Oral Health Topics
Asking patients about their drug and alcohol use is something that dentists often struggle with. Some feel uncomfortable about prying into what they perceive as a patient's 'personal business' when they may not see a direct connection to whatever dental treatment will be provided on a given day. Sometimes dentists don't want to ask about illegal drug use because they are unsure how to respond to an affirmative answer. And other times dentists don't ask because it doesn't occur to them that their patients would be using 'those' drugs.
The epidemic of methamphetamine (sometimes called speed, ice, etc.) abuse, with that drug's devastating damage to teeth and oral tissues, is rapidly making it urgent that dentists not only know what to look for and how to treat it, but how to talk about it—and how to direct patients to get help for their drug problem.
Who are these people who are using meth?
- Adolescents and college kids, looking for that powerful high and a good time
- High-achieving high school and college students wanting to cram more hours into the day
- Women who love the way meth takes away their appetite
- Moms looking for a way to "do it all" really fast
- Long-haul truck drivers needing to stay awake
- Professionals under pressure to do more and more (e.g., lawyers, CPAs in tax season, medical residents on night call)
- Gay men looking to kick up the sexual thrill to a new high
- The bored, lonely, angry, depressed--looking for a way to feel better
- IT COULD BE ALMOST ANYBODY
Patients expect their dentists to be savvy about causes of tooth damage. They expect their dentists to say something. And they think that, if their dentist doesn't say anything, that everything's all right.
One comfortable, 'backdoor' way to ask about drug use, and to educate yourself in the process, is to remark to every patient that you're becoming aware of meth use in your community. What have they heard? What's happening at the high school or on campus? What are they hearing at the gym? Do they have acquaintances who've started using? Have they tried it themselves?
If you're in an area where methamphetamine use is widespread, it doesn't hurt to admonish every patient to avoid its use.
In fact, there is research that supports the efficacy of brief interventions by professionals who are aware of a patient's risk. These interventions are sometimes as simple as admonitions not to start or continue to use a substance, or to decrease the amount and frequency of use. We know that patients have high opinions of recommendations that come from their dentists, and that this may be an opportunity to do a great deal of good.
Point out the first signs of damage to the teeth. Because of the rapid progression of meth addiction, you might not get another chance to do early prevention. Show the patient what's wrong, explain why you're concerned. Express concern and not judgment—the difference looks like this:
"You've got such a bright future ahead of you, I'd hate to see you jeopardize it with drug use." And
"What on earth is a bright kid like you doing putting junk like this into your body!"
One dentist has found she gets the best responses from patients when, after clinical and radiograph findings, asks "How did your teeth get to be this way?"
Remember, meth almost literally hijacks the brain. It happens fast, like slipping on the ice. (Maybe it's no accident that one of meth's street names is ice.) It's very addictive, and addiction is a disease of the brain—not a moral failing.
Find out what patient behaviors beside the drug use itself are contributing to tooth damage. Is it consumption of large quantities of sugar-sweetened beverages? Is it constant sucking on hard candies? What about failure to brush the teeth?
And, what is the patient willing to do? Could they stop using? Would they accept a referral to a treatment program? Would they commit to some harm-reduction strategies, like alternating sodas with ice water (hopefully fluoridated!), brushing their teeth twice a day, wearing a mouthguard?
How can you refer a patient to a treatment program? The same way you'd refer them to a specialist!
"I'm concerned you could be getting in over your head with your drug use. Here's the name of a person at a treatment center. I'd suggest you go talk with them and see if they can help you." It helps if you have a name, and if you know a little about what the patient could expect. For example, "Someone there should be able to see you in the next 24 hours. There's no charge for the first visit. They'll help you find a place you can afford, or that will accept your insurance."
How can you find out about the treatment resources in your community? One of the fastest and easiest ways to do this is to ask your local emergency room staff. They keep current information on local public and private treatment programs and professionals. Your state dental society well-being committee members will be familiar with such resources as well. Each state government should have a division for addiction services in the state, and that information is available on websites. In addition, information can be found at http://findtreatment.samhsa.gov.
For more information about methamphetamine or other drugs of abuse, see:
- A-Z Topics: Meth Mouth
- American Society of Addiction Medicine
- Mayo Clinic, click on D for Drug Addiction
- National Institute on Drug Abuse (NIDA)
- National Institute on Drug Abuse (NIDA)
- U.S. Drug Enforcement Administration (DEA)