Gum and dental disease are the most common diseases in the world and are especially prevalent among people who use drugs.
Manager of the oral health service at North Richmond Community Health, which hosts one of Australia’s busiest NSPs, Associate Professor Rachel Martin says that issues with teeth and gums also have broader implications.
“People come to us for pain relief [due to teeth problems] and, if not for that, then to get their teeth fixed so they can smile, so they can get a job, and so that people don’t identify them as a drug user. They are aware that their teeth are an outward sign that they are using drugs. They are very aware of it. It is a big issue for them,” says Rachel.
“Drugs like heroin, methadone, and methamphetamine (and many pharmaceutical medications) reduce saliva, which serves as a natural protective mechanism in the mouth. Crystal methamphetamine can also cause teeth clenching and grinding.
“Consequent damage is often compounded by poor lifestyle choices and the significant cost and stigma of seeking care,” she says.
Needle and syringe program workers are some of the few people who have the access and rapport to improve poor oral health in people who use illicit drugs.
Rachel says NSP workers on the front line can use clear messaging to help prevent poor oral health before it becomes a major concern.
“It’s as easy as offering simple messages: ‘make sure you stay hydrated with water’ and ‘use fluoride toothpaste’,” Rachel says.
“Most definitely, there are effects of particular drugs that are very detrimental to the mouth, but it’s also about managing diet and sugars too – constant sugar will increase the opportunity for bacteria to wreak havoc in the mouth and cause decay.
“It’s also about directing clients to the appropriate health care services – finding out what services are available in that particular area and directing people to those services.”
While free or subsidised oral health care is available to those who hold a government concession card, it often involves numerous appointments and two to three years on a waiting list. What’s more, the stigma of being identified as a person who uses drugs acts a significant deterrent to most.
As a result, people who use drugs often neglect treatment for oral health issues, which can have untold ramifications on their psychological health.
“We see a direct link between poor psychological health and poor oral health,” says Rachel.
“Oral disease develops over time, it’s not necessarily seen as a priority and we often only see people who are seeking emergency care,” she says.
Leah is a volunteer for the NSW Users and Aids Association (NUAA) and has been on the methadone program for over 17 years. She has experienced many of the psychological consequences of poor oral health. Leah lost a tooth while on the nod almost 20 years ago, and the problem quickly spread through her mouth when she was unable to seek the appropriate care.
“I just didn’t have the money to go to the dentist. I support a family, as well as my drug use, there is nothing left over when you do all that. I don’t get public benefits, so I can’t get it fixed through public health,” Leah says.
“You sort of have to get it dealt with, and I haven’t dealt with it. It should be a priority, but it’s just kinda not,” she says.
“It’s really hard to make it [your teeth and oral health] a financial priority when your money is being sucked into something else. If you don’t get it done straight away then it becomes this huge problem, and the bigger the problem the more its gunna cost, and the harder it is to deal with. It just keeps building.”
Leah says there is definite stigma related to bad teeth.
“Now my teeth are all rotten and crooked, and people definitely treat me differently,” she says.”
“It was quite hard at the beginning of my time at NUAA. I was doing a lot of presenting, and for a while I didn’t do any of it because I didn’t look good.
“Even now, I do try not to open my mouth very much, I don’t get photographed, I don’t smile very much.”
Around 15 years ago, Leah received $2000 to get her teeth fixed as part of a government primary health program, which she says gave a great boost to her self-esteem. But the program disappeared with a change of government.
Today, people who use drugs are limited in their treatment options, says Rachel.
“There is not a lot of choice in Australia, it depends on people’s circumstances – what their access to resources and hygiene and food is. A lot of it depends on what the situation is, what their lifestyle is,” Rachel says.
A Grattan Institute report released in late March 2019 ‘Filling the Gap’, however, has recommended that all Australian’s have access to free basic dental health care. In the meantime, Rachel encourages all NSP workers to advocate for people with poor oral health and direct them to the appropriate services.
“Needle and syringe program workers can be advocates for people who need oral health care. I would encourage people who work in NSP programs to raise the issue of oral health, do a quick account of what community health services are available in that area, and deliver those really simple messages,” Rachel advises.
“It’s the simple things that can really make the biggest difference.”
– Tom de Souza
Dental health fact sheets and flyers
Dental Health Services Victoria:
- Protecting your mouth – all you need to know about tobacco, alcohol, recreational drugs… (fact sheet)
- Dry mouth – what the? (flyer)
- Tobacco, alcohol and recreational drugs – how do they affect oral health?
Information for people working with young people (fact sheet)
SA Dental Service:
- Dry mouth (fact sheet)
Tips for NSP workers talking to clients about oral health:
- Find out what dental services are available locally and assist clients with a referral to those services.
- Things to let clients know:
- It’s not just the drugs that do damage. Lifestyle factors such as a diet high in sugar or frequent consumption of sugary drinks have a big impact too.
- Make sure you stay hydrated with water – this can help to counter the dry mouth (lack of saliva) caused by some drugs.
- Chew sugar-free gum to help produce saliva.
- Don’t forget to brush your teeth using fluoride toothpaste.