Program Would Help Recovering Drug Users Get Their Teeth Fixed

Jonathan Opra likes to think of himself as an approachable guy, especially now that his heroin addiction is behind him. Yet you wouldn’t always know it from the look on his face. That’s because Opra, 34, tries to avoid smiling to conceal his missing teeth.

Three years sober, the Derby resident said he’s proud of what he’s overcome. But what he’d give to be able to talk to a prospective employer or, God forbid, a woman, without fear of being judged.

“You can see it in their eyes,” he sighed.

Opra’s experience is common among former drug users, who sometimes experience painful and embarrassing dental problems even years after they get sober. Unable to afford costly fixes, many simply have bad teeth yanked out, only to find that dentures are equally out of reach.

Missing or damaged teeth can become an albatross for people in recovery, an impediment to employment and a reminder of their destructive pasts. No wonder so many former drug users say they didn’t mind having to wear a mask during the pandemic.

“At least then, no one knew how many of my teeth were gone,” said Jessica Getty, a recovery coach in Springfield who managed to save up for dentures a few years ago.

A local nonprofit wants to ease the burden of bad teeth by helping people in recovery pay for vital dental work. Recovery Partners of Vermont has asked state lawmakers to repurpose $500,000 that was already earmarked for addiction services and put it toward a new oral health fund. The proposal did not make it into the House’s recently approved budget, but it could still resurface in the Senate.

Supporters say it would be an immediate and effective step toward helping former drug users rebuild their lives.

“They can’t talk right. They can’t smile. They have no confidence,” said Joanne Puente, a dental hygienist at the People’s Health and Wellness Clinic in Barre, which offers free, basic dental care for low-income clients. Bad teeth, she said, can ruin a person’s “whole mental outlook.”

Dental problems are not confined to substance users, of course. Many medications — including those legally prescribed to treat depression, high blood pressure and other ailments — can cause dry mouth, which can in turn speed up tooth decay, since there’s not enough saliva to control bacteria in the mouth.

Missing or damaged teeth damaged teeth can become an albatross for people in recovery, an impediment to employment and a reminder of their destructive pasts.

But people who use heroin, cocaine or methamphetamine or who drink at excessive rates can suffer particularly acute dental problems.

One reason is that the addictive nature of those drugs and the chaotic lifestyle they breed can make it harder for people to take care of themselves, including brushing their teeth. The main medications used to treat opioid addiction — methadone and suboxone — also cause dry mouth.

In addition, current and former drug users often find themselves craving sugar, perhaps due to the way it triggers dopamine responses in the brain that are similar to those created by drugs. When Heidi Melbostad was director of the Howard Center’s Chittenden Clinic, she said many people would show up for their early morning methadone doses with bottles of sugar-laden Pepsi and Mountain Dew in hand.

The oral damage caused by years of drug use can be difficult to overcome. People in prison find a system plagued by backlogs for all types of dental care. It’s not much easier in the community, especially for those insured under the state-run Medicaid plan.

Vermont’s program has increased payments twice in recent years and now provides better coverage than many other states. Patients can get two free preventive visits and up to $1,500 per year in nonemergency care. That’s enough for some X-rays and a few cavity fillings. But it’s usually nowhere near enough to cover some of the extensive work needed to save decaying teeth.

When Opra, the Derby man, sought out emergency care earlier this year for a throbbing tooth abscess, he said his dentist told him that he’d need to pay upwards of $1,000 to cover what Medicaid wouldn’t. So Opra had the tooth pulled instead — his sixth lost tooth in the past three years.

He suspects it’s only a matter of time before the rest of his teeth go. He wonders whether it would be easier to have them pulled so that he could get dentures — though he couldn’t afford them right now, anyway.

Many insurance plans, including Medicaid, don’t cover the cost of adult dentures, which can reach $3,500 for a full set. Dentists usually require half of that up front so they can take impressions and send them to a lab.

Patients at the Community Health Centers of Burlington can qualify for a discount that pushes the price per arch down to about $1,000, on average, but that’s still too much for many, according to Dr. Elicia Thompson, the nonprofit’s dental director.

Plainfield dentist Robert Ruhl will sometimes create a multiyear treatment plan for Medicaid patients in recovery who need a lot of work done. He will tackle their biggest issue first, he said, and encourage them to use high-fluoride toothpaste to “slow the fire down” until their benefits reset in the new year.

People who lose their teeth can have difficulty chewing, making them more likely to have poor eating habits. They can find it hard to be understood when they speak. Many suffer from low self-esteem.

Puente, the Barre hygienist, said one of her patients in recovery recently told her that he skipped a parent night at his kid’s school because he was too embarrassed to talk to the teachers.

Fear of judgment is justifiable. Studies have found that people make snap judgments about others based on how their teeth look.

Puente recalled a famous dentistry ad she saw some years ago. It’s a poster that shows three people, one of whom is missing a tooth, and asks: “What’s the first thing you notice?”

Puente said she stared at the ad for a full minute before she realized that the man with the gap in his smile was also missing his eyebrows.

The fate of the proposed oral health program won’t be known until the state budget is approved this spring. If the proposal fails to gain traction in the Senate, then advocates will need to push it again next year.

Among those who could benefit sooner is Brandon Cranton, a Morgan resident who drank heavily and used opioids and stimulants for many years.

At the height of Cranton’s addiction, he said he would spread a tube of the topical numbing medication Orajel across his inflamed gums every week. He has since had all of his upper teeth pulled and hopes to eventually have his lower ones removed, too.

Cranton, who is now 39 and nearly two years sober, recently faced a decision. He had been saving money for months through his job as a machinist and finally pulled together enough either to buy a beat-up car or purchase a pair of upper dentures. One would give him the ability to move freely again, a significant step toward regaining his autonomy. The other would allow him to smile for the first time in a decade without feeling ashamed.

He’s scheduled for a fitting later this month.

The original print version of this article was headlined “The Other Tooth Fairy | A proposed pilot program would help recovering drug users get their teeth fixed”