A recent review published in the scientific journal Addiction has shed much needed light on an important but rarely discussed condition associated with Substance Use Disorders. Advanced dental disease, including tooth decay and periodontal conditions, are common comorbid conditions among persons with Substance Use Disorders.

To determine the prevalence, investigators conducted an exhaustive systematic search for studies from the past 35 years germane to oral health among substance abusers. Medline, PsycInfo, Ovid, Google Scholar, Embase and article bibliographies were reviewed and analyzed. The results were compared with the general population of non-substance using controls. Parameters of oral health were defined in terms of tooth decay and periodontal disease by comparing the percent of decayed, missing and filled teeth (DMFT) or surfaces (DMFS) and probing gum pocket depth. In total, this review culled the results of 28 studies yielding comparative data on 4,086 dental patients with substance use disorder and 28,031 controls.

Drugs and Dental Disease

Drug abuse affects oral health via direct physiological routes including dry mouth, craving and consumption of sugary sweets and processed carbohydrate snacks (munchies), and most recently processed cannabis sweets, such as gummy bears, candy, cookies and of course…brownies. Cocaine, methamphetamine and other drugs of abuse may interfere with the blood supply to teeth and gums. Teeth clenching and grinding (bruxism), is associated with the chronic use of stimulants and Ecstasy as well as anxiety and depression, which are common comorbidities of Substance Use Disorders. Chemical erosion resulting from excessive use of alcohol, coffee or from applying highly acid drugs such as cocaine to one’s teeth and gums are causative of oral disease. Lastly, given the choice between drug self-administration and flossing or brushing regularly, abusers and addicts pick drugs of abuse.

Why Does This Matter?

As we age, oral health has increasingly significant consequences on our quality of life and overall health. At its best, persons with serious dental and periodontal disease suffer difficulty masticating and observable aesthetic problems that negatively impact self-esteem. At its worse, dental and oral disease cause chronic inflammation and bacteremia, which are risk factors for heart disease, stroke, diabetes and compromised respiratory function. The findings from this study are similar to the outcomes associated with severe mental illness and eating disorders.

The addition of 2.8 million new drug users each year is unsustainable for our current healthcare system. It is difficult to get many users primary medical or addiction care. It is almost impossible to get Substance Use Disorders patients to the dentist. Health disparities and access to care are ongoing public health crises. We will either need a lot more doctors and dentists or a lot fewer drug addicts.

In the clinical setting, we can make a difference. Clinicians who evaluate and treat people with substance use disorders should make certain to include a mouth, gum, and dental history and oral exam. We should routinely screen for oral diseases, arrange for dental care as needed, and educate patients of the oral health risks associated with Substance Use Disorders, dry mouth and cravings for foods with high sugar content.