The Probe - Proudly serving the dental profession for over 60 years

The agony and the ecstasy: treating substance abusers in prison


  Posted by: The Probe      8th October 2021

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) used by some of my patients which contain a number of substances from alloy wheel cleaner to rat poison, the latter including 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 have used them last. We also have people who have had masked painful toothaches from opiate drugs like methadone, and who come to us with dental issues which could have been picked up and treated at a much earlier stage.

As challenging as these can be, we also have to deal with the fact that drug users typically do not view their oral health as a priority. Some of them had not 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 oral pharyngeal cancer are attributable to alcohol consumption1 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 to be assisted by my therapist Bridget who 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 which help them clean their teeth without brushing too hard and reach difficult areas more easily, with smaller brushheads.

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.


1Boffetta P, Hashibe M, La Vecchia C, Zatonski W, Rehm J. The burden of cancer attributable to alcohol drinking. Int J Cancer 2006; 119: 884–887.

About the Author

Dr Rachel Lawton is a prison dentist who is being mentored by Victoria Wilson and is part of her 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 are sponsored by Philips

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