health of people who use drugs.
Dr Niall McGoldrick, from the University’s Faculty of Health, was speaking as Minister for Drugs and Alcohol Policy, Maree Todd, visited Dundee to hear from researchers, practitioners, and people with lived experience about the relationship between oral health and substance use.
Dr McGoldrick and colleagues at the University, working alongside Public Health Scotland, NHS Education for Scotland, and the Scottish Drugs Forum, have now developed a series of resources for healthcare professionals, social care professionals and people who use drugs.
These include digital training programmes for dental and social care professionals. The resources are designed to help practitioners understand the interplay between drug use and poor oral health, remove some of the barriers that people face in recovery and raise awareness of how they can help prevent drug deaths.
“Improving oral health is a way of reducing stigma, boosting confidence and ultimately enhancing recovery,” said Dr McGoldrick. “That is what we are impressing upon the dental workforce in Scotland, so they understand they have a role to play in the national mission to reduce drug-related deaths and harm.
“People with lived experience of drugs tell us they feel judged when they go to the dentist and avoid doing so, even when they have problems that need urgent attention. Instead of visiting their dentist to receive safe pain relief, individuals might choose to deal with toothache by self-medicating when taking a variety of other substances, putting them at risk of overdose.
“The participants told us that when they were using drugs they were not thinking about their oral health. In addition to the aesthetic impact of this, it obviously makes them more susceptible to infections and other oral health problems. Also, some people may not realise the extent of their oral pain until they are in recovery. The temptation for them to self-medicate in this situation is a factor that puts them at risk of relapse.
“The resources we have developed take a person-centred approach, exploring these challenges and the appropriate language to use to avoid stigma to ensure that all patients feel comfortable seeking oral health treatment. As a profession, we have a role to play in reducing drug-related harms in Scotland.”
People who use drugs experience significantly poorer oral health compared to the general population. This is driven by multiple factors such as the direct effects of certain substances, high-sugar diets, reduced oral hygiene, and limited interaction with dental services. Poor oral health impacts overall health, mental wellbeing, and social inclusion – all factors critical to recovery.
The Drugs and Oral Health project aimed to identify barriers and facilitators to oral health improvement for people who use drugs and to develop practical resources to address these challenges.
Barriers identified include a low prioritisation of oral health due to competing needs, limited awareness of targeted services, stigma and a lack of trauma-informed approaches within health care, and gaps in professional knowledge about oral health implications of drug use.
It is hoped the outputs will lead to improved oral health outcomes for people who use drugs and reduced health inequalities, as well as enhanced engagement between dental and addiction recovery services.
People with substance use problems report 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.
These findings are backed up by the Scottish Government’s Drugs Deaths Taskforce, which recognised that oral health problems are among the most common comorbidities related to substance use.
The Dundee project was funded by the Scottish Government and also led to the development of physical resources co-designed by those with lived experience and are aimed at both people currently using drugs and those in recovery.
All NHS Health Boards across Scotland now supply this information for patients, while several hundred dentists, health and social care workers, policymakers and third-sector providers recently attended a webinar on the Dundee research.
Drugs and Alcohol Policy Minister Maree Todd said, “We want to make sure everyone gets the treatment they need. I welcome these new resources, supported by Scottish Government funding, and shaped by those with lived experience of using drugs, which aim to reduce oral health inequalities and drug harms in our most vulnerable communities. I’m pleased we have delivered on the Drugs Deaths Taskforce recommendation and our Cross-Government Action Plan on Drug Deaths and my thanks go to all our partners.”