In 1997, when I started treating patients at the Sonoma County Jail, "Breaking Bad" was still 10 years away. I didn't even know what methamphetamine was. However, I immediately became familiar with its oral effects. As I saw patient after patient with advanced dental decay that was blackened, I started asking them about it out of caring curiosity and a desire to create treatment plans that would work. And because I approached the conversation without judgment, they opened up to me about their drug use.
Since then, methamphetamine addiction has only become more common, even as the opioid crisis eclipses it in the headlines. As dentists, we are perfectly positioned to be a front line of healthcare for these patients because of the oral effects of methamphetamine use. Yet drug use of any kind is still a conversation most dentists avoid with patients because they feel it is none of their business.
But it is our business. A patient’s substance use is a health indicator and a risk factor in creating treatment plans. It impacts cardiac and respiratory function, mental health, and—if a patient comes into your office under the influence—the ability to obtain informed consent. With methamphetamine, it means patients are at a higher risk for caries, hyposalivation, and poor oral hygiene, which means you can’t present a complex, high-risk treatment plan, like implants—and yet I’ve seen patients with a mouth full of failed implants and a dentist's missed diagnosis of methamphetamine use.
Treatment Planning with Awareness
My 27 years of experience in Sonoma County taught me that when it comes to drug use, recognition is not the biggest hurdle in effective dental treatment. Communication and understanding how a patient’s drug use will affect their treatment is the biggest obstacle many dentists face. With self-education about the effects of methamphetamine and other drugs, you can set reasonable expectations and treat patients successfully.
As for communication, the first step is simply opening the door to the conversation, which is as straightforward as updating your health history form with 2 questions: "Do you have a history of substance use? If yes, what type of drugs have you used?" With this information, you can avoid awkward questions in the operatory and move straight to an objective, caring dialogue:
“Mrs. Jones, on the health history form, you indicate a history of methamphetamine use. Can you tell me a little bit more about it? The reason I'm asking is that I really want to help you get to a better state of oral health. I want to make sure I'm treating you in a manner that allows us to partner together.”
Approaching your concern this way replaces the patient’s perception of judgment, accusation, or shame with your desire to help the patient achieve optimal oral health. And you might be surprised how often patients open up about their substance use histories.
The Role of Dentistry in Addiction Care
Addiction is a disease. Our job as dentists is to develop treatments, recommendations, and referrals that maintain a bubble of safety for these patients—not to judge them. It is a missed opportunity when we, as dentists, don't discuss our concerns about possible substance use with our patients. The person sitting in your chair is somebody's child. If they were your child, and someone recognized that they were using drugs, wouldn’t you want that person to help them?