Drug Court Smiles: Addressing Dental Care Equity for Justice-Involved People

Abstract

People in the criminal justice system, especially those enrolled in drug treatment courts, have complex health profiles, limited access to medical and dental care, and a high prevalence of substance use disorders (SUD). SUD is associated with poor oral health, including severe dental caries and periodontal disease. Both poor oral health and SUD can contribute to low self-esteem and stigma that pose barriers to seeking care. The aim of this study is to examine dental care and oral health disparities among community-dwelling justice-involved people with SUD enrolled in the drug treatment courts. We surveyed clients (N = 59) and leadership team members (n = 23) in four drug treatment courts. Clients responded to questions about dental care needs and self-reported oral health; leadership team members provided their perspectives on clients’ oral health needs and barriers to care. Most clients (61%) rated their oral health as fair to very poor, and 27% had not seen a dentist in at least 3 years. Most (70%) leadership team members indicated that clients had occasionally or frequently discussed an oral health problem and 26% noted that clients occasionally or frequently missed court due to dental pain. Both clients and team members identified cost, transportation, fear, and stigma as key barriers to addressing clients’ dental health needs. Improving oral health for justice-involved people with SUD may entail a multifaceted approach to address these barriers, and might consider novel approaches, such as co-locating dental and SUD providers.