Study: Dental care improves treatment outcomes dramatically for patients with drug and alcohol addiction

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SALT LAKE CITY — A study published by University of Utah researchers this week has found that comprehensive dental care improves the efficacy of substance use treatment and improves overall mental health.

The study demonstrated that not only did well-rounded oral healthcare improve outcomes of drug and alcohol abuse treatment programs, it also decreased homelessness and helped participants find jobs.

Dr. Glen R. Hanson, DDS and Ph.D., is a professor of dentistry, pharmacology and toxicology and the lead author on the study. The origin of the research is somewhat serendipitous, he explained. “The original intention of our grant was to try and train dental workers on how to care for a patient receiving treatment for a substance use disorder.”

The trajectory of Hanson’s work took a turn when, around halfway through the training grant, First Step (a substance use treatment agency in the program) came to him with data about the length of stays at the treatment facility. They saw a dramatic increase in how long those patients who were also receiving comprehensive dental care through the University of Utah stayed in treatment, according to Hanson.

This went for the full spectrum of patients, according to Hanson, most of which beginning in inpatient care and continuing treatment through outpatient care.

Odyssey House, the other agency the researchers worked with, saw the exact same thing. “If they were receiving comprehensive dental care from the school of dentistry, they stayed in treatment twice as long,” Hanson said.

The researchers collected this data and found that they also showed an 80 percent increase in rates of program completion, according to a University of Utah news release.

“We looked at employment and patients were two to three times more likely to be employed at the end of treatment if they received dental care," Hanson added. "We looked at homelessness and if they received dental care, homelessness almost completely disappeared.”

Hanson said he also examined abstinence from drugs and if they received dental care, participants were two to three times more likely to stop using.

“About half of them were using heroin, a third using methamphetamine and the rest were using alcohol and marijuana,” he explained. “It didn’t seem to matter what drug their abuse problem was with; they all responded the same way.”

The program involved in the study was known as “FLOSS.” Between 2015 and 2017, First Step House and Odyssey House identified individuals in the substance use programs to either be assigned to treatment or control groups, according to the news release. All of the individuals had major oral health problems.

Those selected were randomly assigned to groups, with 158 men in dental and 862 men in the control groups at First Step House and 70 men and 58 women in dental and 97 men and 45 women in the control groups at the Odyssey House, according to the press release. They were treated with anything from root canals to dentures.

Hanson’s research showed gender, sex and age did not play a part in the outcomes. “The only thing predicting improved outcomes was whether they received comprehensive dental care,” he explained.

“We all know (individuals with substance use disorder) have major dental problems,” Hanson explained. “Usually there’s no money to provide comprehensive dental care to these patients.”

More often than not, Hanson said, they are checked into the emergency room if they have an abscess or other serious problem and they get the tooth extracted. He added that that results, for example, in a 30-year-old with two-thirds of their teeth removed. “They won’t talk, they won’t look at you…” Hanson said. “Their self-image is terrible, they can’t get a job and they are in a state of despair.”

Dental care removes chronic pain, health-damaging infections and improves their appearance and self-esteem, Hanson said.

“If you can come and change those problems in a very short period of time, that impact is so dramatic," he said. "It’s exciting to watch these people go stand, look in the mirror and have this great big smile come onto their face.”

The paper may have only just been published, but Hanson said they saw these outcomes much sooner and started working on making dental care more accessible to low-income populations with substance use disorder. A group of patients called “Targeted Adult Medicaid” individuals or “TAM” patients, who were homeless people with mental health and drug abuse problems, were the first subjects of Hanson’s interest.

“We took it to the Legislature and said ‘you’re going to see (these same results as we saw in the study) with these TAM patients if you allow us to provide dental care through the Medicaid program’,” Hanson said. “The House, Senate and governor unanimously voted for it. (Since) March this year, TAM patients have been coming into the U. School of Dentistry network and we have been providing them with comprehensive dental care.”

For now, Hanson’s goal is to get dental care to as many patients with substance use disorder as possible.

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