The Overlooked Connection Between Substance Use and Oral Health
Oral health is a crucial aspect of overall well-being, yet for many houseless individuals, it is often neglected due to barriers in access, stigma, and the effects of substance use. Substance use disorders (SUDs) disproportionately impact houseless populations, further exacerbating their risk of severe oral health issues. Despite the pressing need for care, individuals struggling with both homelessness and addiction often face judgment, systemic neglect, and a lack of accessible treatment options.
How Substance Use Affects Oral Health
Substance use contributes to a higher prevalence of untreated dental decay, gum disease, and tooth loss. Some of the most common substances that negatively impact oral health include:
- Methamphetamine ("Meth Mouth") - Leads to rapid tooth decay due to dry mouth, teeth grinding, high calorie/sugary food cravings and poor hygiene.
- Opioids - Can cause severe dry mouth, weakened immune response, and increased risk of infections.
- Alcohol and Tobacco - Contribute to gum disease, oral cancer, and overall dental erosion.
These conditions often worsen due to lack of access to preventive care, fear of discrimination, and financial constraints that limit treatment options.
The Role of Stigma in Preventing Access to Care
Many houseless individuals with substance use disorders avoid seeking dental care due to judgment from healthcare providers, fear of being dismissed, or previous negative experiences. Some dentists refuse to treat patients they perceive as "drug-seeking" or "noncompliant," further alienating a population already facing systemic barriers to healthcare.
This stigma creates a cycle of neglect: untreated oral health issues can make it even harder for individuals to seek employment, access stable housing, or maintain their health-pushing them further into a state of vulnerability.
Solutions: Moving Toward Compassionate, Low-Barrier Care
To break down barriers, healthcare systems and policymakers must adopt harm-reduction approaches to oral health care.
Key solutions include:
- Expanding low-barrier dental care options (mobile dental clinics, free or reduced-cost services, harm-reduction-informed care).
- Training dental professionals to treat substance users with compassion instead of judgment.
- Increasing funding for state-appointed defense attorneys and public defenders to reduce overuse of plea bargains, which disproportionately affect houseless individuals and contribute to legal entanglements that hinder healthcare access.
- Advocating for policy changes that expand Medicaid dental coverage and integrate dental care with addiction treatment services.
Call to Action
Substance use should never be a barrier to receiving essential healthcare, including oral health services. By addressing systemic inequalities, dismantling stigma, and prioritizing compassionate care, we can create a system that supports houseless individuals in their journey toward better health and stability. Oral health is not just a privilege-it is a human right that should be accessible to all, regardless of their circumstances.
- American Dental Association. (n.d.). Meth mouth. MouthHealthy. Retrieved from https://www.mouthhealthy.org/all-topics-a-z/meth-mouth
- Care for the Homeless. (2023, December 4). Dentistry kit initiative: Addressing oral health among the homeless. Care for the Homeless. Retrieved from https://www.careforthehomeless.org/news/dentistry-kit-initiative/
- Forward Pathway. (n.d.). The oral health crisis among the homeless and its impact on mental health. Retrieved from https://www.forwardpathway.us/the-oral-health-crisis-among-the-homeless-and-its-impact-on-mental-health#:~:text=For%20homeless%20individuals%2C%20the%20stigma,as%20noted%20in%20recent%20studies
- Springer Nature. (2025). Breaking the vicious cycle of delayed healthcare seeking for people who use drugs. Harm Reduction Journal, 22(3), 1-12. Retrieved from https://link.springer.com/article/10.1186/s12954-025-01166-3
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