Impact of Drug Use on Oral Health: Drugs That Cause Dental Problems

How Does Drug Misuse Affect Oral Health?

Substance misuse can negatively affect multiple systems of the body, including everything from the cardiovascular and respiratory systems to reproductive, digestive, and musculoskeletal systems. Not surprisingly, then, a host of oral and dental health issues are associated with substances ranging from cocaine and methamphetamine to alcohol and marijuana.^1,2

That said, other factors occurring alongside substance use can impact oral health and can muddy the waters in terms of causality. For example, some people with substance use disorders regularly use one or more other substances and may exhibit a range of contributing behavioral factors, such as consuming sugary drinks and snacks, not satisfying nutritional requirements, avoiding dental treatment/exams, and otherwise struggling to maintain adequate oral hygiene.^3-5 All of these factors can negatively impact oral health, making it difficult to single out a substance as the sole cause of an oral health problem.

Nevertheless, research has revealed associations between misuse of various substances and several oral and dental health conditions. The following content provides an overview of some of the more common conditions linked to substance misuse, along with insights about key substances associated with each.

Dry Mouth (Xerostomia)

Dry mouth (aka xerostomia) occurs when there’s not enough saliva to keep the mouth wet. While many people experience dry mouth occasionally, particularly when they’re nervous or stressed, the condition can be caused by various medications and substances, and it may lead to or worsen several other oral health issues.⁶

Not only does saliva contain minerals that keep teeth strong and help fight off tooth decay and fungal infections, but saliva also helps to moisten and break down food, wash away food particles from the gums and teeth, and aid in swallowing. Thus, dry mouth can lead to the development of tooth decay, cavities, periodontal disease, and more.^2,6

Literally hundreds of prescription and over-the-counter (OTC) drugs can impede normal salivary gland functioning.⁶ However, here are a few commonly misused substances that are associated with dry mouth and potentially related oral health issues:

• Marijuana. As with several other substances, research on marijuana use is complicated by the fact that people often also use alcohol, tobacco, and other drugs in conjunction with marijuana. However, research indicates that marijuana use is associated with dry mouth, and one study revealed that 69.6% of users experienced dry mouth almost immediately after cannabis use.^1,7
• Alcohol. Upon consumption, alcohol comes into immediate contact with the oral cavity, including the gums, lips, cheeks, tongue, salivary glands, etc. Thus, alcohol use can damage the salivary glands and interfere with saliva secretion.⁸ The degree to which alcohol affects oral health typically depends on its concentration, the nature and contents of the drink, and the quantity and frequency of consumption.⁹
• Methamphetamine (aka meth). Meth is linked to a significant decline of salivary buffering capacity, which in turn can lead to an increased risk of dental erosion (i.e., a wearing away of the tooth surface).^4,10 In a recent cross-sectional study of people who used meth, 72% of participants reported experiencing dry mouth.^11,12
• MDMA/Ecstasy: While most research involves case reports as opposed systematic studies, research indicates that oral complications of MDMA/ecstasy include dry mouth, which can persist for up to 48 hours after consumption.^4,13

Cavities, Enamel Erosion, and Tooth Loss

Also known as cavities or caries, tooth decay begins when bacteria and acids in the mouth—often from food and beverages high in starch and sugar—attach to and begin to erode the tooth enamel. The enamel can repair itself during the early stages of decay if it has enough minerals from saliva. But if saliva isn’t sufficient and/or the tooth is repeatedly exposed to acids, the tooth surface continues to weaken, and a small hole in the tooth called a cavity is created. When left untreated, cavities can lead to infection, pain, and tooth loss.¹⁴

Given that dry mouth and tooth decay are interrelated, multiple substances are associated with enamel erosion, cavities, and tooth loss. A few of the more well-known culprits include:

• Meth: The link between meth and tooth decay is so well established that there’s a slang term to describe the associated excessive tooth damage, namely “meth mouth” (aka “crank decay”).¹⁰  In fact, those who use meth are twice as likely to have untreated tooth decay and four times more likely to have cavities than nonusers.^1,5 Meth is also linked to a unique pattern of cavity development, where the decay typically starts near the gums and involves the outer surface of the teeth facing the cheek and the spaces between the front teeth. This damage can progress to destruction of the coronal portion of the tooth (i.e., the hollow casing enclosing the pulp), ultimately requiring tooth extraction.¹⁵ Several factors may contribute to the process of methamphetamine-related tooth decay. As discussed earlier, methamphetamine use is commonly associated with dry mouth, which can promote tooth decay. Other factors include the long duration of action of the drug, insufficient oral hydration in users, and dehydration due to meth-induced increases in physical activity. Additionally, given the acidic nature of meth, the drug has directly corrosive effects on oral tissue when smoked or inhaled. That said, those who inject meth also have more dental disease than nonusers.¹
• Alcohol: Since alcohol is consumed orally, the substance has direct contact with the teeth. While some types of alcohol are acidic and others are sugary, it can upset the pH balance in the mouth. According to a cross-sectional study, alcohol-dependent individuals had a significantly higher number of decayed, missing, and filled teeth than nondependent participants.⁹
• Marijuana: Dry-mouth-related decay is associated with marijuana.^7,16 However, the THC in marijuana can also stimulate the appetite, which can lead to increased consumption of snack foods that can also contribute to increased tooth decay.⁷
• ADHD Medications: Some drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD) with the potential to be misused (e.g., Ritalin, Concerta, Adderall, Dexedrine, etc.) also have loose associations to dry mouth and tooth decay. One study indicated that children with ADHD are 12 times more likely to have more decayed, missing, or filled teeth than those without ADHD. While adequate studies are lacking, some professionals hypothesize that since many ADHD medications cause dry mouth, this lack of saliva leads to increased decay. Plus, the symptoms of dry mouth may prompt children to drink more sugary beverages, which in turn is also associated with tooth decay.⁴

Periodontal Disease, Gingival Lesions, and Gingivitis

When exposed to bacteria for long enough, the teeth develop a film called plaque, which eventually hardens into tartar. If left untreated, tartar buildup then spreads below the gumline, where it’s difficult to remove. This bacteria and tartar, then, can infect tissue surrounding teeth, causing irritation and inflammation, which lead to gingivitis.¹⁷

With characteristic red, swollen gums that may bleed, gingivitis is an early stage of periodontal disease. As the condition progresses, it develops into periodontitis. During this stage, the gums pull away from the teeth, which can become loose or fall out, and bone can be lost. Good oral hygiene and regular cleanings are paramount to preventing plaque and tartar buildup and periodontal disease.¹⁷

While various factors often seen in those with substance misuse issues (e.g., nutritional deficits, absence of dental cleanings, other hygiene issues, etc.) may come into play with regard to periodontal issues, additional substance-specific processes may contribute to the progression of gingival lesions, gingivitis, and/or periodontal disease. Related substances include:

• Alcohol: According to a study in the Journal of Clinical and Diagnostic Research, alcohol may harm the body’s ability to defend against periodontal disease. That is, alcohol can lead to a deficiency in an important component of immune system functioning known as the complement system. It can also cause problems with the function of neutrophils, which are white blood cells that help fight infections. This, then, can lead to decreased ability of neutrophils to stick to surfaces, move around, and engulf bacteria. As a result, people who consume alcohol may be more susceptible to periodontal infections. In addition, the presence of pockets (i.e., the space created when the gum pulls away from the tooth) are significantly higher in those with an alcohol use disorder (AUD) compared to those without the condition. In fact, a recent study revealed that more than one-third of the teeth of those with an AUD had a pocket depth of equal to or greater than 4mm, a measure that’s often a sign of periodontal disease.⁹
• Marijuana: Based on data from the American Dental Association, there’s a direct link between marijuana use and periodontal disease.⁷ Data shows that medium- to long-term cannabis smoking can be a risk factor for periodontal disease independent of the use of tobacco. The periodontal symptoms most associated with marijuana include increased pocket depth and loss of tissue that attaches the tooth to the bone.¹⁸

Grinding, Clenching, and Related Orofacial and Temporomandibular Joint Pain

Teeth grinding, clenching, and/or gnashing—also known as bruxism—is another oral health concern often associated with psychosocial factors such as stress, mood, nervousness, distress, etc. However, it’s also linked to certain kinds of substance use, such as consumption of nicotine, caffeine, and alcohol as well as the use of specific medications. While mild bruxism may not require treatment, severe forms of it can lead to damaged teeth, jaw pain, fatigue, and headache.¹⁹

Since some people experience bruxism only while sleeping, it’s helpful to understand the symptoms in order to better determine if you or someone you love has condition. Symptoms include:¹⁹

• Flattened cracked, chipped, or loose teeth.
• Tooth sensitivity.
• Worn enamel.
• Jaw muscle soreness, tightness, and/or fatigue.
• Headache and/or facial pain.

The exact way in which substance use can lead to bruxism isn’t fully understood. However, it may be a risk due to the way that some drugs, such as stimulants, increase various types of neurotransmitter activity throughout the central nervous system.¹ For instance, studies suggest an association between bruxism and certain substances such as:

• MDMA/Ecstasy: Jaw clenching and grinding during ecstasy use has been reported in 50% to 89% of users. Additionally, individuals who used ecstasy report more pain in the jaw joint compared to individuals who used other illicit drugs. Plus, one study revealed that in 60% of ecstasy users related tooth wear progressed through the enamel into the underlying bone. This progression only occurred in 11% of nonusers.¹³
• Methamphetamine: Meth-related bruxism is thought to be due to the increase in neuromuscular jaw activity caused by an increase in noradrenergic neurotransmission in the central nervous system.¹ In a study of 100 individuals who used meth, 68% reported jaw clenching and 47% reported jaw joint pain.¹¹

Mucosal Tissue Changes and Leukoplakia

A type of potentially premalignant lesion, oral leukoplakia is characterized by white patches on the mucous membranes of the mouth. The condition can include thickening of the outer layer of skin (i.e., hyperkeratosis) and abnormal growth and development of cells that can progress to various types of cancer.²⁰ Various substances are linked to changes in mucosal tissue and leukoplakia, including:

• Cocaine: Oral cocaine use can have harmful effects on the oral mucosal tissues, including changes in cell growth and damage to genetic material.¹ In fact, one study showed that 37.5% of those with a cocaine-related substance use disorder had an oral mucosal lesion, a factor that was almost 3 times greater than those without an SUD.¹¹
• Marijuana: Various oral soft tissue changes have been documented in relation to smoking marijuana. Among them are some types of abnormal cell growth and lesions, including leukoplakia and erythroplakia.¹

Oral Cancer

Accounting for roughly 3% of all cancers diagnosed annually in the U.S., oral cancers develop on and under the tongue, in the mouth, on gum tissue, at the base of the tongue, and in the area of the throat at the back of the mouth. Independently, tobacco and alcohol increase the risk of developing oral cancer, but when used together, the risk is further intensified.²¹

Symptoms of oral cancer can include:²¹

• Persistent sore throat, hoarseness, and/or a feeling that something is caught in the throat.
• Pain, bleeding, and/or white or red patches in the mouth.
• A sore, irritation, lump, or thick patch in the mouth, lip, throat, or neck.
• Difficulty chewing, swallowing, speaking, and/or moving the tongue or jaw.
• Jaw swelling that causes dentures to fit poorly or become uncomfortable.
• Numbness in the tongue or other areas of the mouth.
• Ear pain.

Substances associated with oral cancer include:

• Marijuana. Both tobacco and marijuana smoke contain a variety of carcinogens. However, compared to tobacco, marijuana smoke contains 50% more carcinogenic hydrocarbons.^1,16 Additionally, compared to a filtered tobacco cigarette of the same weight, a marijuana cigarette deposits 4 times as much tar in a smoker’s respiratory tract.¹
• Alcohol. An important risk factor for oral cancer, alcohol can change the rate at which certain types of substances within the mouth penetrate the mucosa, which may contribute to the development of cancer. In fact, some evidence suggests that the increasing incidence of oral cancer, particularly in younger adults, may be associated with increased alcohol consumption–as opposed to tobacco use on its own.⁹
• Cigarettes and alcohol. As mentioned earlier, a combination of both smoking and drinking can synergistically increase the development of some types of oral malignancies.⁹

Treatment for Drug Misuse and Addiction

Treating the oral health effects of substance misuse typically involves various types of medical and/or dental care based on the severity of the conditions. However, to create sustained improvement in all types of physical and emotional health, it’s critical to treat the substance use disorder while also addressing oral health concerns.

Various forms of substance use disorder treatment are available to suit the unique needs of each individual, including:²²

• Medical detox.
• Inpatient rehab.
• Outpatient programs—including Intensive Outpatient Programs (IOPs), Partial Hospitalization Programs (PHPs), and telehealth care.

Within these levels of care, multiple types of therapies are available, as are a variety of services and amenities. With facilities and services scattered across the country, American Addiction Centers offers the full spectrum of care as well as a wide range of payment options. Plus, AAC treatment centers are in-network with a number of insurance providers, which typically cover part or all treatment costs.

To verify your insurance and figure out just how much you’d pay out of pocket for treatment that suits your needs, reach out to connect with an AAC admissions navigator or complete the insurance verification form. Caring professionals are available 24/7 . They can confidentially answer your questions about treatment, discuss your care and payment options, and help you take the first steps toward recovery today.