Using Evidence-Based Dentistry in the Clinical Management of Methadone Maintenance Therapy Patients

There is an increased interest to incorporate interprofessional educational models in the academic dental institutions to serve both student education and patient care. The aim of this report is to integrate evidence-based dentistry (EBD) with an interprofessional approach to treat methadone maintenance therapy (MMT) patients. Current example illustrates the case of a 26-year-old man receiving MMT who presented at Tufts University School of Dental Medicine with the chief complaint of "I want to fix my teeth." He presented with a collapsed vertical dimension of occlusion, extensive partial edentulism on both arches with bone loss, and a past history of drug abuse since the age of 16 years.

The 5-step (ask, acquire, appraise, apply, assess) framework for the EBD process was used. First, the PICO (population, intervention, comparison, and outcome) question was asked, and then the literature was acquired and appraised. An expert librarian assisted in finding articles on the effects of methadone on the oral cavity and consequences that will affect dental treatment. The search was conducted on PubMed, using the following keywords: oral health, dentistry, dental health, and methadone. The search was performed from 1/1/2005 to 1/1/2018. After appraisal, the studies were applied in the clinical setting and treatment outcomes were assessed both subjectively and objectively.

The initial search identified there is sparse evidence on the topic. Only 34 articles were acquired. Based on the scientific evidence published, the interprofessional expertise of the clinical care team, and patient's perspective, 4 treatment plan options were proposed. The selected treatment plan was considered the best option considering an EBD person-centered approach. Progress of treatment, outcomes, and lessons learned were assessed.

This study demonstrates that incorporating EBD concepts and an interprofessional approach, MMT patients can be successfully treated. Future studies on this topic are recommended, specially considering the growth of the opioid epidemic in the past years and the need to treat the MMT patients and educate students.