A patient recovering from addiction may not have “visit the dentist” at the top of their to-do list. However, as staff dentist at UVM Medical Center, I have seen that the medication they rely on in recovery – as well as some habits they might be carrying with them – can impact their oral health.
As Vermont’s medical community works to address the opioid epidemic, an increasing number of physicians and other clinicians are training to prescribe suboxone and bupenorphrine. Patients generally take suboxone by placing a film under the tongue, and allowing the medication to absorb into the mouth. Unfortunately, the films are acidic, and the acid remains in the mouth – creating a perfect environment for tooth decay.
One day during my residency year, I examined a patient who had a seriously dry mouth, significant chalky plaque buildup on her teeth, and cavities all along her gums. At her side was a 20-ounce Dunkin’ Donuts sweetened coffee. She told me she smoked half a pack of cigarettes a day.
Since then, I have noted that the majority of my patients who take suboxone have similar symptoms: a very dry mouth, heavy plaque accumulation, and decay along the gumline. We already know that many prescription medications can cause dry mouth. And while there is not much literature yet, anecdotal evidence has continued to pile in from other residents and community dentists around the country.
Many patients, such as the patient I saw early on in my residency, also have other habits that can contribute to dental problems – such as smoking, drinking sugary or acidic beverages, having irregular dental care access and poor home care.
We are still learning about the side effects of suboxone, and raising awareness through efforts such as hosting dental clinics at places where people in recovery can access them. Last month, I hosted a clinic at the Turning Point Center of Chittenden County, where we screened patients for urgent dental needs and offered them education about oral health.
Fortunately, the steps patients in recovery can take to limit the side effects of their medication are similar to the steps that anyone can take to improve their oral health, including:
- Avoid smoking. If you’re not ready to quit, consider cutting back. Even reducing the number of cigarettes smoked per day is a step in the right direction.
- Drink more water, and try to stick to water only. If you really need your caffeine fix, try to have a small amount (12 oz or less) over a short period of time (30 minutes or less). The longer your mouth is exposed to the sugars and acids in many of the beverages we consume, the more risk for irreversible breakdown of the teeth.
- Consider chewing a gum that is sugar free and has xylitol in it, which helps neutralize the saliva. (For those who suffer from jaw joint or chewing muscle discomfort or tightness, it is better to avoid chewing gum. Mints also contain xylitol.)
- Brush your teeth regularly and well, in the morning and at night, for two minutes at a time, and make sure to remove the plaque that builds up along the gumline. Floss daily.
- Seek routine dental care and hygiene visits. A professional cleaning is the only way to remove heavy buildup, and regular dental examinations help detect areas of concern early.
The UVM Medical Center’s Dental and Oral Health practice provides care for patients of all ages. We accept Medicaid and most other forms of insurance. Call 802-847-1777 to make an appointment and start on a path to better oral health.
Katera F. Hopkins, DMD, is clinical dentist and residency faculty at the UVM Medical Center Dental and Oral Health Care.