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Often Overlooked Opioid Side Effect Can Add $200,000 to a Claim

Long-term opioid use can cause a claim to increase by $200,000 as a result of dental issues. In this WorkersCompensation.com feature, Nancy Glover highlights one of the unknown effects long-term opioid use - dry mouth. Catch the entire article, featuring National Product Leader for Dental Leigh Kuhns, and learn about the problem long-term opioid use can cause and ways to prevent mounting dental claim costs.

Sarasota, FL (WorkersCompensation.com) - Certain medications cause dry mouth, especially opioids. Left untreated, this can cause crumbling teeth and require extensive – and expensive — dental procedures. While not uncommon in the workers' compensation system, many adjusters and other stakeholders don't realize it's a problem until they are faced with an enormous and unexpected bill. Experts advise taking precautions to prevent permanent damage to injured workers' teeth and unnecessary costs to payers.

The Problem

Cases typically affected are those that involve surgery, especially of the neck, back or knees, as well as catastrophic injuries. The 1,800 medications that cause dry mouth include pain medications — especially opioids, as well as drugs for anxiety, depression, blood pressure, heart, allergies and inhalers. Methadone, often used to help a patient wean off opioids, also causes dry mouth.

“We have 53 open cases right now and over $1 million in treatment for those 53 people,” said Leigh Kuhns, national Product Leader for Dental at One Call. “It's a deceiving number because it's a domino effect. We get them a year or two after treatment is done [for their injury]. What happens is while you're trying to provide the dental treatment, the condition continues to worsen; the person may not have knowledge of oral hygiene or may not be going to appointments. Three months later a new dental treatment comes up and/or changes if they are still taking the medication.”

The problem is twofold; one is that the medications inhibit saliva production, causing bits of food to remain in the mouth and cause tooth decay and gum issues. The other challenge is that the medication itself may mask the pain from a toothache that develops, so the injured worker is not aware there is a problem.

By the time the injured worker seeks treatment, his teeth may be crumbling and have no supporting structure left in his mouth. At that point, he may need a full mouth implant or prosthesis. The entire treatment can be a two-year ordeal. In many states, payers must cover the costs of conditions stemming from long-term opioid use.

“If I had to put a number on it, [the average] is around $50,000,” Kuhns explained. “We've had claims up to $200,000.”

Prevention

The earlier an injured worker is treated for dental problems, the more likely he will have a better and less expensive recovery. If possible, he should be sent to a dentist early in the claims process.

“They should at least have a general evaluation,” she said. “Things happen very quickly depending on how good they are with their oral hygiene.”

When possible, Kuhns also advises stakeholders to obtain previous dental records, including examinations and x-rays. Since the problem becomes worse the longer a person is on opioids, Kuhns also suggests the injured worker have regular visits with a dental hygienist and receive a fluoride prescription.

The main key to preventing extensive dental damage is education.

“Dry mouth sufferers, for example, tend to suck on hard candies or have sugary drinks to relieve the discomfort. While they may experience some short term relief they're actually accelerating the rate of dental disease,” she said. “So if we can get them in there and educate them to avoid Coca Cola and Red Bull, and instead drink water, that would definitely go a long way to control costs.”

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