Spring 2019

Recovering a Smile

Oral health is an oft-neglected aspect of addiction treatment.

By Kim Thurler

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Illustration: Eva Tatcheva

Opioid addiction and recovery can seriously affect oral health. Swaitha Maripuri, D19, saw this up close while treating a patient recovering from drug addiction—the first patient to receive care through what became the School of Dental Medicine’s Impact Fund, a program that assists patients with medically complex cases who also have unusual financial or other needs. Maripuri’s experience, which she shared with Tufts Dental Medicine, also inspired her to pursue a master’s in public health from George Washington University.

How did you get involved with this patient and the Impact Fund program?

I was assigned to new patient exams, and he walked into the waiting room with his earphones in, sunglasses on, hood up, obviously scared. It was November 2017, and I’d only been on clinic for three months. I first thought, ‘Oh man, this is going to be hard.’ I quickly discovered that while the dental issues were difficult the patient was anything but.

Swaitha Maripuri, D19. Photo: Alonso Nichols

I learned he was in recovery from ten years of drug addiction. He was here trying to get his mouth back into a state where he could reintegrate into society. I remember him sitting in my chair and saying his mouth looked like a car bomb went off in there. I thought he was kidding. He was only twenty-six. How bad could it be? Then he smiled and, oh wow. Only two front teeth were visible, and they were severely decayed. His gums were inflamed and bled when I examined them.

He was embarrassed and scared of being judged. In his previous experiences with anyone in the health-care field, he had just been dismissed as an addict. I knew I could help him, whether with dentistry or just hearing him out. We had all the best resources at Tufts; we had the Complex Case Program. I just knew we could do it. He ultimately became the pilot patient for the Impact Fund.

What’s the link between addiction, methadone treatment, and tooth decay?

Methadone, which is taken every day in recovery, is commonly administered as sugary syrup that you’re told to keep in your mouth for thirty minutes for full absorption. Sugar on your teeth for thirty minutes a day every day—you can imagine what that’s going to look like. There is a sugar-free version, but it’s very expensive.

Opioids—and methadone is an opioid—are also among the many drugs that are anticholinergic, meaning they cause dry mouth, which in turn promotes tooth decay. The excessive sugar and lack of saliva is a perfect environment for rampant decay. We can’t attribute all a patient’s oral-health problems to methadone, but the route of methadone administration and the lack of accompanying oral hygiene contribute to the severity of the disease. A lot of these problems could be avoided if recovery clinics gave dental-hygiene instructions, but right now there’s a gap between the two professions.

“Dental medicine is moving toward more interdisciplinary care where all the specialties and medical professions are going to talk to each other. I got to see that true interdisciplinary care at its best.” —Swaitha Maripuri, D19

This is a hard population to treat, a population that is often dismissed. They have to go to a methadone clinic every day and sometimes wait for several hours, so they find it hard to hold a steady job. Plus they don’t seek care because of their previous health-care experiences and fear of being judged. The result is a lot of patients in recovery who are full-mouth denture cases by the time they’re in their thirties.

After he got his upper denture, my patient said he couldn’t remember the last time he’d smiled and he could actually talk to people again without getting embarrassed. Getting to know him as a person and helping him, even a little, to get back into society was the biggest reward.

It’s clear that the fund helps patients but what about students?

I would not have been able to have half the work experience I’ve had without this case and all the support I received from everyone at Tufts. As dental students, we refer cases to other specialties, of course, but I was able to go to all of his appointments, the endodontist, oral medicine, the methadone clinic. Dental medicine is moving toward more interdisciplinary care where all the specialties and medical professions are going to talk to each other. I got to see that true interdisciplinary care at its best.

What’s next for you and for him?

I’ll complete George Washington University’s online MPH program in December 2019, and I’m doing a practicum at a methadone clinic where I hope to incorporate oral-hygiene instruction into treatment—for example, proper brushing, fluoride application, and how to safely remove sugar from patients’ teeth after methadone administration so as not to disturb the enamel’s remineralization process. Then I hope to get involved with public policy work. I’ll also be joining a practice this summer and, I hope, teaching. We’re monitoring our patient to see if he’ll need a different treatment plan, but right now he’s decay-free and pain-free—and he can talk and he can smile.

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Recovering a Smile

Oral health is an oft-neglected aspect of addiction treatment.