October is National Substance Use Prevention Month and as the month comes to an end, KOHC is recognizing the important role dental professionals play in substance use prevention and treatment. KOHC heard from Dr. William E. Collins about the connection between substance use disorder (SUD) and oral health. He serves as the Dental Director at Red Bird Clinic, Inc in Beverly, Kentucky.  

Here’s what Dr. Collins had to say about the role of oral health professionals in prevention and treatment of substance use disorders. 

What is the relationship between substance use disorders and oral health? 

The relationship is not solely based on misusing substances, we see an impact on the oral health of a person with the use of prescription medications, over the counter medications, and illegal street drugs. Any medication that causes a decrease in salivary flow (dry mouth) hinders the natural cleansing ability of the mouth. Once this happens the dietary habits and oral hygiene practice of the person plays a significant role. Poor oral hygiene and diets consisting of sugars and acids will prove detrimental to teeth and oral health. Because of this, we typically see rampant decay in patients with substance use disorders, but these effects can also be observed in those taking prescription or over the counter medications if oral health is not properly cared for.   

Although opioids and opiates are not stimulant drugs, they can cause users to grind their teeth, which cracks teeth and damages the jaw. Those who inject these drugs put themselves at higher risk for many infections, which can cause oral fungus or viral infections that affect the mouth. Since opioids also reduce pain, the associated loss of sensitivity could lead to the person ignoring pain from cavities or gum disease.  

In addition to the impacts on the environment created in the mouth from decreased salivary flow, smoking any substance causes an increased risk of mouth and throat cancers. People who smoke are also twice as likely to have periodontal (gum) disease. The intake of drugs through the mouth and nose can lead to sores and damage to the tissue, as well as the possibility of infection.  

How can dentists contribute to prevention efforts to reduce the risk of using substances or becoming dependent?  

Dentists should review patient medical and prescription history to determine if there are any medicines or disorders that directly or indirectly affect oral health of an individual. When prescribing, the dentist should always prescribe the minimal dosage of a drug that will achieve the desired goal. Unfortunately, dental surgery may lead to opioid addiction, for some people. Oral surgery to correct dental problems is common, and dentists typically prescribe a course of opioid painkillers after surgery. While these are typically milder opioids, the drugs may still trigger addiction for some individuals.

The American Dental Association recently issued guidelines for opioid prescriptions to help dentists become more aware of their role in the opioid addiction epidemic. 

Why should oral health be considered a part of recovery for those with substance use disorder? 

Damage to oral health means that teeth may be lost, and gum disease could cause lasting harm to the mouth. This could make eating difficult even after drug use has stopped, and it can damage a person’s self-esteem, which can make emotional recovery from substance use harder. Getting help with detox, then entering a rehabilitation program, can help a person overcome addiction. Oftentimes, treatment centers will assist individuals in finding dental care. It is important that dental care is started during the recovery phase and patients are educated in the importance of their oral care during recovery. Often this is a lengthy process to correct the damage to the dentition.  

What role can a dental provider play in helping those suffering from substance use disorder?  

The dental provider should be supportive of the recovery process. They must encourage the individual to improve their oral hygiene techniques and assist in smoking cessation. The dentist should be positive with their treatment plans and allow the patient options if possible. Changing dietary habits and ceasing tobacco use is not an easy task, it takes time and positive reinforcement.

The key is to remember to avoid negativity. Patients with a substance use disorder have already experienced a great deal of negativity from society in general, the road to recovery is difficult but not impossible. Encouragement, effective treatment, and support are key to success. 


Join KOHC in recognizing the important role dental professionals play in preventing and treating Substance Use Disorders, and advocating for policies that support individuals with SUD.