Recovering from drugs and alcohol addiction is an ongoing and honorable process. Having a healthy smile and overall oral hygiene is an important, and often times overlooked, facet of our daily lives. Sadly, the damage to our smiles as a result of substance abuse acts as a constant reminder of our less than ideal choices. This can be demoralizing to our recovery process. But don’t be dismayed, you can get through it, fixing your smile and getting over your addictions!

With mental health and substance abuse issues becoming more and more prevalent in Canada (Henderson, 2024), it is an important topic to understand why, what and how we can help with this issue.

How Substance Abuse Affects Our Oral Health

Substance abuse affects many systems of both our physical and psychological health. It is not surprising that while the affects can be quite prominent in our cardiovascular, respiratory, digestive and musculoskeletal systems to name a few, so to does it have a detrimental effect on our oral health (Teoh et al. 2019).

Not only do specific substances hurt our oral health such as tobacco, cannabis and alcohol (Department of Health, 2024), so to do other factors such as other substances used in conjunction, as well as developing other negative habits. Such examples include excessive sugary drinks and snacks often paired with drug use, or avoiding proper oral hygiene regiments and bruxism due to substance abuse (A, S., & D, J. 2016).

Xerostomia (dry mouth) and Tooth Decay :
Xerostomia is brought on by insufficient saliva to keep the mouth wet. For oral health, saliva plays an integral role in maintaining mouth pH, keeping bacteria in check, and contains minerals as well as growth factors aiding with tooth enamel growth and oral damage repair (Miller & Brennan, 2024)

There are a multitude of factors that lead to this, such as stress, dry environments and excessive mouth breathing. However, another factor is by various drug substances (medicated and recreational) usage that often lead to various worse oral health issues (Rossow, 2021). There are many substances that can cause this, to list here are a few:

• Cannabis (e.x. Marijuana): multiple researches indicate that marijuana use leads to dry mouth, with one such study showing that 69.6% of users experienced dry mouth soon after (ADA, 2023).
• Alcohol: as alcoholic drinks are liquid, they make physical contact with virtually all parts of the mouth, from the teeth, gums and lips, to the salivary glands. As a result, alcohol can damage the salivary glands (Bode & Bode, 1997) in charge of producing the saliva, drying the mouth.
• Methamphetamine: commonly known as just ‘meth’, is linked to decline in salivary buffering capacity, in essence effecting the mouth’s pH changes, causing the mouth to have a too acidic or basic environment. In a study, with many others corroborating it’s findings, it found that methamphetamine users have significantly lower saliva production and a more acidic saliva content (Rommel et al. 2016).
• MDMA/Ecstasy: similar to the effects of cannabis, this also is shown to result in dry mouth symptoms which can last for many hours (A, S., & D, J. 2016).
• Tobacco/Smoking/Nicotine: nicotine, found in all tobacco products and other substances, minimize saliva flow (Mt. Holly, 2021), dehydrating the mouth. Smoking, either tobacco or e-cigarettes, both are shown to reduce saliva flow rate as well as irritating and damaging the salivary glands (Rad et al. 2010).

Xerostomia not only causes mouth discomfort due to the dryness, but it also causes oral decay. With an imbalance of pH from what is healthy, periodontal diseases fester and tooth decay, via enamel decay, occurs (Baliga et al. 2013). Additionally, saliva acts as a lubricant for chewing (Vinke et al. 2021), with a decreased rate, it increases the friction in the mouth, causing pain and damage to tissues and enamel. Saliva also helps re-mineralize tooth enamel and overall oral repair (Miller & Brennan, 2024), an aspect that is decreased with xerostomia.

Bruxism (teeth grinding) and Other Physical Aspects
Bruxism is a negative habit that some may experience, which is in layman’s terms, is teeth grinding. While stresses and habits can cause this, so too can substance abuse (Bruxism, 2022). This can lead to jaw issues, broken teeth, enamel wearing and tooth pain (Bruxism, 2022). Other physical aspects also includes increased consumption of sugary drinks and snacks, gum diseases, and poor oral hygiene care (Le, et al. 2022), all of which leading to various decay, diseases and illnesses.

• Cannabis (e.x. Marijuana): cannabis usage are shown to significantly increase the risk of bruxism (Rommel et al. 2016). It is also observed to increase the frequency of sugary drinks and snacks consumption (Le, et al. 2022), making users ‘snack-ish’. Paired with poor oral hygiene which often occurs in this scenario (Le, et al. 2022), tooth decay, enamel loss and various oral diseases increase their prevalence (Le, et al. 2022). The Canadian Cancer Society gives the belief that long-term smoking of cannabis may also develop into cancer, including oral cancer (ADA, 2023).
• Alcohol: due to it’s liquid nature that it is ingested through, it makes direct contact with almost all parts of the mouth. Since most alcoholic drinks are acidic and/or sugary, it also causes tooth decay, tooth loss and other oral issues (Priyanka et al. 2017). Nocturnal bruxism is also a risk for alcohol use (Ronsivalle, et al. 2024).
• Methamphetamine: meth and oral decay has undergone soo much research and study, with the link between being strongly observed, that it has it’s own term, ‘meth mouth’ (ADA, 2023). Those who use methamphetamine are four times as likely to have dental carries (Teoh et al. 2019). Meth-related carries development is also unique, beginning at the gums, moving to the outer surface of the teeth facing the cheek and spaces in-between the front teeth (Wang et al. 2014). Meth not only causes dry mouth, but is acidic as well, thus having a corrosive effect on oral tissue and teeth, as well as increasing dehydration due to increased physical activity (Teoh et al. 2019). This physical activity also typically leads to bruxism. Similar to cannabis use, meth may also causes increased usage of sugary drinks and food without proper oral hygiene, thus further tooth decay and disease (Teoh et al. 2019).
• Tobacco/Smoking/Nicotine: Many studies show the correlation between smoking (with or without tobacco) and developing dental carries as well as other decay and issues (Jiang et al. 2019). Oral, and other, cancers developing is also a strong risk, widely accepted and proven (Jiang et al. 2019).

Bruxism causes various oral health issues, wearing down teeth, wearing down gums, jaw problems, and other periodontal issues (Bruxism, 2022). Due to substance abuse, lack of proper hygiene, consuming excess sugar, various oral issues, diseases and cancers are at high risk of occurring (Le, et al. 2022). All these aspects create a deadly environment for your oral health, promoting tooth decay, loss and overall oral health decline (Le, et al. 2022).

Treatment And How We Can Help

Treating the oral health effects of substance abuse in most occurrences requires professional dental care, influenced by the severity of the effects. However, it is also just as important, if not more, to treat the root of the problem, substance abuse and addiction. The American Addiction Centers state that the best, and most effective treatment plan is to address and treat both. Thankfully, there are many treatment options available, each better suited for different circumstances. These include:

• Medical/Drug Detox: the process of fully getting rid of the substance(s) from the body. This, depending on the severity of the addiction, can be done independently (although may come with health risks), or through formal detox programs, which are far more safer. These use a set of interventions, such as medications and other therapies, to safely manage the side effects that come from quitting substance addictions.
• Inpatient Rehab: live-in program where a patient can be given supervised, and structured care for their addiction. These are done by professionals where patients reside in dedicated rehabilitation facilities 24/7 until their addiction is gone and/or manageable. The benefit that this offers is that patients are able to be surrounded by those helping to get them over their addictions all the time for as long as the program continues. Ever-present help is provided and being removed from addiction stressors and distractions is proven to be beneficial.
• Outpatient Programs: these programs are a type of substance abuse/addiction rehab programs that allows patients to live at home as opposed to in a rehab center, not requiring overnight stays. This gives the benefit of being a more flexible program, allowing patients to be out in their natural environment, interacting with the public, going to school, work, etc. While allowing more flexibility in their recovery journey, it is less intensive that inpatient rehab, however a variety of therapeutic interventions still take place.

Alongside this, oral health treatment is also strongly recommended to occur simultaneously. Oral health issues, such as dental decay and other periodontal issues, often only get worse over time. As a result, it is important to address them as soon as possible. Also, as one of my previous posts had talked about, by increasing oral health, letting us feel good and look good, our own mental health increases dramatically. Ultimately, this can only help on the recovery and treatment journey, bettering one aspect of our health often times betters other aspects. “You look good, you feel good”.

In Conclusion

Recovering from substance abuses takes a lot of strength and endurance, and is somethings that should be honored and uplifted in society. Hopefully, this post was able to portray the effect that substance abuse has on our oral health, and multiple ways that it can be treated and recovered from, both the oral health and addiction.

At the end of the day, recovering and treating the issue of substance abuse is a venerable ordeal. Remember to uplift anyone who suffers from this issue, and help them to get over their addictions, regaining their mental health and oral health.

One more point _{(I know I keep going on and on)}, be supportive of others in the hard times, and you will find support in others when you need them.

References

A, S., & D, J. (2016, October 4). Stimulants of Abuse and Oral Health. American College of Prosthodontists. https://www.prosthodontics.org/about-acp/position-statement-stimulants-of-abuse-and-oral-health/

ADA Cannabis: oral health effects. American Dental Association. (2023, October 26). https://www.ada.org/resources/ada-library/oral-health-topics/cannabis-oral-health-effects/

ADA Methamphetamine. American Dental Association. (2023, July 12). https://www.ada.org/resources/ada-library/oral-health-topics/methamphetamine/

Baliga, S., Muglikar, S., & Kale, R. (2013). Salivary pH: A diagnostic biomarker. Journal of Indian Society of Periodontology, 17(4), 461–465. https://doi.org/10.4103/0972-124X.118317

Bode, C., & Bode, J. C. (1997). Alcohol’s role in gastrointestinal tract disorders. Alcohol health and research world, 21(1), 76–83.

Bruxism. National Institute of Dental and Craniofacial Research. (2022). https://www.nidcr.nih.gov/health-info/bruxism

Canadian Cancer Society / Société canadienne du cancer. (n.d.). Cannabis and cancer-are they connected?. Canadian Cancer Society. https://cancer.ca/en/cancer-information/reduce-your-risk/live-smoke-free/cannabis-and-cancer-are-they-connected#:~:text=It%20is%20possible%20that%20cannabis,people%20who%20smoke%20tobacco%20cigarettes.

Department of Health & Human Services. (2024, July 2). Teeth and drug use. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/teeth-and-drug-use

Henderson, J. (2024, October 24). Making mental health and substance use services accessible in the community. Canadian Institute for Health Information. https://www.cihi.ca/en/taking-the-pulse-measuring-shared-priorities-for-canadian-health-care-2024/making-mental-health-and-substance-use-services-accessible-in-the-community

Jiang, X., Jiang, X., Wang, Y., & Huang, R. (2019). Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis. Tobacco induced diseases, 17, 34. https://doi.org/10.18332/tid/106117

Le, A., Khoo, E., & Palamar, J. J. (2022). Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists. International journal of environmental research and public health, 19(22), 15261. https://doi.org/10.3390/ijerph192215261

Miller, K., & Brennan, R. (2024, October 14). Saliva and your mouth. WebMD. https://www.webmd.com/oral-health/what-is-saliva

Priyanka, K., Sudhir, K. M., Reddy, V. C. S., Kumar, R. K., & Srinivasulu, G. (2017). Impact of Alcohol Dependency on Oral Health – A Cross-sectional Comparative Study. Journal of clinical and diagnostic research : JCDR, 11(6), ZC43–ZC46. https://doi.org/10.7860/JCDR/2017/26380.10058

Rad, M., Kakoie, S., Niliye Brojeni, F., & Pourdamghan, N. (2010). Effect of Long-term Smoking on Whole-mouth Salivary Flow Rate and Oral Health. Journal of dental research, dental clinics, dental prospects, 4(4), 110–114. https://doi.org/10.5681/joddd.2010.028

Rommel, N., Rohleder, N. H., Koerdt, S., Wagenpfeil, S., Härtel-Petri, R., Wolff, K. D., & Kesting, M. R. (2016). Sympathomimetic effects of chronic methamphetamine abuse on oral health: a cross-sectional study. BMC oral health, 16(1), 59. https://doi.org/10.1186/s12903-016-0218-8

Ronsivalle, V., Marrapodi, M. M., Siurkel, Y., Cicciù, M., & Minervini, G. (2024). Prevalence of Bruxism in alcohol abusers: a systematic review conducted according to PRISMA guidelines and the cochrane handbook for systematic reviews of interventions. BMC oral health, 24(1), 108. https://doi.org/10.1186/s12903-024-03862-1

Rossow I. (2021). Illicit drug use and oral health. Addiction (Abingdon, England), 116(11), 3235–3242. https://doi.org/10.1111/add.15360

Teoh, L., Moses, G., McCullough, M.J.(2019) Oral manifestations of illicit drug use. Australian Dental Journal, 64: 213–222.

Tips to combat dry mouth caused by smoking. Mt. Holly Family Dentistry Blog. (2021, March 8). https://www.mthollyfamilydentistry.com/blog/dry-mouth-smoking/

Vinke, J., Oude Elberink, M., Stokman, M. A., Kroese, F. G. M., Nazmi, K., Bikker, F. J., van der Mei, H. C., Vissink, A., & Sharma, P. K. (2021). Lubricating properties of chewing stimulated whole saliva from patients suffering from xerostomia. Clinical oral investigations, 25(7), 4459–4469. https://doi.org/10.1007/s00784-020-03758-8

Wang, P., Chen, X., Zheng, L., Guo, L., Li, X., & Shen, S. (2014). Comprehensive dental treatment for “meth mouth”: a case report and literature review. Journal of the Formosan Medical Association = Taiwan yi zhi, 113(11), 867–871. https://doi.org/10.1016/j.jfma.2012.01.016