Dentists tapped for new role: Drug screenings

A visit to the dentist has the potential to be more than a checkup of our teeth as patients are increasingly screened for medical conditions like heart disease and diabetes. A new study by researchers at Columbia University's Mailman School of Public Health focuses on dental screenings for drug misuse, finding 77 percent of dentists ask patients about illicit drug use, and 54 percent of dentists believe that such screenings should be their responsibility. Results of the study are online in the journal Addiction.

"There are a sizeable number of people whose visit to a dentist represents their sole interaction with the healthcare system, highlighting the significance of the dental visit as a key opportunity to identify substance use disorders," said Carrigan Parish, DMD, associate research scientist in the Department of Sociomedical Sciences. "However, our findings underscore a significant barrier in dentists' attitudes that may limit the potential of the dental venue to play a role in screening for substance misuse."

The researchers, led by Lisa Metsch, PhD, principal investigator and Stephen Smith Professor and chair of the Department of Sociomedical Sciences, sampled 1,802 U.S. dentists in general practice from a nationally representative survey by the American Dental Association Survey Center conducted from 2010 to 2011. The survey achieved a very high response rate of 71 percent, increasing the ability of the survey results to capture a complete picture of the U.S. dental workforce. According to Metsch, "there is an increasing recognition about the need to better integrate oral and systemic health," and "questions remain about the feasibility of offering preventive screening and testing alongside dental care--many of which are being answered in this study."

Those dentists who embraced substance misuse screening as part of their professional role were more likely to query about misuse with their patients (86 percent) compared with those who did not accept such screenings as their responsibility (68 percent). In general, both agreement with the purpose of and use of health history forms with substance misuse questions increased with the amount of prior training and knowledge regarding substance use. 

Older dentists were less likely to report that their health history form included questions about substance misuse than those who were younger. Dentists under the median age of 53 were also more apt to say that illicit drug use screening should be part of the dentist's role than their more senior counterparts (62 percent versus 47 percent). As with age, agreement with screening as part of dentists' role and health history form screening increases markedly with how recently the dentist graduated.

Gender was also associated with dentists' attitudes toward screenings. More female dentists (61 percent) than their male counterparts (52 percent) agreed that illicit drug use screening should be the role of the dentist. 

Drug use can have a negative impact on dental health as well as overall health. Patterns of oral health pathology attributed to methamphetamine users, for example, include rampant tooth decay, accelerated tooth wear, unexplained advanced gum disease, missing multiple teeth, and overall detrimental dental effects that are rapid and severe. These patients also often seek cosmetic dental treatment, such as veneers and whitening, which give dentists another opportunity to discuss suspected substance misuse, provide referrals for treatment, and encourage cessation of drug misuse. 

Furthermore, dentists are the second-largest group of prescribers of opioid pain medication. "Because dental care routinely involves treating pain and emergencies, dentists may encounter substance-seeking patients who complain of pain more severe than anticipated based on the nature of their dental condition, who report lost prescriptions for opioid pain medications, or who only seek dental treatment sporadically," noted Parish. 

"In order for substance misuse screening to be compatible with the dental setting, two-way communication between patient and dentist needs to occur more openly," observed Parish. "While surveys have shown that patients are amenable to receiving medical screenings by dentists 'chair-side' for such conditions as HIV, heart disease, and diabetes, further studies directly addressing patient attitudes on substance misuse screening are key in determining patients' acceptance of such services." Dentists may also need additional education to increase their awareness, comfort, and knowledge of substance misuse, given that "dentists are well situated to make appropriate referrals to treatment centers if instilled with the proper training and supports."