The patient group investigated in this study represents a unique population that is at greater risk for oral/dental disease yet is often less able to receive appropriate dental care. They exemplify the inadequacies and inequities of our oral health care system. They all come from poor and minority groups with minimal education and limited work skills. Their psychiatric illness, alcohol dependence and drug addiction further hamper their ability to take better care of themselves.
Despite the adverse and difficult living conditions, all subjects owned a toothbrush and most made the effort to brush their teeth. This desire to own a toothbrush and use it certainly indicates interest in oral health among this group. Alcoholics preferred using a hard toothbrush. This choice may be related to a faulty perception that a hard toothbrush would be more effective in eliminating the alcoholic odor after alcohol consumption.
Alcoholics, despite reporting similar brushing frequency, brushed less effectively than the non-alcoholics. Also, tooth brushing in the alcoholic group did not benefit their oral health (as measured by periodontal clinical attachment levels and percentage of decayed teeth). These finding suggest that alcoholics are unable to practice basic dental hygiene adequately. It may be explained by impaired motor activity associated with prolonged and excessive alcohol use. It also may be related to their use of hard toothbrush. The stiffer bristles of a hard toothbrush may be less effective in reaching between the teeth to remove plaque.
Forty-four percent of the subjects of this study had access to professional dental care. This figure is comparable to reported figures for dental care access among US workers that ranged from 35 to 57% (Caban-Martinez, Lee, Fleming, Arheart, Leblanc, Chung-Bridges, Christ, & Pitman 2007
). This relatively high access to dental care in the population we examined may be atypical of the alcohol dependent population in general and may be influenced by the fact that the subjects in this study are care-seeking subjects who were recruited from an alcohol treatment center.
The relatively high percentage of alcoholics and substance abusers in this population having access to professional dental care suggest that local communities are active in helping this group of underserved patients. Still, more than half of the subjects (56%) did not have access to dental care. Also, treatment provided under charity care programs, unlike regular dental programs, are limited to the very basic of dental services. As indicated by the questionnaire, tooth extraction, caries control and tooth cleaning were the main therapies provided. Due to the economic limitations of such programs, no advanced or continued therapy could be provided. The main focus is emergency care with tooth extraction as the main option to relieve oral/dental discomfort and pain. Despite the limitations of these charity programs, limited service appears far preferable to no service at all.
Alcoholics benefited the most from ability to access professional dental care. Being able to visit a dental clinic was inversely correlated with loss of periodontal attachment among alcoholics (data not shown). Since periodontal therapy was not specifically provided, the most likely explanation to this favorable outcome is that alcoholics with advanced periodontal problems opted to have the affected teeth extracted. If true, this “favorable” outcome may not reflect a true improvement in periodontal health.
A recent report (Turner, Laine, Cohen, & Hauck 2002
) examined the effect of medical, drug abuse, and mental health care on receipt of dental care by drug users. They reported that HIV-positive drug abusers without AIDS are more likely to seek dental care than HIV-negative drug users. However, drug users with AIDS are less likely to receive dental care probably due to disability and other significant health issues. Our study focused on medically healthy alcohol and drug users, a group less studied in previous reports. All the subjects in our study expressed a desire to see a dentist and seek dental care. Those subjects who were not able to visit a dentist within a twelve-month period prior to the date of their enrollment in the study indicated that the main reason was economic.
In conclusion, the results of this study show that oral/dental health is important to alcohol and drug abusers. The practice of basic oral hygiene and access to limited professional dental care were helpful in reducing oral disease in this population. Access to professional dental care compensated for the inadequate personal hygiene of alcoholics. Health care providers involved in the treatment of alcohol and drug abusers should promote oral care.