Is there a relationship between sugar-containing methadone and dental caries? A systematic review

This summary is based on the article published in Health Education Journal: The relationship between sugar-containing methadone and dental caries: A systematic review (July 2013)

Sheela Tripathee; Tahira Akbar; Derek Richards; Markus Themessl-Huber; Ruth Freeman

Context

Methadone is currently one of two first-line drugs recommended by the National Institute of Clinical Excellence (NICE) in the management of drug dependence. Owing to its lower cost, is it recommended when there is no clear benefit from the alternative and more expensive buprenorphine. (1)

Dispensed as a single daily dose, typically supervised for the first three months of treatment, methadone is administered at a dose which minimizes individual experience of withdrawal but with none of the euphoric effects of opiates.

While extensive research has been conducted to clarify the cost-effectiveness of methadone compared with buprenorphine, there are currently no evidence-based guidelines of the benefits in using sugar-free compared with sugar-containing formulations to prevent dental caries. (2)

Purpose of the Review

The aim of this systematic review is to examine the evidence of the relationship of sugar-containing methadone and dental caries in patients undergoing methadone maintenance treatments.

Key Findings

• The current literature shows no robust evidence which links sugar-containing methadone, with dental caries experience.
• It is widely recognized that sugar-content of methadone is only one risk factor within a multi-factorial aetiology of tooth decay. (3), (4),(5-8), (9), (10), (11).
• The recommendation to use sugar-free methadone is consistent with oral health messages to reduce the frequency of sugar intake. There is no firm evidence, however, to support this recommendation.

References

1. NICE. Drug Misuse: Psychosocial Interventions and Opioid Detoxification, Clinical Guidelines CG52. London: National Institute for Clinical Excellence, 2007.
2. Richardson J, Longworth L, Marschke E. Methadone and Buprenorphine for the Management of Opioid Dependence. London: National Institute for Health and Clinical Excellence, 2007.
3. Lewis DA. Methadone and caries. British Dental Journal, 1990: 168: 349.
4. Rees TD. Oral effects of drug abuse. Critical Reviews in Oral Biology and Medicine, 1992: 3: 163–84.
5. Sheedy JJ. Methadone and caries. Case reports. Australian Dental Journal, 1996: 41: 367–9.
6. 15. Preston A. The Methadone Handbook, 3rd edition. London: Island Press Ltd, 1996.
7. 16. Meaney PJ. Methadone and caries. Australian Dental Journal, 1997; 42: 138.
8. Titsas A, Ferguson MM. Impact of opioid use on dentistry. Australian Dental Journal, 2002: 47: 94–8.
9. Graham CH, Meechan JG. Dental management of patients taking methadone. Dental Update, 2005: 32: 477–8.
10. Nathwani NS, Gallagher JE. Methadone: Dental risks and preventive action. Dental Update, 2008: 35: 542–8.
11. Brondani M, Park PE. Methadone and oral health – a brief review. Journal of Dental Hygiene, 2011: 85: 92–8.

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