Introduction

Substance use disorders remain a significant epidemic in present day society. According to the 2022 National Survey on Drug Use and Health, 17.8% of the United States population (48.7 million Americans/age 12+) have a substance use disorder. Substances abused include tobacco/nicotine, marijuana/hashish, alcohol, and opioids (heroin and prescription pain medication – including fentanyl and illegally made fentanyl).^61,63,64

As contemporary dental professionals, it is important we are educated about the effects of commonly used and abused substances including alcohol and nicotine products. On a daily basis, we come into contact with patients who range from non-users to addicts. Medical histories may present the opportunity for our patients to reveal their past and present habits regarding drug, nicotine and alcohol use, but up to 50% of patients, when surveyed, say they lie on medical histories due to embarrassment, fear of being judged, fear of losing insurance benefits, or because they believed that information was none of the clinician’s business. According to this same medical survey, patients aged 25 to 34 are more likely to lie to their doctors than patients 55 and older. Specifically, younger patients lie about recreational drug use, sexual history, and smoking habits. Men were found to withhold the truth significantly more than women about how much they drink: 24% vs. 15%.¹⁹

The dental setting brings a wide variety of patients for treatment. Drug interactions, systemic reactions and side effects of medications are a few of the considerations we must take seriously as licensed professionals. The effects drugs, alcohol and nicotine have on teeth and the oral cavity is another health and educational matter of concern. Pairing this with the survey results, our patients are not revealing the true scope of substance use, presenting a need for a new communication paradigm where sensitivity and awareness need to be honed.