Interview: Treating Patients with Substance-Use Disorders

In Blog by Dr. Ronni Brown

One of the biggest challenges that we face as dental professionals is treating patients with substance-use disorders.

Addiction is a sensitive topic that is easily misunderstood, extremely sensitive and sometimes extremely personal!

Although national statistics estimate that 1 out of every 10 Americans has a substance-use disorder…which means 1 out of every 10 of our patients…very little time is spent in pre-doctoral education training dentists on substance-use and dependency. (Substance use and dependence education in predoctoral dental curricula: results of a survey of U.S. and Canadian dental schools. Huggett KN, Westerman GH, Barone EJ, Lofgreen AS. J Dent Educ. 2011 Aug;75(8):1003-9. PMID: 21828293; PMCID: PMC3348623.)

That explains why as dental professionals, we are not competent in recognizing, communicating or treating patients with substance-use disorders!

Want to know more? Here is an excerpt from my interview at SmileCon 2021 with Dr. Pamela Alston, 97th President of the National Dental Association!

Q:  Is addiction just a lack of control or a lack of willpower?
A:  Addiction is a very misunderstood word and I think it is important to define what it is and what it is not.    Addiction is not a choice one makes nor is it a moral failing. In 1956, the American Medical Association determined that addiction is a disease because it has the hallmarks of other diseases, like hypertension or diabetes.  Addiction has genetic, environmental and biologic risk factors inherent with all diseases and if untreated, is progressive, debilitating and can result in death!  Addiction is the uncontrollable use of a drug despite harmful consequences and results in irreversible damage to the brain

Q: Our colleagues are drawn to dentistry because we are compassionate.  We want our patients to feel embraced, and respected.  But I will admit that I have felt uncomfortable embarking on conversations that might offend a patient or be misunderstood or conversations in which a patient is obviously not being truthful or dismissive.  Substance use is one of those topics.  So, tell me Ronni, why should oral health professionals embark on that difficult conversation?
A: Great question! As dental professionals, we need to discuss and have conversations with our patients about substance abuse really for the same reasons we interview our patients about their diabetes and hypertension…so that we can be aware of their systemic diseases, make an oral-systemic connection, keep our patients safe when they are in our offices and develop treatment plans with appropriate modifications based upon their co-morbidities. And these conversations, do not have to be difficult or awkward!

Q: You’re really good about getting your patients to talk about their addictions. How do you do this?
 A: I have not always felt this degree of ease and comfort in discussing substance-use with patients. I remember absolutely avoiding the conversation as a young dentist, despite the tell-tale signs of a substance-use disorder with my patients. Not only did I fail to discuss, I also failed to modify treatment plans to address the high caries rate, hyposalivation, and attrition that de-rail treatment success for these patients! But I have learned over the years what to say and how to say it in ways with compassion and empathy to obtain the information that I need to maintain patient safety, responsibly manage pain, and modify treatment plans based upon patient’s drug use patterns!

Q: How can dental professionals obtain these skills and know what to say, what not to say, how to treat and more importantly, how to recognize a patient with a substance-use disorder?
A: On January 28-29, I will be hosting a 2-day workshop, Breaking Bad and Breaking Through-Managing and Treating Patients with Meth Mouth. This is a 2-day interactive, virtual workshop that will bridge the gap between what we didn’t learn in dental school and what we need to learn to treat the 10% of patients who are in our practice with a substance-use disorder. This is virtual, interactive, and dare I say fun, 12-hour learning experience (12 CEU’s) where participants will develop the skills necessary to treat patients with substance-use disorders.