With Your Patients
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
looking for a way to “do it all” really fast
truck drivers needing to stay awake
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/ Substance
Abuse Treatment Locator for the Substance
Abuse and Mental Health Services Administration.
For more information
about methamphetamine or other drugs
of abuse, see: