Abstract
OBJECTIVES: In 2022, the FDA issued a drug safety communication based on case studies that transmucosal buprenorphine, a medication for opioid use disorder (MOUD), may contribute to dental disease. We sought to assess longitudinal dental care utilization patterns among patients with opioid use disorder (OUD) in the 18 months before and 36 months after MOUD initiation. METHODS: Using data from the Veterans Affairs Corporate Data Warehouse (2003-2020), we created a cohort of patients coded for OUD and prescribed MOUD. Outcomes included preventive and therapeutic dental visits and oral infections within 18 months before and up to 36 months after index MOUD. We used unadjusted Poisson models to estimate incidence per 1000 patients by MOUD. We performed analyses with and without interval censoring for edentulism, death, or a 60-day gap in MOUD. RESULTS: Among 49,675 eligible patients, 21,551 received methadone, 17,759 transmucosal buprenorphine, 8993 oral naltrexone, and 1372 injectable naltrexone. Median (IQR) days on treatment varied by drug: methadone 95 (52, 257), buprenorphine 309 (102, 968), oral naltrexone 49 (30, 101), injectable naltrexone 28 (28, 85). We observed an immediate increase in dental visits from a baseline range of 135-144 visits/1000/6-month period to 223-686 visits/1000/6-month period after initiating any MOUD. Patterns were similar by MOUD agent and formulation. Results were similar in analyses with and without interval censoring. CONCLUSIONS: Both preventive and therapeutic dental utilization increased immediately following initiation with MOUD. Future observational studies of the effects of MOUD on adverse dental outcomes should account for confounding due to health-seeking behavior.