Wednesday, 16 December 2015

SPHPM study finds poorer oral health-related quality of life among people who inject drugs in Australia

Arthur Truong, Shelley Cogger and Professor Paul Dietze from the Centre for Population Health at the Burnet Institute and SPHPM have had their research published in the Journal of Public Health Dentistry on the Oral Health-related Quality of Life (OHRQoL) of people who inject drugs (PWID) in Australia.

The study was a first of its kind; previously no specific research has ever been undertaken on the OHRQoL of PWID.

Poor oral health is an important public health issue linked with serious health conditions such as cardiovascular disease, coronary heart disease and respiratory diseases along with wider health and social problems such as poor nutrition, speech impediments and low self-image.

Previous work has shown PWID frequently experience poor oral health with unstable accommodation, poor oral hygiene habits and physiological effects of drug use such as ‘dry mouth’, teeth-grinding, jaw clenching and the analgesic effects of opioids masking the pain of a dental condition all possible contributing factors delaying proper treatment.

However, oral health impacts beyond the physical effects and the team used the Oral Health Impact Profile-14 (OHIP-14) to measure OHRQoL. This is a standardised instrument used to measure subjective oral health impacts on the lives of PWID, contrasting with other studies that have simply highlighted that PWID are much more likely to experience dental problems such as cavities, missing and/or filled teeth.

“We used this instrument to compare our population group to data from the Australian general population, our study revealed that our sample of PWID had significantly poorer OHRQoL than the Australian general population,” Arthur Truong said.

“Oral health more generally has been a neglected topic in alcohol and other drug research in Australia,” said Truong.

“There are a number of studies that have highlighted the prevalence of dental problems among PWID and the links between poor oral health and other health concerns such as poor nutrition, heart disease and cardiovascular disease.

“However, very little is known about the effects of specific drugs on oral health and the extent of these oral health impacts on PWID, and these can be substantial, affecting things like employability and entrenching disadvantage” he said.

The data was drawn from the 2013 Illicit Drug Reporting System (IDRS) which involves detailed one-hour interviews with PWID in all Australian capital cities to gather information on demographics, drug use and health related outcomes of participants.

Interestingly, frequencies of heroin or methamphetamine use were not significantly associated with poorer OHRQoL, suggesting that lifestyle factors and personal circumstances are more important for the oral health of PWID than drug types used and the physiological effects associated with them.

Worryingly, the IDRS participants scored lower across all OHIP-14 indicators than a population of homeless people in South Australia when the OHIP-14 results of the two groups was compared by researchers.

Researchers also found a consistent pattern of poorer OHRQoL among women and those with longer injecting careers in the study.

Such evidence about their OHRQoL is useful to researchers and would allow the development of clearer strategies for ameliorating this burden, for example, by enabling policy-makers to assess the need for and benefits of incorporating dental health in PWID-specific services.

“The data has informed the development of a dental health service for PWID at a primary care service in Melbourne that is now using the OHIP-14 as one of their outcome measures. We have also submitted grant applications based on our findings,” said Truong.

Truong also said that this study is an important stepping stone for further research and they are now using the OHIP-14 instrument in the follow-up questionnaire for longitudinal cohort studies of PWID in Melbourne which they hope will build additional data on existing knowledge in this area.

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