opioids and dental disease

Hi All,

I was wondering how common it is for chronic pain patients taking opioids long term to develop dental disease (specifically tooth decay). I know that is a problem commonly seen in long time drug abusers, but what about those taking opioids as prescribed for medical use?

I only ask because I went to the dentist yesterday for a routine cleaning, and it turns out that I have significant decay in two teeth, such that they need root canals, and mild to moderate decay that will need to be addressed in at least two other teeth. I had noticed some pain on and off in several of my teeth over the past 6 mo. And it had been a year or more since my last visit to the dentist, due to financial reasons. But I have never before had any significant problems with my teeth, and I am only 26. So I assumed that maybe I had developed a couple cavities. I never expected anything like this!

The dentist was legitimately concerned, which really scares me, given that I am so young. I don't want to lose any teeth!! And unfortunately, it is going to be at least 4 - 6 mo before I can have my teeth addressed, as I go back to grad school tomorrow. And that is assuming that we can come up with the money to pay for the root canals this winter (no dental insurance, and at least $1000 per root canal). In the mean time, the dentist put me on a prescription high fluoride tooth paste to try and prevent any further decay & buy me some time.

The only thing that I can think of is that in addition to a slew of other medications (mostly antidepressants and the like), I have been taking hydromorphone on and off for the last 5 yrs, and daily/round the clock now for the past year. Sometimes I notice that it gives me dry mouth, but it is not horrible. So I am surprised at the level of decay that the dentist found.

Does anyone else have any experience with this and have any suggestions for anything I could do to prevent this from worsening/ happening again in the future (other than stoping my medications and avoiding sugary foods)? I'd definitely appreciate any insight you all might have! Thanks.

Skeye

Thanks, WB!

I'll definitely look into the Biotene. I did mention the dry mouth to the dentist, and I do suspect that that is the cause (ie. hydromorphone induced dry mouth). Actually, that was the first thing that I brought up when he asked how I was doing. I've been having issues with pain in several teeth on and off for the past 6+ mo, and I told him that I suspected that I had a couple cavities & that I wondered if they were a result of dry mouth from my meds.

As it turns out, I have decay, not cavities. But the dentist didn't really say one way or another as to whether or not he thought that the dry mouth was the cause. Nor did he really suggest anything that I could do to address it. The only thing he told me was to use the high fluoride toothpaste until I can get my teeth addressed. I should have been more aggressive in asking about what I could do re: the dry mouth, but I was just in such a state of shock after receiving the news about the teeth that my mind just kinda went blank.

Skeye

PS - Great to "see" you, too, WB! And thanks. Year 3 starts on Monday. One more semester of the hardcore academics and then I start clinics in January! So I'm getting there -- officially at the halfway point, and about to start down the homestretch! With all I have against me with my health, no one ever thought that I'd make it this far (me included). But I'm doing it! I just have to take things one day at a time...

Hope all is well with you and Pumpkin, too! I do lurk and read some threads here from time to time. But even when I can't make it to the computer, you and others here are constantly in my thoughts!

Post Edited (skeye) : 8/16/2014 11:54:18 PM (GMT-6)

I also have very significant dental problems, mostly due to dry mouth. My dentist and I have been fighting it for about 20 years, since I was 16 and began taking antidepressants. They often cause dry mouth too, and that really messes up your teeth. Then I began taking pain meds at age 20, so it's been a rough road for my teeth!

Please get some biotene, before you end up with a mouth like mine. I now have the spray (not bad) and the mouthwash, which I was told to use especially before bedtime, and I also use a prescription toothpaste designed for dry mouth. Helps, but a little too late for me. And my case of dry mouth is a bit extreme....I saw my general dentist and prosthodontist this week and both times, when they were examining my mouth, their instruments actually stuck to the inside of my cheek!! In addition to the special toothpaste and biotene products, try to sip more water throughout the day. The water may not hydrate your mouth for long, but it does help some. And of course, avoid sugary things and things with high acidity.

As for me, my two dentists are going to be meeting with each other in the near future to form a long term plan for my mouth. We know that over a period of a couple years, all of my teeth will be removed and replaced with the implant system. Very expensive, not sure if any dental insurance covers that yet, but they have said it would really be my best option for long term. Earlier this year, it was discovered that I had an infection in my upper jaw, who knows for how long, and it had eaten away at the bone so much that when I had the surgery to remove the tooth, clean out the infection, etc, the nerve roots from the next tooth over were actually exposed. Actually had no idea the infection was there until I ended up with a big bump on my gums--it was an abscess. No pain (dentists were shocked) from the infection. Ended up on antibiotics for quite a while and had to have the area packed with bone graft material. Had my 4 month post-surgery check up this past week, and the CT scan showed the bone graft worked better than anticipated. So, in 3 weeks I can have my first implant surgery done!! How fun!!

I tell you my story not to scare you or anything, just want you to be aware of what can happen and that you need to do everything possible now to prevent something like that from happening to you!! I know you are concerned and doing what you can, dental stuff is hard because of the financial part of it. I think it's really weird that teeth are not covered under general medical insurance. Last time I checked, they were a part of my body and can greatly impact my health in many ways if not taken care of. Apparently healthy teeth are a luxury item!

Sorry for my rambling. Hope that these issues with your teeth will be the first and last you have to deal with. Take care!!

Yep, they can definitely be related. I now have dentures, but not after pouring tens of thousands (yes, that is correct) into my mouth since my 20's trying (futility) to save teeth that couldn't truly be supported.

No one told me about this connection and assumed I had poor oral hygiene. I didn't. I continued to spend money to repair teeth, desperate to save whatever was "real" as if that was more important than the fact that I was in dental pain, couldn't chew, and most definitely never smiled.

Not to mention, when I finally did get all my teeth extracted (I wish I had done it sooner and all at the same time), a number of other health conditions seemed to clear up, so it tells me my who system was getting funky because of my teeth.

Love my new dentures and now I really can smile, and often do, can eat, and yes I still take my meds but w/o that worry anymore.












M.

I recently went to the dentist, and he said the only correlation between prescription opioid use and an *increase* in the occurrence of dental issues, is the dry mouth factor.

He said there are a lot of factors that contribute to having dental problems, and a lot of people have these issues without even being aware of it. Then they take pain medication for an extended period of time and experience dry mouth on a regular basis, and that just adds to the other issues.

For example...

-He said that some people are more genetically predisposed to dental issues than others. ie a persons enamel isnt as good as it should be, or the teeth themselves are softer etc.

- Also, people do not get enough of the vitamins and minerals that support healthy teeth and gums

- OR they have other habits that damage teeth, like smoking cigs, drinking coffee, eating lots of acidic or sugary food...even drinking from a straw a lot is bad for your teeth.

He also mentioned that statistically people (in general, not just those who use pain meds) dont go to the dentist as often as they should to get cleanings and other treatments.

His advice to me was just to use a product like biotene, and/or have water next to me as often as possible so that I could fix the problem asap.

Everyone experiences dry mouth, its just that those who are on pain meds long term, experience it more often.

Since you're in school, you might see if you can get affordable help from the dental school if there is one. If there isn't one, maybe there is one at another school nearby.

Also, don't students have to have some sort of insurance? Most universities have something available through the university.

If you don't get the dental work you describe I would expect you could lose the teeth. It's expensive, I know. There are a couple of ways to delay the expense. First, see if you can get a temporary crown rather than gold. That would save hundreds for several months. I've had one for well over a year now. the important thing is to get the decay stopped before it gets into bone or gets loose in the blood stream, maybe even causing a brain abscess. The second thing is to see if you can set up a payment plan. If the dentist won't take it, maybe see another dentist.

Also, are you eligible for Medicaid or other assistance? There might be some way to get help. The university might be able to help you find assistance.

@Skeye--sorry you are going thru this. Do whatever you can to try to get those teeth taken care of soon, the longer you wait, worse it's going to get. Even if your mouth doesn't feel that dry to you, keep sipping on the water and using biotene or whatever works for you. It may seem like little things, like it won't really matter, but really, anything you can do to protect/save those teeth is worth it. My dentist has also said that using an electric toothbrush, doesn't have to be a real expensive and fancy one, will help much more than a regular toothbrush. When you have dry mouth, any "bad" stuff in your mouth (such as food/sugar particles, tartar buildup, plaque, whatever) will just stick on and eat away at your teeth much more and more rapidly than it would if you had "normal" moisture in your mouth. Definitely do not put off care if you don't have to. Unfortunately, teeth are one of the things in the body that once they are damaged, they aren't going to recover and get better. I hope you find a way to get the dental care you need, without having to put it off. I agree with what someone else said about trying a dental school, generally cheaper. Glad you are looking into things and taking care of it!!

@LexiRae--why is drinking with a straw harmful to your teeth? Just curious.

@Merrida--just wondering, when you stopped putting the $ into teeth you couldn't save and decided to have them all removed, did you have it done all at once? Or a few at a time, or what? Don't know if you noticed my post above, but my dentist and prosthodontist feel that we are pretty much at the point where it's not really worth putting more $ into my teeth, because they cannot be saved. I am 36 years old, and they have suggested the best option for long term is to go with implant system. Expensive, my parents will help me with the insane cost, but we have not yet sat down to discuss what the plan is. Obviously, I have the final say-so on what happens, but just wondered what you had done and what the timeline was, whether it's good to get them done slowly over time or just yank 'em all and get it over with.

Yikes! Wow! Very scary to hear everyone's stories. But I am really thankful that you are all being honest with me about what can happen and providing me with really great information and ideas. I just hope that now that I know about this, I can halt or at least slow down any further damage. It terrifies me to think about losing teeth at such a young age!

I did go out to the store and buy Biotene mouth wash and mouth spray, as well as some kind of dry mouth gel, and dry mouth lozenges -- basically everything they had at the store for dry mouth! haha. My mom also suggested that I try using breathe right strips on my nose at night to try and open up my nasal passages, and promote breathing through my nose instead of my mouth. I thought that that was a good idea, as I know that I usually do breathe through my mouth when I sleep, which certainly does not help with the dryness. I tried the nasal strips for the first time last night. While I'm not sure if I breathed through my nose or not when I slept, it actually did make it much easier to breathe in through my nose -- at least while I was awake!

I will be switching my health insurance to the plan offered by my school starting this winter (am currently on my parents' plan, but I get kicked off of it when I turn 27). I am not sure if there is dental coverage or not, but it is definitely something that I will have to look in to. Unfortunately there is no dental school up here. My school is in the middle of nowhere, and all of the human health professional schools associated with it are located in the city, 5 hrs away. I may end up having to look for a dentist up here if I have problems, but I am a little wary of doing that since I like my dentist back home/have been with them forever, and have heard so many horror stories from other people about bad dentists.

Anyways, thanks again for all of your help! I really, really, really appreciate all of the tips, advice, and information! You guys are the best!

Skeye

Some of what I take a tad of issue with is dry mouth. I'm a huuuuuge water drinker. I always have been. So my drinking water in large amounts was not because of opioid use or dry mouth. I genuinely enjoy drinking water for the sake of drinking water.

My teeth would crumble and break off. I had little numbs and sharp points.

I would go to the dentist quite often, probably more than most, because I was so hung up on how drastically my mouth was changing. I have never neglected dental care.

The more my teeth would erode, the more I sought the help of dentists.

Not a single one ever mentioned this to me despite me mentioning it to them. Since I was very good about dental hygiene, they couldn't very well tell me I wasn't taking care of my teeth.











M.

Merrida and quincy that is thing about all these ailments, what might be the cause with one person might not be the same cause in another.  So treatment also varies accordingly. Everybody is so different, and what works for one person might not work for another. Just like the pain meds! No one cause and no one fix for everyone, thats what makes diagnosing and treating us so perplexing and difficult! I think that is what frustrates allot of people too, because, often doctors take that attitude, "" I treated you! You have to be fixed!" I think allot of surgeons have that attitude too! And that is unfortunate! I guess it is what it is.

By the way I drink allot of water too! I alway have my insulated mug full of ice water close at hand, and next to my bed so I can reach it during the night. Lately, now and then, I have been using the flavor enhancers to add a little change! I am fond of the blueberry/raspberry and the cranberry/raspberry flavor. Ha

White Beard

Heck Merrida maybe the medical community doesn't really know that much about it, I am sure if they did they would use it as an excuse not to prescribe pain meds for chronic pain. With the way things are going they don't need much of an excuse to not prescribe pain meds for long term.  It is either that or they just don't care! Like I said before in the other post they did their job, treated the patient and that is that!  I know that sounds terrible, but I guess I am just a bit more skeptic about the medical community these days!. Like so many things, it is up to the patient to be his or her best advocate, and try to find out about these things! I am not saying that is right but it is what it is!

White Beard