The agony and the ecstasy – treating substance abusers in prison

drug abuser in prisonRachel Lawton is a prison dentist who is being mentored by Victoria Wilson. She is part of Victoria’s Smile Revolution cohort of dental professionals working on the business aspects of developing oral health projects to benefit the wider community. The courses and mentoring programme is sponsored by Philips. In this article Rachel describes her treatment of patients in the prison system.

My patients are not the standard patients you would expect to see. Many of them are heavy drinkers, drug users with some levels of eating disorders.

Generally speaking, individuals who lead or have led a very chaotic life and who need a great deal of education from us.

Whether drugs are recreational or prescribed medication (including psychotropics and antipsychotics), it is important to tell my patients that these can cause cravings for sugar and subsequently lead to tooth decay.

Methadone and heroin also tend to cause dry mouth, which is another risk for periodontal disease. Ecstasy and cocaine can lead to jaw clenching and bruxism resulting in tooth wear.

Then there are the new psychoactive substances (NPS) some of my patients use. These contain a number of substances from alloy wheel cleaner to rat poison. The latter include warfarin, a blood thinner that increases the risk of bleeding.

Performing any kind of dental treatments on them can potentially lead to death. So it is important that our patients know the risks and tell us when they use them.

We also have people who have masked painful toothaches from opiate drugs like methadone. They come to us with dental issues that could have been picked up and treated at a much earlier stage.

Oral health habits

As challenging as these are, we also have to deal with the fact that drug users typically do not view their oral health as a priority. Some of them haven’t seen a dentist for a decade or two.

It might be because the environment they have been brought up in was not conducive to good oral hygiene habits or a healthy diet. Or because they could not get past their fear of the dentist.

Alcohol users are also very frequent amongst my patients. When we read that over 30% of all cases of oralpharyngeal cancer are attributable to alcohol consumption (Boffetta et al, 2006) with over 10,000 people a year diagnosed with oral cancer and 2,500 people dying from it every year, our role in education is enormous.

I have 1,100 patients in one prison and 450 in another one. I feel lucky have my therapist Bridget as an assistant. She is an absolute asset for me and our patients.

It is reassuring to see that once we get patients on board, 95% of them really improve long term. Many of my patients lack basic education in oral hygiene and they tend to struggle understanding how to master good brushing techniques.

For this reason, we recommend they use electric toothbrushes. These can help them clean their teeth without brushing too hard and reach difficult areas more easily. Particularly with smaller brushheads.

Keeping motivated

It is clearly a mountain to climb. But equally, if we all try to make a difference, every little step really should count.

I recently had the opportunity to join Victoria Wilson’s Smile Revolution business oral health promotion course thanks to Philips, which agreed to sponsor my place and fund my mentoring with Victoria.

I am now working on educational assets specific for my patient demographics to become more informed on how drugs, eating disorders, drinking can affect their oral hygiene. And, more importantly, how they can take ownership of their oral health for their own long term benefit.

It is still early days. But I remain very motivated. Especially when my patients start trusting me and my therapist and make efforts to improve their oral hygiene.


Boffetta P, Hashibe M, La Vecchia C, Zatonski W and Rehm J (2006) The burden of cancer attributable to alcohol drinking. Int J Cancer 119: 884-7

Follow on Instagram to keep up with all the latest dental news and trends.

Get the most out of your membership by subscribing to Dentistry CPD
  • Access 600+ hours of verified CPD courses
  • Includes all GDC recommended topics
  • Powerful CPD tracking tools included
Register for webinar
Add to calendar