Improving the Oral Health of People Seeking Substance Use Treatment
People who experience substance use disorder (SUD) also face barriers to accessing oral health care, including those related to social determinants of health: low income, reduced access to transportation, and lack of adequate insurance coverage. These challenges can make it difficult to prioritize oral health, find a dentist, get to appointments, and carry through with recommended care.
This is compounded by the direct effects of substance use, including dry mouth and vascular changes, which worsen oral health. Some medications for opioid use disorder can also have side effects that affect oral health, including dry mouth and mouth acidity. Meanwhile, periodontitis is associated with heart disease, uncontrolled diabetes, substance use, and other systemic conditions.
Dr. Hugh Silk at UMass Chan Medical School is developing a scalable oral health intervention for providers treating people experiencing SUD with funding from RIZE. The model is being offered in three tiers of progressively in-depth interventions based on clinician expertise, training, and local internal and external resources. In the first two years of the project, Dr. Silk’s team reached 566 unique patients and distributed oral health kits to each. One hundred eighty patients were scheduled with dental professionals, with 51 completing visits, up from just 18 at the end of year one. Surveys show that nearly all patients found the supplies and case management helpful, and over half reported improved brushing habits. Findings from the pilot year were presented at the National Healthcare for the Homeless Council Annual Meeting in May 2025.
In year three, Dr. Silk’s team will continue to expand into new outreach settings, including those beyond Worcester, while increasing the availability of fluoride varnish treatments and adding silver diamine fluoride, reducing patient need for urgent dental appointments. A medical student researcher will track patients and identify strategies that increase completed visits, helping to strengthen the evaluation needed for program sustainability. The team will create a “how-to guide” to train SUD providers, and the model and findings will be presented at the National Oral Health Conference in Oklahoma in April 2026. This third year of funding represents a bridge from a successful pilot to a scalable solution – transforming oral health access for people with SUD and advancing equity in care statewide.