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While individuals with substance use disorder (SUD) undergo multiple mental and physical health assessments during recovery, one critical area remains consistently neglected: oral health. Often overlooked by both healthcare providers and patients, poor dental health can severely impact quality of life and, in some cases, even jeopardise recovery.

Prof Dirk Smit, a dentist and specialist in the Department of Community Dentistry at the University of the Western Cape (UWC), recently completed his Doctor of Philosophy (Dental Public Health) at the Faculty of Dentistry at UWC. His dissertation, titled Oral Health-Related Quality of Life, Dental Status and Treatment Needs of People with Substance Use Disorder, investigated the profound impact of SUD on the oral health of the 504 participants from eight substance use treatment centres in the Western Cape. Smit said: “Oral health professionals can play a significant role in the early detection and provision of care, and the research showed that 98% of participants had very high levels of tooth decay.”

The management of mouth and teeth problems in people with SUD is often not prioritised. Yet, these patients need holistic dental treatment for improved well-being, as many have dental care needs at the start of a rehabilitation programme. Smith said: “Oral health behaviours among participants were poor with over 60% of respondents indicating they brushed their teeth less than twice a day and that their daily sugar intake through beverages was extremely high, averaging 123g.” Smit added that early screening and dental referrals are critical interventions. Worryingly, pain from dental issues may cause relapse in recovering users. Some respondents expressed that untreated toothache made them consider drug use again to relieve pain.

Some of the findings of the study include: 

• For every filled tooth, there were four missing teeth, indicating poor access to dental care and advanced tooth decay.
• Dry Mouth (Xerostomia) was reported by 76% of participants during drug use (especially when using methamphetamine/Tik). Dry mouth is a major contributor to tooth decay and gum disease due to reduced saliva production.
• 54% reported gum issues, including bleeding gums, and the clinical findings supported this, with a mean bleeding score of 41%, and 23% diagnosed with gum disease.
• 61% of the participants reported tooth sensitivity and dental pain during drug use.
• Nearly 45% of respondents experienced grinding and clenching of teeth (Bruxism), with methamphetamine (Tik) users being the most affected (53%).
• Nearly half (47%) of the sample had suspected periodontitis after completing the basic periodontal examination (BPE). The prevalence was especially high among users of cannabis, alcohol, opiates, and methamphetamine (Tik).

 

Smit’s study highlights that there is a lack of dedicated oral health services within substance use treatment programmes. Most facilities don’t offer structured oral care, even though oral health issues negatively impact patients' overall well-being and their ability to fully participate in recovery programmes. 

Smit advocates for integrating oral health services into SUD treatment programmes in the Western Cape and across South Africa.