Barriers and facilitators for use of oral healthcare services among people with substance use disorders: A qualitative study in Norway

Background: People receiving opioid maintenance treatment (OMT) have poorer oral health compared to their aged counterparts. More than half of OMT patients are dissatisfied with the appearance of their teeth and mouth, and they suffer impaired oral health related quality of life. Recent figures suggest that only 42% of OMT patients visit a dentist annually. Nevertheless, knowledge of the use of oral healthcare services among OMT patients is insufficient, despite the fact that the offer in Norway is free of charge. We aimed to qualitatively examine and understand the barriers and facilitators for use of dental health services amongst patients in OMT.

Methods: Sixty-three individuals participated; 30 OMT patients and 33 dental healthcare workers (DHW). Five focus groups were conducted (6–8 participants) with 27 OMT patients, and four focus groups with 29 DHWs. Three individual interviews with OMT patients and four with DHWs were conducted. A bottom-up, data-driven process with inductive thematic analysis was used to identify, analyse, and report the main themes.

Results: Teeth were a significant factor in OMT patients’ quality of life and recovery. Identified facilitators were; accompaniment to dentist appointments, adapted anaesthesia, and dentist–patient relationship. Furthermore, individual and structural barriers such as struggling to attend appointments, discrepancies between patients’ expectations and the services offered, and perceived stigma prevents patients from using the free oral health care services. Besides, DHWs’ lack of knowledge and information of the OMT system was a barrier.

Conclusion: OMT patients face several barriers in accessing and using oral health care services. However, through relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be improved. Both patients and DHW are are motivated to make the most out of the free dental health care offer.