Improving Dental Health for Clients on Methadone
Greater Southern Area Health Service
This project was entered in the Baxter 2006 NSW Health Awards, Effectiveness of Health Care, category.
Abstract
Clients accessing the Opioid Treatment Services (OTS) at Albury Community Health Centre are at high risk of dental decay. Drugs such as methadone, alcohol and other illicit drugs can be causes of tooth decay. The most common condition associated with methadone is xerostomia ('dry mouth'), as the use of methadone restricts the body's natural ability to produce saliva. Even a small change in saliva production can cause tooth decay.
Current research indicates several approaches to reduction of tooth decay in methadone clients, including brushing, flossing, drinking water, eating more fresh fruit and chewing sugar free gum (Egar W M, O'Mullane D M 1996).
Albury Community Health decided to approach the management of dental hygiene in the methadone client group through a coordinated approach with the Public Dental Program. A dental kit was developed in consultation with the dental team which combined a comprehensive assessment, information and equipment package to inform clients how to reduce the effects of the xerostomia whilst on methadone and lessen the chance of tooth decay.
Planned outcomes are to reduce the incidence of xerostomia, improve awareness and performance of 'tooth friendly' practices and promote the availability of public dental services. Evaluation includes a survey to measure these outcomes and review of public dental clinic data for improved attendance of methadone clients for dental care.
Aim
To provide an improved approach for managing the dental health of clients on the Methadone/Buprenorphine Program.
Background
Methadone users suffer from a common problem xerostomia, which is a direct result of their methadone intake.
Most clients who are on the Methadone/Buprenorphine program are generally from a financially unstable background, usually dependant on government benefits and on a health care card. Direct questioning of the clients by the staff found many clients were unaware of the public dental system and the treatment available through this system, and the affect that methadone can have on oral health.
The effects of untreated xerostomia can have a significant impact on the client as the resultant severe tooth decay can have a negative impact on social activities and can be associated with low self esteem. Treatments, such as extraction, can be costly.
It has been shown that prevention through early intervention for xerostomia can be effective in reducing the long term impacts.
Method
The OTS at Albury Community Health Service is currently staffed by one (1) fulltime and one (1) part time worker and a clinic which runs once a week for half a day by a prescribing doctor. It was identified by these workers that client's dental needs were of concern to them and in discussion with the dental clinic preventative measures needed to be introduced.
A cross check of clients on the OTS program in conjunction with the dental service indicated that 54% used the Public Dental clinic.
Concern then shifted to the 46% of clients who did not access the dental clinic.
Due to the current waiting lists for non urgent treatment the clients were not receiving advice or treatment that would assist in preventing the ill effects of xerostomia. The Dental service was aware of the associated problems with methadone use and extremely eager to promote preventative measures to stop tooth decay with these clients.
The existing practice of providing only verbal information on the possible links between tooth decay and methadone use was felt to be limited in its potential to improve the clients overall dental health.
Planning and Implementation
Consultation with key stakeholders, OTS staff, clients, dental therapists and dentist were engaged to discuss an approach to the need to educate the clients on dental care.
It was agreed that a dental hygiene kit would be trialled. This kit was to be handed to clients and informal verbal education provided on dental health practices and how to access the public dental clinic.
After consultation, the kits were developed and comprised of:
1. A toothbrush;
2. Tube of tooth paste
3. Packet of sugar free gum
4. Information pamphlet (dental health information for people taking methadone) Used with permission of the Royal Women?s Hospital.
Funding for the kits was provided internally by the Dental Clinic in conjunction with the OTS service.
Seventy kits were compiled and distributed to the clients attending the OTS clinic over a period of 3 months.
Outcomes and Evaluation
Fifty kits were distributed to clients.
A survey is underway to assess the effectiveness of the kit (attached) and will be completed by June 30th, 2006.
At June 30th 2006 a comparative report will be run regarding OTS client access to the public dental health clinic with an expected outcome of improved access, however, due to public dental staffing shortages this may not be an accurate indicator of the success of this program as access will be limited, with priority to dental emergencies. The public dental service is unable to provide preferential treatment places for OTS clients.
Future Scope
The Dental service is keen to continue to promote good oral health for the OTS clients, and particularly the clients with xerostomia. A display at the Centre is planned.
Possibility of dental hygienists being involved in an oral care day, where OTS clients are instructed on correct brushing and flossing techniques.
Dental service in association with OTS will fund more kits if the evaluation shows the effectiveness of these interventions.
Address other preventative measures through engagement of other service providers, such as the community dietitian to educate regarding diet and water consumption.
Regular discussions with clients on oral hygiene through the methadone clinic.
Reference
Edgar WM, O'Mullane, D.M (1996) Saliva and Oral Health 2nd Edition. British Dental Journal, London, Great Britain
Primary Author: Gareth Jones, Albury TAFE D&A Student after consultation with OTS Staff.
Dental Survey for OTS Clients
Are you aware methadone causes a dry mouth? Y N
Are you concerned about the effect methadone has on your teeth? Y N
Do you get a dry mouth after dosing with methadone? Y N
If yes what do you do about the dry mouth? ……………………..
…………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………..
Are you currently on any government benefits? Y N
If yes did you know you could use the public dental service? Y N
Are you a current client of the public dental service? Y N
If yes then for how long? Years…………….. Months…………..
When was your last check dental checkup? ……………………..
Have these check ups helped with your dental needs? Y N
Do you know about preventative measures?:
Chewing sugar free gum Y N
Eating fresh fruit Y N
Drinking water Y N
Brushing Y N
Flossing Y N
Would you like more information on methadone and tooth decay Y N
Have you been given a kit containing Y N
1. Toothbrush
2. Toothpaste
3. Sugar Free Gum
4. Information leaflet
If yes did it reduce the incidence of dry mouth? Y N
Would you use sugar free gum if it was available at no cost? Y N
Thankyou for your time in completing this survey.
