BSDH Spring Meeting: Drugs and Homelessness in Dentistry

Back in April, I attended the British Society for Disability and Oral Health's spring meeting. I presented a poster WHICH I WON, but also learnt lots across the 2 days including lots about managing substance misuse... 

The 2 days of the conference were cram packed full of interesting talks, from learning about the city of Bradford, to the Special Olympics. I'm going to summarise a talk by Caroline Graham about drugs in dentistry since it really helped give me practical tips I could relate the work I have been doing with the homeless. 

Is Drug Misuse a Problem?

Depending on the area and the population you deal with, drug misuse can be a day to day occurrence with your patient group. Certainly in East London on the mobile dental van, it was something I came across all the time. 

1 in 11 adults have taken drugs last year, with 2.1% of the population using them frequently - most commonly, cannabis and cocaine. Often, the drug use has co-morbidities associated such as mental health problems, complicating medical problems (such as blood borne viruses), as well as complex social situations such as homelessness or domestic violence. 

How is Drug Addiction Treated?

There are some amazing drug and alcohol services out there. The services I come into contact with in Tower Hamlets is Reset and in Newham CGL: both provide amazing support for those engaged in their services and include outreach onto the streets. 

A client is often assigned with a specific keyworker who can support them. Treatment can be:
  • Substance replacement prescriptions e.g. Methadone
  • Harm reduction treatment
  • Detox
  • Family support


Many of you may have seen the effects of this replacement for heroin: Meth mouth. 

Methadone is gradually titrated as heroin use is reduced; eventually with the idea to wean completely off the methadone but people can be taking it for years. The overall success rate for methadone programmes is 26%. 

The problem with methadone which means it can cause significant caries is twofold; it causes xerostomia which increases the risk of decay, and traditional constituents were sugary syrups. Nowadays, services are more aware of the effect of sugars so often prescribe sugar free solutions. 

Methadone is a less potent analgesic than heroin, so once clients switch over, chronic pains such as toothache which were masked by the heroin become an issue. Prescriptions are usually given daily as among users there is a trade of the drug, especially since a tolerance is built over time.

Oral Effects of Drug Use

The effects we can see of current or previous drug use include:
  • Xerostomia
  • Oral Cancer
  • TSL (erosion due to vomiting, bruxism often in stimulant use)
  • Mucosal erosion/perforation (common in cocaine use)
  • BBV (50% of IV users are Hepatitis C positive)
  • Vascular damage from chronic injecting (DVTs, abscesses, increased risk of infective endocarditis)
  • Caries - due to chaotic lifestyles, poor OH and diet
  • Periodontal disease due to poor OHI and smoking
  • Late presentation of problems. Patients have marked pain and infection, acute anxiety and stigma 

Top Tips in Management

I really related to these tips for managing not only patients with substance misuse, but all groups that can experience social exclusion e.g. homeless, travellers, sex workers. 

  • Treat patients in the contexts of their lives i.e. should you just treat their symptoms and leave that retained root not causing an issue, should you address the class V cavities on their incisors rather than providing RSD?
  • Improve health wherever you can, make every contact count and signpost to other services the patient needs
  • Work out how you can improve motivation e.g. making them a spoon denture to replace a front tooth to improve self esteem which could motivate them to improve self care
  • Patient's pain tolerance can be poor especially if they have just started treatment with methadone. Make sure you have adequate LA
  • Note of possible cardiac interactions with LA for those taking stimulants. Consider reducing dose
  • Sedation is rarely appropriate and can be unpredictable, so treatment should ideally be with LA
  • Access to services is important and may need some adjustments e.g. drop in clinics, mobile surgeries, appointment reminders

My Poster

During the conference, I presented some of the work I have been doing with the homeless population in East London including background work before launching our Mobile Dental Surgery!

The poster that was displayed at the conference presented the planning of how we decided where the van visit as well as planning and logistics around this. 

To see a copy of my poster, click here.

Overall, I had a wonderful time up in York at the conference bumping into familiar faces and making new acquaintances! See everyone at the Winter Conference in London!

Have you managed patients with substance misuse problems? What adjustments did you make if any? Let me know in the comments below!

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