Psychosocial support to improve dental attendance in opioid-dependent patients

Integrating psychosocial support into dental care may enhance attendance, oral health, and empowerment in opioid agonist therapy patients by addressing stigma, fear, and treatment adherence

Background: Individuals receiving opioid agonist therapy often experience severe oral health problems, exacerbated by medication side effects such as dry mouth and sugar cravings. Low utilization of dental treatment among individuals receiving opioid agonist therapy is often influenced by fear, stigma, anxiety, and past negative experiences. Despite free access to dental care in Norway, only 40% of these individuals visit dentists annually. Psychosocial interventions, including psychoeducation, motivational support, and social skills training, have shown promise in enhancing engagement and adherence. This study aims to evaluate the feasibility and effectiveness of integrating psychosocial support into dental treatment for patients undergoing opioid agonist therapy

Methods: This research project is led by Haukeland University Hospital in collaboration with the County Dental Officer of Vestland, the Oral Health Centre of Expertise in Rogaland, Stavanger University Hospital, the University of Bergen and user-organization proLARnett. Protocol consists of an initial pilot study followed by a multi-centre, open label, randomized controlled trial in Western Norway. Eligible participants must be adults (>18 years), receiving opioid agonist therapy and wanting assistance with initiating dental treatment.

Pilot study design (n=10-15): A single-arm, 8-week, mixed methods assessing feasibility, recruitment, retention, attendance, and acceptability of the intervention among patients and dental professionals. Trial design (n=80): Participants will be randomized 1:1 to psychosocial support or standard care for 12 weeks, with a follow-up at week 36.

The intervention will be delivered by a multidisciplinary team, including a dental nurse and a peer worker, focusing on motivational interviewing, psychoeducation, and practical support. The primary outcome of the trial is attendance at dental appointments, while secondary outcomes include quality of life, empowerment, social integration, oral anxiety, and diet behaviours.

Expected results: The pilot study will provide important insights necessary for modifying the intervention and for trial implementation. A mixed-methods approach will integrate qualitative and quantitative assessments to identify both barriers and facilitators to engagement. The subsequent trial will determine whether psychosocial support significantly increases dental attendance and improves secondary outcomes.

Conclusion: This research project will evaluate interventions aimed at increasing the utilization of dental healthcare services among patients receiving opioid agonist therapy. The findings will contribute to evidence-based strategies for improving dental attendance, oral health outcomes, and overall quality of life in this population.