Drug Use and Your Mouth

In collaboration with the National Institute of Dental and Craniofacial Research

Revised October 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 information about your overall health. Your mouth can give the dentist clues about your eating habits, oral hygiene, and other behaviors such as smoking and drug use.

Using drugs can harm your teeth and gums, the roof of your mouth (the hard palate and soft palate); the area under the tongue (floor of your mouth), the lining of your cheeks; the tongue; lips; salivary glands; chewing muscles; and jaw joint.1

Studies show that people with substance use problems have worse oral (mouth) health than other people, including more tooth decay and gum disease.2

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.

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 someone 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.3
  • Tooth decay. Some drugs cause an increased urge for sugary snacks and drinks. If you eat frequently throughout the day—especially high-sugar snacks and drinks—you can develop 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 loose, chipped, or worn teeth, or pain in the jaw muscles and joint.
  • Erosion of tooth enamel. Sometimes people rub cocaine on their gums and near their teeth to get high. The mixture of cocaine and saliva is acidic, which can cause erosion of tooth enamel (the protective outer layer of the tooth). It can also cause sores on the gums.

3 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 and also go for long periods of time without taking care of their teeth; this combination can lead to severe tooth decay. Unfortunately, many people who struggle with addiction do not take care of their mouth. Common effects on the mouth from methamphetamine use include:    

  • brown or blackened, stained teeth
  • tooth decay
  • bad breath
  • loose teeth that may need to be removed
  • gum disease
  • dry mouth
  • jaw muscle and joint pain

These effects can become so bad that the damaged teeth cannot be treated, and they must be removed.

A NIDA-funded study of more than 500 people who repeatedly used methamphetamine found 96 percent had experienced dental cavities and 58 percent had untreated tooth decay. Only 23 percent retained all of their natural teeth, compared to a tooth retention rate of 48 percent among the U.S. general population. The study found that the more methamphetamine a person used, the more likely they were to have untreated tooth decay.4

Learn more about methamphetamine and its effects.

4 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 about prescription drugs such as opioids?

Dentists and oral surgeons most often prescribe opioids to manage dental pain that lasts for a short time, called “acute pain.” The short-term pain from dental surgery such as wisdom tooth extraction is an example of acute pain. Dentists rarely prescribe opioids for long-term pain, called “chronic pain.”

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

In 2016, the American Dental Association issued recommendations for dentists about prescribing opioids. The recommendations say dentists should consider a type of pain medication called non-steroidal anti-inflammatory drugs, also known as NSAIDS (like ibuprofen, for example), as the first option for acute pain.

What can teens do to prevent addiction to opioid pain medications?

For many teens, their first experience with opioid pain medications is through a prescription from their dentist or oral surgeon to manage acute pain after a dental procedure. Some research says that even taking opioids as prescribed, such as after wisdom teeth extraction, makes teens 33 percent more likely to misuse opioids later on.5 Teens might like how prescription opioids make them feel. They could ask for more medication just to get that feeling again, not realizing how dangerous these medications can be when used for the wrong reasons.

Together with your parents, talk with your dentist about the best way to manage dental pain. You can also include your pediatrician in the conversation, especially if you are being treated with other kinds of medications 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 in adults suggests that non-opioid medications might offer the best balance between benefits and possible harms. Non-opioid options include the following over-the-counter drugs either alone or in combination:

  • non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (example: Advil)
  • acetaminophen (example: Tylenol)6

What To Do if Opioids Are Prescribed

If the dentist or oral surgeon decides to prescribe an opioid pain medicine:7,8

  • Ask if there are other ways to relieve the pain besides opioids.
  • Ask when you can switch to a non-opioid pain medication.
  • 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 medications.
  • 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 medication?
    • 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 medication? Read about drugged driving.
  • Take the medication according to the directions.
  • Never mix opioid medications with alcohol.
  • Never share the medication with others or sell it to anyone.
  • Store the medication in a cool, dry place, out of reach of young children.
  • Dispose of unused medication properly. Read about how to dispose of prescription drugs.

5 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).

6 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.

7 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. Available at https://www.nidcr.nih.gov/health-info/opioids/more-info.

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

What are the effects of tobacco products on the mouth?

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

We know tobacco contains chemicals that can have harmful effects throughout the body, including increased risk for different types of cancers. Tobacco also contains nicotine, which is highly addictive, and can keep you hooked.  (Read about the many effects of tobacco and nicotine.)

A person who smokes tobacco cigarettes or uses chew or snuff (smokeless tobacco) is at increased risk for oral health problems. Here are some effects tobacco cigarettes and chew and snuff can have on the mouth:

Tobacco Cigarettes

  • gum disease
  • slow healing after injury, tooth extraction, or other oral surgery
  • oral cancer9
  • stained teeth

Smokeless Tobacco (Chew or Snuff)

  • wearing down of teeth
  • gums pulling away from teeth
  • tooth decay
  • white patches that may turn into cancer
  • oral cancer

E-Cigarettes and Vaping

Vaping devices containing nicotine or THC (the psychotropic ingredient in marijuana) are becoming increasingly popular. Sometimes called “e-cigarettes,” these devices contain a liquid that is vaporized by a metal heating element. A growing body of research suggests these devices are not completely safe, and health officials are looking into whether vaping contributed to serious lung illnesses and seizures found in people who vaped nicotine, THC, or other “home brews.”  There is not much known about the oral health effects of these e-cigarettes or other vaping devices. Vaping liquids often contain solvents and flavorings, whose safety profiles when vaporized and inhaled are unknown. One study suggests some sweet flavorings in e-cigarettes may increase the risk of tooth decay. Other research suggests that the heated metal in these devices delivers potentially toxic chemicals like cadmium, chromium, lead, manganese, and nickel to the mouth and lungs. More research is underway.

We do know that teens who either vape nicotine products or smoke regular cigarettes are exposing their brains to the highly addictive nature of nicotine. We also know that teens who try e-cigarettes often start using regular tobacco cigarettes within a year, which carries the risk of a lifetime of smoking and the many diseases that result from it.  

What about quitting?

Teens and young adults who smoke or vape 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.10  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 Mamudu HM, Want L, Owusu D., Robertson C, Collins C, Littleton MA. Prospective study of dual use of e-cigarettes and other tobacco products among school-going youth in rural Appalachian Tennessee. Ann Thorac Med. 2019 Apr-Jun;14(2):127-133.

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:

Blog Posts

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