Nicolas Coomber – COLTENE National Account & Marketing Manager
Addiction can affect anyone from any socioeconomic background, at any age, but the effects are more devastating for patients from impoverished backgrounds.[i] While some people addicted to alcohol, controlled substances or prescription drugs may be able to maintain relationships, family lives and work, for many, addiction negatively impacts all aspects of life. For sufferers of addiction, there can be a significant effect on oral health, leaving patients with complex restorative needs after recovery.
An understanding of the impact of addiction on patients’ oral health and wellbeing, as well as an awareness of their needs during recovery and remission, can greatly assist clinicians in developing strategies for restorative treatment. For example, pain management is a particular issue for recovering addicts. Developing a rapport has been shown to reduce the need for post-operative analgesics, encouraging these patients to return and receive much-needed care.[ii]
What is addiction?
The condition of being addicted to drugs or alcohol, also known as substance use disorder (SUD), has been identified by the American Psychiatric Association as a cluster of cognitive, behavioural and physiological symptoms resulting in the patient continuing to use despite significant problems related to the substance. The condition is characterised by risky usage, and impaired control. SUD damages essential decision-making functions, making it difficult for the patient to understand the consequences of continued substance abuse.[iii]
Recovering from addiction is a difficult process requiring patients to refrain from certain compulsive behaviours as well as to learn new ways of managing triggers. Patients living with addiction are more likely to be successful with recovery if they receive help and support.[iv]
Some of the oral symptoms associated with drug and alcohol abuse
Self-care through practising regular oral hygiene is one of the most important factors in maintaining oral health. Very often people who have experienced substance addiction have neglected this while under the influence of drugs or alcohol. Many patients also lack awareness of some of the additional oral healthcare challenges associated with many addictive substances.[v]
Alcohol use disorder is the most prevalent SUD, and it can result in acute dental pain as well as decay, erosion, and oropharyngeal cancer. Alcohol also decreases saliva production.iii Excessive consumption of alcohol impairs the immune system and causes oxidative stress, promoting inflammation. This leads to a greater susceptibility to infection.[vi]
Opioids, including heroin and opioid pain killers, lead to salivary hypofunction causing xerostomia, caries, burning mouth and taste impairment. Evidence suggests that opioids induce a preference for sweet foods, increasing the risk of decay and infection. Methadone, used to treat opioid addiction, usually has a high sugar content, and the common co-prescribing of antidepressants can cause xerostomia.[vii]
Cannabis acts as an immunosuppressant. When smoked without a filter, it increases inhaled smoke which causes cannabis stomatitis, leukoedema of the buccal mucosa and hyperkeratosis. Frequent cannabis-use is associated with an increased risk of periodontitis. Local anaesthetics containing epinephrine can cause prolonged tachycardia in patients who use the drug.[viii]
The intranasal use of cocaine can cause perforations of the hard palate and nasal septum, as well as maxillary sinusitis, burns, blisters and sores. Intraoral use of cocaine powder has been shown to decrease saliva pH, creating an opportunity for caries-inducing bacteria.[ix]
Due to its sympathomimetic effect, methamphetamine induces clenching and bruxism. Meth-use is associated with tooth wear and can cause osteonecrosis of the mandible. Again, xerostomia is a feature of meth-addiction, leading to a high incidence of high caries and periodontal disease among users.[x]
Dental pain is a common feature for many recovering addicts, and has been identified as a route for some patients seeking to self-medicate with the use of drugs. Clinicians are advised to coordinate pain management with patients’ medical teams to prevent unwanted drug interactions or overdosing.[xi]
A new lease of life
Providing a patient with restorative treatment while they are in remission or recovery can be life-changing. Direct dental restorations, where appropriate, can be an excellent minimally invasive solution. This is especially beneficial when patients suffer from dental sensitivity or pain, especially when pain management is an issue.[xii]
Universal composites, BRILLIANT EverGlow and EverGlow Flow and new BRILLIANT Bulk Fill Flow from COLTENE use submicron hybrid technology to provide durable and beautiful results. Developed with an intuitive shading system and user-friendliness, the BRILLIANT range blends exceptionally well, and work perfectly together for a smooth workflow.
Providing restorative dental treatment to former addicts requires sensitivity and care, as well as a meticulous clinical approach. By fostering a supportive environment, using appropriate pain management strategies and being mindful of the psychological and social factors involved in addiction, dental professionals can play a crucial role in restoring not only the physical health of their patients but also their confidence and self-esteem.
For more on COLTENE, visit https://colteneuk.com/BRILLIANT-EverGlow
email info.uk@coltene.com or call 0800 254 5115.
[i] Grinspoon P. Poverty, homelessness, and social stigma make addiction more deadly. Harvard Health Publishing. September 2021. Available at: https://www.health.harvard.edu/blog/poverty-homelessness-and-social-stigma-make-addiction-more-deadly-202109282602 Accessed May 2025
[ii] Sainsbury D. Drug addiction and dental care. N Z Dent J. 1999 Jun;95(420):58-61. PMID: 10396929.
[iii] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[iv] Grella CE, Stein JA. Remission from substance dependence: differences between individuals in a general population longitudinal survey who do and do not seek help. Drug Alcohol Depend. 2013 Nov 1;133(1):146-53. doi: 10.1016/j.drugalcdep.2013.05.019. Epub 2013 Jun 21. PMID: 23791039; PMCID: PMC3786033.
[v] Poudel P, Kong A, Hocking S, Whitton G, Srinivas R, Borgnakke WS, George A. Oral health-care needs among clients receiving alcohol and other drugs treatment-A scoping review. Drug Alcohol Rev. 2023 Feb;42(2):346-366. doi: 10.1111/dar.13583. Epub 2022 Dec 18. PMID: 36529982; PMCID: PMC10107646.
[vi] Tharmalingam J, Gangadaran P, Rajendran RL, Ahn BC. Impact of Alcohol on Inflammation, Immunity, Infections, and Extracellular Vesicles in Pathogenesis. Cureus. 2024 Mar 25;16(3):e56923. doi: 10.7759/cureus.56923. PMID: 38665743; PMCID: PMC11043057.
[vii] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[viii] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[ix] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[x] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[xi] Cuberos M, Chatah EM, Baquerizo HZ, Weinstein G. Dental management of patients with substance use disorder. Clin Dent Rev. 2020;4(1):14. doi: 10.1007/s41894-020-00078-8. Epub 2020 Jun 15. PMCID: PMC7294521.
[xii] Azeem RA, Sureshbabu NM. Clinical performance of direct versus indirect composite restorations in posterior teeth: A systematic review. J Conserv Dent. 2018 Jan-Feb;21(1):2-9. doi: 10.4103/JCD.JCD_213_16. PMID: 29628639; PMCID: PMC5852929.
