Drug Use and Your Mouth

Revised May 2019

How does drug use affect the mouth?

parts of the mouthCourtesy of PubMed Health
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When dentists say, “open wide,” they can see a treasure trove of clues about your overall health. Your mouth can give the dentist clues to your eating habits, personal hygiene, and other behaviors, such as drug use.

Using drugs can affect the health of your teeth and gums, and also the top of the mouth, called the hard palate; the soft area under the tongue, called the soft palate; the lining of your cheek (soft mucosal tissue);  the tongue; lips; salivary glands; chewing muscles; and jaw.1 This is all referred to as “oral health.” Studies show that dental patients with substance use problems have worse oral health than other people, including more tooth decay and gum disease.2

Not only can your dentist help keep your mouth healthy, he or she can also help protect you from addiction. How?

For many years, dentists were a major prescriber of prescription pain medicines called opioids, usually after a painful dental procedure. These dental prescriptions of opioids for teens have increased in recent decades. One study shows the increase was the sharpest for 11- to 18-year-old patients. 

However, in 2018, the American Dental Association issued recommendations for dentists about prescribing opioids. The recommendations say dentists should avoid prescribing opioids for pain after a dental procedure unless absolutely necessary, and then only for a very short period of time.

1 U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

2 Baghaie H, Kisely S, Forbes M, Sawyer E, and Siskind DJ. A systematic review and meta-analysis of the association between poor oral health and substance abuse. Addiction. 2017, 112: doi:10.1111/add.13754.

Why do dentists prescribe opioids?

Dentists and oral surgeons most often prescribe opioids to manage dental pain that lasts for a short time, often called “acute pain.” The pain from dental surgery, removal of teeth, and root canals are all examples of short-term, or acute, pain. Dentists rarely prescribe opioids for long-term pain, called “chronic pain.”

When taken for a short time, opioid pain medicines are relatively safe and can reduce pain. However, when used incorrectly, they can increase the risk of opioid misuse, addiction, and overdose deaths.

What can teens do to prevent addiction from opioid pain medicines?

For many teens, their first experience with opioid pain medicines is through a prescription from their dentist. Some research says that even taking opioids as prescribed, such as after having wisdom teeth removed, makes teens 33 percent more likely to misuse opioids later on.3 Teens might like how prescription opioids make them feel. They could ask for more medicine just to get that feeling again, not realizing how dangerous these medicines can be when used for the wrong reasons. So, dentists are working to find other solutions for acute dental pain.

Together with your parents, talk with your dentist about the best way to manage dental pain and reduce your chance of addiction. You can also include your pediatrician in the conversation, especially if you are being treated with other kinds of medicines for different health issues. 

Non-Opioid Options for Managing Mouth Pain

Ask your dentist or oral surgeon if there is an option other than prescription opioids to treat your pain. Research suggests that non-opioid medicines might offer the best balance between benefits and possible harms. Non-opioid options include:

  • non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (example: Advil)
  • acetaminophen (example: Tylenol)4

What To Do if Opioids Are Prescribed

If the dentist or oral surgeon decides to prescribe an opioid pain medicine, follow these steps:5,6

  • Double-check to see if there are other ways to relieve the pain besides opioids.
  • Ask how quickly you can switch to non-opioid pain medicine.
  • Tell the dentist or oral surgeon about your medical history and any medications you are taking. It might not be safe to take opioids with some other medicines.
  • Tell the dentist or oral surgeon about any substance use disorders or addiction in your family. This will help the dentist decide if opioids are safe for you.
  • Ask the dentist or oral surgeon about the medication prescribed:
    • When and how should you take the medicine?
    • How long should you take it?
    • What are the side effects?
    • Should you take it with food?
    • Is it okay to drive while you’re on the medicine? Read about drugged driving.
  • Take the medicine according to the directions.
  • Never use the medicine with alcohol.
  • Never share the medicine with others or sell it to anyone.
  • Store the medicine in a cool, dry place, out of reach of young children.
  • Dispose of unused medication properly. Read about how to dispose of prescription drugs.  

3 Miech R, Johnston L, O'Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. Pediatrics. 2015 Nov;136(5):e1169-77. doi: 10.1542/peds.2015-1364. (National Institute on Drug Abuse [NIDA] and National Institute on Alcohol Abuse and Alcoholism grant support).

4 Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. JADA. April 2018, 149(4):256–265.

5 U.S. Department of Health and Human Services. National Institutes of Health. National Institute of Dental and Craniofacial Research (NIDCR). "Opioids." Last Reviewed July 2018. Availalbe at https://www.nidcr.nih.gov/health-info/opioids/more-info.

6 American Dental Association, Mouth Healthy. "Opioids." Available at https://www.mouthhealthy.org/en/az-topics/o/opioids.

What are the effects of other drugs on the mouth?

Many drugs affect the mouth, including illegal drugs that people take to get high. These effects include:

  • Dry mouth. A common side effect of some drugs is that a person’s mouth does not make enough saliva. When a person has dry mouth regularly, it can be difficult to chew, swallow, or even talk. Dry mouth also increases the risk for tooth decay or fungal infections in the mouth because saliva helps keep harmful germs in check.7
  • Tooth decay. Some drugs cause an increased urge for snacking, including high sugar foods. This can lead to more cavities.
  • Jaw pain from clenching teeth. Drugs that work as stimulants, like methamphetamine, cocaine, and Ecstasy (“Molly”), can make a person clench and grind teeth. Over time, this can lead to weakened teeth and jaw pain.
  • Erosion of tooth enamel. Sometimes people rub cocaine on their gums and near their teeth to get high. The acid in cocaine can cause erosion of tooth enamel (the protective layer on the tooth). It can also cause stains on the teeth.
  • Mouth cancer. Tobacco use can cause cancer of the mouth.

7 U.S. Department of Health and Human Services. National Institutes of Health. National Institute of Dental and Craniofacial Research. "Dry Mouth." Available at https://www.nidcr.nih.gov/health-info/dry-mouth.

What is meth mouth?

meth mouthCourtesy of the American Dental Association

You have probably heard that “meth mouth” is caused by using methamphetamine (meth), a very addictive drug. Methamphetamine is a stimulant, which means it can boost mood, increase energy, and make you feel extra alert. However, it has serious and dangerous effects—like raising your heart rate and blood pressure—and using it can lead to addiction. It can also ruin your teeth.

Several things can lead to mouth problems in people who use methamphetamine. While using, people often crave sugary drinks like soda, which can rot their teeth, especially if they have long periods of poor dental care. Many people who struggle with addiction do not take care of themselves with regular teeth brushing. Common effects on the mouth from methamphetamine use include:   

  • brown or blackened, stained teeth
  • jaw pain
  • tooth decay, cavities, rotting teeth
  • bad breath
  • teeth falling out

These effects can become so bad that there is no hope of treating the damaged teeth, and they must be removed.

These effects might be much worse than previously thought. A study of more than 500 people who repeatedly use methamphetamine found that 96 percent had cavities, and about one-third had six or more missing teeth. The study found that the more methamphetamine a person used, the worse the tooth decay was.8

Learn more about methamphetamine and its effects.

8 National Institute on Drug Abuse. 2015. High Rates of Dental Gum Disease Occur Among Methamphetamine Users. Available at https://www.drugabuse.gov/news-events/news-releases/2015/11/high-rates-dental-gum-disease-occur-among-methamphetamine-users.

What are the effects of tobacco and nicotine on the mouth?

Mouth cancerDip contains up to 30 cancer-causing chemicals. Photo courtesy of The Real Cost

We know tobacco and nicotine have harmful effects, including increased risk for lung and other cancers. (Read about the many effects of tobacco and nicotine.) What many people don’t know is that tobacco and nicotine can also cause problems in the mouth. And different types of tobacco/nicotine can affect the mouth differently.

Most of the harm to the mouth is not from the nicotine, but from other chemicals in tobacco or those produced when tobacco is burned. A person who smokes cigarettes or uses a smokeless tobacco product (sometimes called chewing tobacco) is at increased risk for oral health problems.

Here are some effects that regular cigarettes and smokeless tobacco products can have on the mouth:

Smoking Tobacco

  • stained teeth and tongue
  • dulled sense of taste and smell
  • slow healing after a tooth is removed or other surgery
  • gums pulling back away from the teeth
  • oral cancer9

Smokeless Tobacco

  • stained and discolored teeth
  • gum disease that can lead to tooth loss
  • tissue and bone loss around the roots of the teeth
  • scratching and wearing down of teeth
  • bad breath
  • oral cancer: mouth and throat10

E-Cigarettes and Vaping

There is still little known about the oral health effects of vaping. However, we do know that teens who try e-cigs often start using regular tobacco cigarettes within a year. This can lead to oral cancers, stained teeth, and bad breath.

What about quitting?

Teens and young adults who smoke but want to quit have good options for help. If you or someone you know needs more information or is ready to quit, read more about quitting the use of tobacco and nicotine. If you have a friend who smokes, it puts you at higher risk for starting, because your friend is likely to pressure you into trying it. You might decide to step away from the friendship for a while to protect your own health. Even secondhand smoke is bad for your health.

9 American Dental Association, Mouth Healthy. "Smoking and Tobacco." Available at https://www.mouthhealthy.org/en/az-topics/s/smoking-and-tobacco.

10 American Dental Association, Mouth Healthy. "Smoking and Tobacco." Available at https://www.mouthhealthy.org/en/az-topics/s/smoking-and-tobacco.

What should I do if someone I know needs help?

If you or a friend struggle with drug addiction, or are in any kind of crisis and need to speak with someone now:

  • Call the National Suicide Prevention Lifeline at 1-800-273-TALK (they don't only talk about suicide—they cover a lot of issues and will help put you in touch with someone close by).

If your friend is not in crisis but you just aren’t sure how you can help, you can:

For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.

Where can I get more information?

Drug Facts

NIDA Resources:

Other Resources:

Statistics and Trends

NIDA Resources:

Other Resources:   

Additional Resources

NIDA Resources:

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