Objectives: Methamphetamine (MA) is a widely used illicit drug and a nationwide public health concern. Although dental complications are consistently reported among MA users, yet limited nationally representative studies on the associations between MA use and oral health currently exist. Methods: Using the National Health and Nutrition Examination Survey 2009-2014, we analyzed 8,762 respondents aged 30-64 years who had completed a periodontal examination. MA use was self-reported; periodontitis, untreated caries, and missing teeth were assessed by calibrated dentists. Descriptive statistics as well as multivariable regression analyses were performed. Data were weighted to yield representative estimates of the US adult population. Results: Overall 7.8 percent of US adults aged ≥30 years had ever used MA. Ever-use prevalence was higher among males, whites, and individuals below the federal poverty level. Established MA users had a higher prevalence of untreated dental caries (36.6 percent), any periodontitis (54.8 percent), and severe periodontitis (12.2 percent) than those who had never used MA. The prevalence of any periodontitis was higher among current MA users (PR: 1.31; 95% CI: 1.05-1.62) than those who never used MA. Prevalence of untreated dental caries was higher among current MA users (PR: 1.53; 95% CI: 1.10-2.13) and established users (PR: 1.21; 95% CI: 1.02-1.48) than never users. Taking MA orally and/or through injection was associated with higher odds of severe periodontitis than orally only (AOR: 3.72; CI: 1.79-7.75). Conclusions: MA users had a higher prevalence of periodontitis and dental caries. Continued research assessing the relationship between MA use and oral health can inform clinical interventions and management of dental diseases in MA users.

Purpose To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. Methods This study used an explanatory sequential mixed‐methods approach. A 46‐question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. Results Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three‐quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02–0.41) for programs with none‐to‐minimal levels of SDH integration in their clinical settings compared to close‐to‐fully integrated ones. Coding of PD interviews (N = 13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. Conclusions AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person‐centered care.

PURPOSEThis study evaluated the integration of behavioral health topics (anxiety disorder, depressive disorder, eating disorders, opioid use disorder, and intimate partner violence) into primary care postgraduate dental curricula. METHODSWe used a sequential mixed methods approach. We sent a 46-item online questionnaire to directors of 265 Advanced Education in Graduate Dentistry programs and General Practice Residency programs asking about inclusion of behavioral health content in their curriculum. Multivariate logistic regression analysis was used to identify factors associated with inclusion of this content. We also interviewed 13 of the program directors, conducted content analysis, and identified themes pertaining to inclusion.RESULTS A total of 111 program directors completed the survey (42% response rate). Less than 50% of programs taught their residents to identify anxiety disorder, depressive disorder, eating disorders, and intimate partner violence (86% taught identification of opioid use disorder). From the interviews, we identified 8 main themes: influences on the inclusion of behavioral health in the curriculum; training strategies; reasons for incorporating the training strategies; training outcomes (ie, ways in which residents were evaluated); training outputs (ie, ways in which a program's success was quantified); barriers to inclusion; solutions to barriers; and reflections on how the current program can be made better. Programs housed in settings with no to minimal integration were 91% less likely (odds ratio = 0.09; 95% CI, 0.02-0.47) to include identifying depressive disorder in their curriculum compared with programs in settings with close to full integration. Other influences for including behavioral health content were organizational/government standards and patient populations. Barriers to including behavioral health training included organizational culture and lack of time.CONCLUSIONS Advanced Education in General Dentistry and General Practice Residency programs need to make greater efforts to include in their curricula training on behavioral health conditions, particularly anxiety disorder, depressive disorder, eating disorders, and intimate partner violence.