HUNTINGTON — Even under the smothering toll of addiction, the human body has a remarkable capacity to repair itself.
Track marks will fade into a healthier skin tone, sunken cheeks will refill, and eventually the brain will even rewire the synapses addiction overwrote to fuel itself.
But teeth don’t grow back, and it’s often one of the first spots on the body that addiction physically shows itself. In West Virginia, like many states, where Medicaid covers only emergency extraction but not the replacement of teeth through dentures and partials, it’s likely tens of thousands of both active and recovered drug users have no means to a full set of teeth once they’re gone.
It’s beyond a cosmetic concern, professionals and those who suffer agree, and it remains a major barrier, yet lightly discussed, to cultivating productive citizens beyond their addiction.
“I don’t believe you’re going to get a truly functional adult without rehabilitating their teeth as well,” said Dr. Daniel Brody, a clinical dentist of 35 years practicing at Valley Health Westmoreland in Huntington. “And there’s very little resources out there for folks who need to have their teeth replaced.”
West Virginia’s state government has no mechanism to provide prosthodontics — like dentures and partials — to its citizens, though many of those suffering from addiction are Medicaid eligible. The resources that do exist to connect individuals with new teeth are scattered, localized and often rely purely on the goodwill of certain providers.
Work can be done at one of the seven free dental clinics across West Virginia, including the Ebenezer Medical Outreach in Huntington, though the waiting lists stretch back months. A few local providers, like Valley Health, are federally subsidized to treat and bill patients based on their ability to pay, but they’re often slammed with work, too. Some treatment centers, like Recovery Point Huntington, may facilitate free dental work for their clients with local clinics, though that arrangement only allows for three clients per month.
While most people suffering from addiction have varying degrees of dental decay, it’s likely caused by both the drugs themselves and the unhealthy lifestyle choices typical of those suffering.
Toothaches are among the first side effects of ongoing drug use, making dentists often the first — and sometimes only — medical care a person who used drugs may see. Those first signs are now common sights for dentists across the region, and Brody has traveled nationwide this past year lecturing other oral health providers on how to spot addiction.
Narcotics like heroin, methamphetamine and prescription pills tend to dry the mouth of saliva, diminishing its protective and restorative effect on teeth. Meth in particular, which is more often smoked than heroin, is especially acidic. A person’s diet tends to become more refined, particularly high in sugar, and their overall personal hygiene tends to be a second thought.
Another major cause of tooth decay in those currently in recovery is from Suboxone — an oral strip given to those in medication-assisted treatment (MAT) to ween an individual from their withdrawal symptoms. Suboxone itself is highly acidic, with a pH of about 3.4 — the same as tomato juice — and patients are told to let it dissolve in their mouths as long as possible.
“The problem is that most folks come in medication-assisted treatment already compromised, so by the time (dentists) get to see them, the teeth are so far gone that there’s not a lot you can do other than extract the teeth,” Brody said.
“I don’t think I’ve had one patient that I’ve seen that’s in a MAT program that doesn’t have decay to the point they have to lose their teeth.”
Replacing a person’s teeth may also substantially increase their chances of completing a recovery program, according to a University of Utah study Brody referenced.
As in West Virginia, Utah’s Medicaid does not cover prosthodontics. When the university’s School of Dentistry was granted a state Medicaid waiver to provide dentures and partials for people in a MAT program, the study found 80% of those who had dental treatment completed their recovery.
“It destigmatizes the patient. It helps them to find employment. They’re going to eat a less refined diet that they can chew properly, and that’d be a real issue if they’re diabetic on top of all that,” Brody said.
A reason to smileAs the rest of Recovery Point Huntington’s roughly 120 clients clattered on in their classes and daily chores recently, Richard Myers and Robert Bain dutifully scrubbed away at the new teeth prior to being photographed. The value of a bright smile had never in their lives been more valuable, having lived the lives they have.
Myers, a 36-year-old Elkview, West Virginia, native, became addicted to prescription painkillers in 2002 after an injury while in the Marine Corps. By 2010, he had switched to street drugs, but has since been sober for 13 months.
“When you’re taking opioids, it takes that pain away so you can handle it, but eventually it gets to the point where the tooth is just gone,” Myers said, speaking alongside Bain in one of the center’s meeting rooms.
Bain, a 35-year-old Martinsburg, West Virginia, resident, had been an alcoholic since his early teens. A string of assorted misdemeanors eventually led to heavier charges, and in January he was sentenced — in a hearing he missed because he had been drinking — to complete Recovery Point’s program. He’s now nine months sober.
Both men had their teeth rot to the point their top teeth, and some of their bottom ones, had to be extracted — with no means to replace them.
“A lot of things run through your head — about your appearance and just thinking like, ‘What woman would want me?’” Myers recalled.
“That was my self-confidence just gone,” Bain added. “I was never smiling or anything. I just didn’t like my appearance at that time.”
If it weren’t for what Myers compared to winning the lottery, their teeth would have been the same as in the lowest point in their lives. Both men were selected as one of Recovery Point’s three prosthodontic recipients per month — with Bain’s still so new he couldn’t yet apply a full bite.
“Now I don’t have to worry about the pain or the embarrassment of my looks. It’s brought my self-confidence up tremendously,” Bain said. “I can look in the mirror and feel good about myself now.”
It sounds minor for those fortunate enough to have a full, healthy set of teeth, but that confidence can propel a person through the recovery program, Myers and Bain agreed.
“Every little thing toward getting our confidence back is great because we’ve been through so much as far as relationships, losing your kids, or this and that,” Myers said. “Every little thing that’s good that happens, we latch onto it, and it helps.”
“I carry myself with a little bit of dignity now,” Bain added.
Both were cognizant of how lucky they got, and the scope of the need.
“There’s 120 guys here that need teeth worked on — it’s not enough. It’s just by the grace of God that they got us in,” Myers said.
“This right here,” he waved toward a porcelain white half-grin, “this is a big deal. It really helps.”
A deeply rooted problem, with signs of improvementWest Virginia has long dragged the bottom in adult dental health compared with the rest of the nation. For generations, the caricature of Appalachians as a whole has mockingly left out a few teeth to reflect that stereotype.
But there’s no substantial evidence widespread addiction has exacerbated West Virginia’s existing dental health problems over the past decade, said Dr. Jason Roush, West Virginia state dental director.
Roush noted the lifestyle of a refined, sugary diet and poor hygiene — which are frequent with or without addiction — is probably as much to blame for West Virginia’s continual dental woes.
“Sometimes it’s not drugs; sometimes it’s the Mountain Dew,” Roush said in a call recently. “So is it the drugs or is it the behavior associated with the drug use?”
While West Virginia does continue to lag behind in adult oral health, Roush noted there have been quantifiable improvements statewide.
In 2016, 57.5% of West Virginia adults 65 and older had lost six or more teeth due to decay, down from 65.1% in 2012, according to the national Behavior Risk Factor Surveillance System. By comparison, 36% of adults 65 and older had lost that many teeth nationwide.
More than 30% of West Virginia adults 65 and older had lost all of their natural teeth in 2016, according to the data, down from 33.7% in 2012. The national average for adults with no natural teeth was 14.4% in 2016.
“With respect to adult oral health in general, we’re still below the national norm, but we’re seeing progress,” Roush said.
As for expanding safety net programs, Roush noted West Virginia offers emergency extraction through Medicaid, though it is not required by law. He added that he’d like to see the existing system improved upon first — including redirecting emergency patients from ER visits to those free clinics, better communication between dental providers and other medical branches, and continued prevention education.
“We’ve done the best we can in regards to adult oral health,” Roush said.
As hundreds of municipalities begin to seek compensation for the opioid epidemic from major drug manufacturers, a potential lump sum settlement could, and should, help fund oral services not covered through Medicaid, Brody added in a follow-up email.
“I can’t help but feel that a portion of any settlement should be set aside for (substance use disorder) patients that are actively undergoing treatment for oral health services not covered by Medicaid (such as dentures, partial dentures), maybe in the form of a voucher,” Brody wrote.
He specifically referenced Cabell County as an example, which is seeking a $500 million settlement to address the impact of the opioid epidemic.