Medication-assisted treatment (MAT) helps manage withdrawal symptoms and cravings in individuals battling opioid addiction. Despite their effectiveness, these medications can cause xerostomia (dry mouth) and an increased craving for sweet foods. These factors together contribute to accelerated dental decay, gum disease, and oral infections. The U.S. Food and Drug Administration issued a warning in January 2022 about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain. Methadone, a long-acting opioid, and buprenorphine, a partial opioid agonist, are both known to cause side effects, such as dry mouth or xerostomia. Saliva plays a crucial role in maintaining oral health by neutralizing acids produced by bacteria and washing away food particles. Reduced saliva production can make the oral environment more conducive to tooth decay, gum disease, and oral infections.
Another side effect is an increased craving for sweet foods, often observed in patients on these therapies. An increased sugar intake, coupled with a dry mouth, can speed up the progression of dental caries and other oral health issues. Some of these patients lose self-confidence and the ability to smile due to the damage to their teeth, adding to one of the factors which result in relapse to the addiction. However, it is important to remember that these effects, though undesirable, should not discourage patients from pursuing these life-saving treatments. Instead, the onus is on us, the health care providers, to help manage and minimize these side effects. That is where the collaborative efforts of physicians and dentists can make a difference.
Physicians initiating medication-assisted treatment (MAT) need to consider oral health as an integral part of their treatment protocol. Alerting patients to potential oral health complications and advising them on preventive measures can be the first step. Regular screenings for oral health issues can help in early detection and treatment. Dentists, on the other hand, can play a proactive role in educating patients about maintaining good oral hygiene, moderating sugar intake, and topical fluoride treatment. They can also help in managing symptoms of xerostomia through recommendations like sugar-free chewing gums, which can stimulate saliva production, or saliva substitutes, in more severe cases. Definitive dental treatment should also be deferred until it is made sure that the patient is committed to medication-assisted treatment (MAT). Furthermore, research should be encouraged into developing less xerogenic opioid treatment options or exploring adjunctive treatments that can mitigate these side effects. As health care providers, our collective aim should be not just to treat the addiction but also to minimize the side effects that can compromise our patients’ quality of life. In the fight against opioid addiction, a collaborative approach can lead to better outcomes. By bridging the divide between medical and dental care, we can help patients on their path to recovery, ensuring they are not just freed from addiction, but also enjoy a healthy smile.
Sandeep Singh is a dentist.
