A medication that treats opioid use disorder – buprenorphine – has become a well-known therapy in part for its convenience: In film or tablet form, it can dissolve under the tongue in a patient’s mouth and ease the craving for heroin or other potent drugs. Less recognized is one of its side effects, and a group of Virginia Commonwealth University health sciences students has come together to address the issue.

Severe dental problems have been linked to buprenorphine, and those oral health issues on rare occasions can become life-threatening on their own. Led by VCU School of Pharmacy students, a recent initiative – a recent initiative – the Resilient Smile Project – aims to both help patients maintain their oral health and educate health care providers about addressing buprenorphine’s side effects when dissolved within the mouth.

In 2022, the Food and Drug Administration recognized that tooth loss and decay could accompany use of the medication, and concern has grown. Despite these concerns, the benefit of buprenorphine outweighs these risks.

“When they first released that announcement in 2022, there weren’t any cases reported of death caused by dental complications,” said Christian Moon, a second-year Pharm.D. candidate in the School of Pharmacy whose interests include public health and psychiatric conditions. “As we looked at that again with the same criteria, in 2024, we noticed a rise in cases of death, indicating the issue has gotten worse.”

Moon is vice president of VCU’s student chapter of the American Association of Psychiatric Pharmacists, and the student group had been considering the buprenorphine issue with its advisor, Ericka Crouse, Pharm.D. She is an associate professor in the School of Pharmacy’s Department of Pharmacotherapy and Outcome Sciences, and she specializes in psychiatric pharmacy and substance use disorders.

Moon led the formation of Resilient Smile. The project's service chair, Taylor Mitchell, recruited students from across the VCU health sciences enterprise, including the schools of Medicine, Nursing and Dentistry, as well as the College of Health Professions and VCU Graduate School to conduct an oral hygiene donation drive and participate in two service days in February.

Through the combined support of the health science community, this initiative resulted in 270 kits, 70 of which contain pediatric oral health supplies to support patients with families in Richmond. Every kit included a patient-specific education pamphlet designed by the team's education chair, Anaelle Dahourou, outlining local dental resources for indigent and medically underserved populations and discussing overdose prevention and proper buprenorphine administration.

The kits – which contain ultra-soft bristle toothbrushes, gentle toothpaste, mouthwash, dental floss, sanitary wipes and educational pamphlets – are being distributed to five area pharmacies and clinics that serve individuals with opioid use disorders: Bremo Pharmacy, Daily Planet Health Services, Verity Psychiatry, Richmond Behavioral Health Authority via Westwood Pharmacy, and VCU Health’s MOTIVATE Clinic, which offers a full spectrum of addiction-related services.

“From a health professional perspective, it helps bring an early introduction to keep an eye out” for oral health issues among clients – and to educate and guide them, said Taylor Mitchell, a second-year Pharm.D. student and the AAPP service chair.

She added that monitoring buprenorphine’s benefits and side effects must be a team effort: “Doctors are the ones prescribing the medication. Dentists are the ones that are able to see the decline in oral health. And then pharmacists are the ones that are filling the prescription and are able to talk to the patients about the medication.”

Reflecting that interdisciplinary spirit, the project’s approach grew through coordination with leaders from the Center of Interprofessional Education course for health sciences students. Moon coordinated with IPEC leaders to broaden its outreach throughout VCU’s health sciences community.

Alongside Moon, Crouse and Mitchell, the Resilient Smile Project team across VCU Health Sciences includes: P2 Anaelle Dahourou, AAPP Education Chair; P2 Taylor Murphy, AAPP Promotions Chair; P3 Shawna Keane, AAPP VCU Collegiate Chapter representative; Natasha Smith, School of Dentistry representative; and Kate Gibson, School of Nursing and RAMS in Recovery representative. “These individuals have been instrumental in promoting the project among their peers and colleagues,” Moon said.

At February’s service days, the students learned from Crouse about opioid use disorder – from how drug treatments intersect with oral health to a larger, more sobering truth.

“The opioid crisis has been going on for a while now,” she said. “Overdose is one of the top reasons people in the 18- to 35-year-old age group are dying these days.”

Crouse and Moon secured a grant from the national AAPP’s Collegiate Chapter Impact Grants program to support Resilient Smile and received a donation from Verity Psychiatry for the program. Moon is looking forward to sharing results of the VCU’s buprenorphine initiative at AAPP’s national conference in April.

“My hope here is to be able to start facilitating further conversations,” he said. “We’ll be able to further put a light on the issue that is getting worse. … It’s not just a pharmacist perspective that we should be tackling it from. It’s the entire health care team.”

From the VCU student team, undergraduate dental hygiene senior Natasha Smith is president of the campus chapter of the American Dental Hygienists Association, and she was Resilient Smile’s point person for the School of Dentistry. She helped identify items for the oral hygiene kits and secured donations of supplies from on and off campus.

Several organizations supported this project, including American Dental Hygienists Association VCU student chapter, RAMS in Recovery, Allen Family Dental and The Horizon at Springdale Park.

Smith said she and her classmates joined the project in part to reflect how dental hygienists play crucial roles in patient care, including discussions of how pharmacology intersects with oral health.

“We go beyond prevention and ‘just cleanings’ to offer comprehensive dental care,” Smith said. “A big focus is education, so taking the time with these patients, educating them – it’s a good effort to help everybody be on the same page.”

Mary Kate Brogan contributed to this article.