Substance abuse and oral health

From “meth mouth” to a host of other problems, one of the most obvious effects of substance abuse is the damage it can do to oral health. Fortunately, treatment and support are always available to help beat addiction. And there are many ways to help avoid substance abuse and its effects altogether.

Common oral health problems caused by substance abuse

People with substance use disorders have much higher rates of cavities, gum disease, dry mouth, tooth wear, and tooth loss than the general population. These problems can lead to pain, abscesses, difficulty eating, and lower self‑esteem, which may make recovery feel even harder. Here are some of the most frequent issues people deal with:

• Methamphetamine (meth) is highly acidic, can cause dry mouth and may trigger cravings for sweets. As a result, meth use often leads to severe tooth decay, gum disease, and broken, stained and rotten teeth that can fall out.¹

• Heroin abuse can cause decayed and lost teeth, along with increased frequency of gum disease.² This is often due to poor oral hygiene and malnutrition caused by lack of appetite.^{3, 4}

• Cocaine is very acidic, so smoking crack-cocaine or putting powdered cocaine in the mouth can break down tooth enamel and cause decay and gum disease.⁵

• Ecstasy can cause dry mouth, cavities and gum disease. Because ecstasy is a stimulant, users experience an increase in energy and activity. This leads to grinding and clenching of teeth, which often results in fracture or wear.⁶

• Marijuana is no longer illegal in all states, but it can still have negative effects on oral health. Heavy marijuana smokers are three times more likely to have severe gum disease than those who don’t smoke marijuana.⁷ Smoking can also cause cavities and oral cancer.⁸

• Alcohol: Heavy drinking dries the mouth and is linked to tooth decay, gum disease, and higher risk of oral cancer, especially when combined with smoking.

• Tobacco (smoked or smokeless): Strongly associated with gum disease, tooth loss, delayed healing, and oral cancer.

• Vaping and e‑cigarettes: Often contain nicotine and other chemicals that can irritate tissues, contribute to gum inflammation, and may increase cavity risk due to sweet flavorings.

Why substances damage teeth and gums

Substances can be tough on your mouth for several reasons:

• Dry mouth. Many drugs (and even some addiction‑treatment medicines) reduce saliva. Less saliva means:

  • Food and bacteria stick to teeth more easily

  • Acids are not washed away

  • Cavities and gum disease can develop faster

• Everyday habits change. When someone is using substances, it’s common to:

  • Brush and floss less often

  • Skip dental visits

  • Reach for sugary snacks and drinks for quick energy

• Grinding and clenching. Stimulants like meth, cocaine and ecstasy can cause:

  • Jaw clenching without realizing it

  • Grinding teeth at night

  • Cracked, chipped or worn‑down teeth over time

• Overall health takes a hit. Poor diet, dehydration and poor sleep all affect the body’s ability to fight infection, including in the gums and other tissues in the mouth.

All of these factors add up, which is why drug use can cause serious damage to teeth and gums in a short amount of time.

Dental treatment and recovery

Getting professional dental care can be an important part of recovery. If you are struggling with addiction or are in recovery, it is important to see a dentist or dental hygienist, even if you feel nervous or embarrassed about the way your mouth looks.

Dental professionals are trained to provide care without judgment and can help with cleanings, fillings, and other treatments to repair damage and relieve pain. In some cases, more advanced care such as root canals, extractions, dentures or implants may be needed to restore comfort and the ability to eat well. Your dental team can also work with your doctor or addiction specialist to manage pain safely and support your recovery goals.

Treatment and support are always available

Overcoming addiction starts with making a commitment to change, setting goals and leaning on friends and family for support.⁹ Free, confidential help is provided 24/7 from the Substance Abuse and Mental Health Services Administration at 1-800-662-HELP (4357).¹⁰

Addressing stress in positive ways can be crucial to avoiding drug use. Experts recommend these natural mood lifters:^{11, 12, 13}

• Release endorphins with exercise.

• Eat a healthy, balanced diet.

• Get plenty of sleep.

• Enjoy sunshine and fresh air.

• Practice meditation.

• Pamper yourself.

Try mixing positive stress busters and rewarding activities into your life to see what works best for you or your loved ones.

Practical self‑care tips for your mouth

Here are simple steps anyone can start right away, whether you’re still using, in treatment or in long‑term recovery:

• Clean your teeth every day.

  • Brush gently with fluoride toothpaste twice a day

  • Floss or use other tools to clean between your teeth once a day

• Fight dry mouth.

  • Sip water throughout the day

  • Choose water instead of soda, energy drinks or juice when you can

  • Chew sugar‑free gum or use products made for dry mouth (like special rinses or lozenges)

• Be smart about sugar.

  • Save sweets and sugary drinks for mealtimes rather than sipping all day

  • Rinse your mouth with water after having something sweet

• Avoid extra harm.

  • Skip tobacco and vaping, which make gum disease and oral cancer more likely

  • Try not to chew on ice, pens or hard candies that can crack teeth

• Stay on top of checkups.

  • See a dentist regularly for exams and cleanings

  • Let them know about any medicines you take and any recovery programs you’re in

Even small changes, like drinking more water or brushing a little more often, can make a big difference for your mouth over time.