Drug use and oral health status

Very few studies in this review, measured or adjusted for use of other substances such as cannabis.

Problematic and long-term drug use lead to a range of economic, social and health issues. Studies have also shown that people who use drugs (PWUD) have more oral health problems.

The aim of this review was to investigate relationship between drug use (methamphetamines, heroin, opiates, cocaine, cannabis and crack) and oral health.


Searches were conducted in the PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Original cross-sectional and longitudinal prospective and retrospective observational studies published in English that reported the effect of using a specific type of drug use (methamphetamines, heroin, opiates, cocaine, cannabis and crack) on oral health conditions (DMFT/periodontal disease) were considered. Two reviewers independently selected studies extracted data and assessed risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist for observational studies. Meta-analyses were conducted for DMFT and periodontology disease.


  • 10 studies involving 3083 patients were included.
  • Sample sizes ranged from 18 to 1015.
  • 6 studies were considered to be of high quality and 4 of moderate quality.
  • 5 studies (3 cross sectional, 1 cohort and 1 case-control) considered the relationship between drug type and periodontal disease with meta-analysis showing no relationship OR = 1.44 (95%CI; 0.8 – 2.6).
  • 7 studies (4 case-control, 3 cross-sectional) considered the relationship between the type of drug used and DMFT showing a positive relationship OR = 4.11 (95%CI; 2.07 – 8.15).


The authors concluded:-

Our study identified poor DMFT and caries and periodontal diseases among PWUD which may be explained by irregular tooth brushing and a long history of drug use. There is evidence to show that it is possible to treat caries and periodontal complications among PWUD by linking substance treatment programs with oral hygiene services. Addressing dental health issues among PWUD is vital, and despite o the analytical challenges of segregating the direct impact of drug use on oral health morbidities. The data highlight the need for developing affordable and accessible prevention programs that improve the oral health status among PWUD by the policymakers and public health authorities.


A good range of databases have been searched however restricting included studies to those published in English may have excluded some relevant papers. As would expected all the included studies are observational with a majority being considered to be high quality studies. The authors note that they excluded studies people experiencing homelessness and those with mental health problems and both groups are likely to be PWUD.

While the meta-analysis showed a higher level of periodontal disease in PWUD the difference was not statistically significant. On the contrary the meta-analysis demonstrated a clear and significantly higher DMFT in PWUDs. Drug use is clearly a significant risk factor for caries so addressing oral health problems as part of support program may be advantageous.


Primary Paper

Yazdanian, M., Armoon, B., Noroozi, A. et al. Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis. BMC Oral Health20, 44 (2020). https://doi.org/10.1186/s12903-020-1010-3

Other References

Dental Elf – 13 Jun 2016 

Psychological disorders associated with poor oral health




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