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An Introduction to Substance Use Disorders for Dental Professionals


Patricia A. Frese, RDH, MEd; Elizabeth McClure, RDH, CDHC, MEd

Credit Hours:

3 Hour(s)


This course will review the various signs, symptoms, and other aspects that substance use disorders can have on our patients. We will limit our scope to the effects on the oral cavity and we will cover more commonly abused substances. Infor...

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This course will review the various signs, symptoms, and other aspects that substance use disorders can have on our patients. We will limit our scope to the effects on the oral cavity and we will cover more commonly abused substances. Information will be provided for the clinician to make distinctions, begin safe dialogues, document patient comments and oral findings, and provide resources and follow-up support to patients with substance use disorders.

Substance use disorders (SUD) remain a significant epidemic in present day society. According to the 2022 National Survey on Drug Use and Health (NSDUH) , 48.7 million people aged 12 and older in the United States (17.8%) have a substance use disorder.61 As contemporary dental professionals, it is important that we are educated on the current effects of commonly used and abused drugs or medications including alcohol and nicotine.

There are several reasons why today’s dental clinician needs to be observant when treating patients who may be using drugs, alcohol and/or nicotine. Medical emergencies during dental treatments spurred by health or drug interactions would be cause for concern. Long-term health of the oral cavity is another, but perhaps the most important consideration would be the quality of life and health that could be restored after abuse or addiction.

Focused chairside observation is essential considering that 50% of patients will reveal less about their lifestyles than they should. Unsubstantiated observations should not cause the clinician to assume the patient has a substance use disorder. Instead, careful questioning of the patient may reveal a substance use disorder. At the end of each section, we will review various approaches and acceptable means of guidance that a dental professional might employ with a patient regarding that particular substance. While this course is intended to encourage observation and detection of the signs and symptoms of various substance use disorders, sensitivity for the patient’s right to privacy should be respected. Providing gentle educational explanations about a particular oral condition and posing either straightforward or benign questions to the patient about how or why a particular condition might be arising is the best professional action. If dental professionals develop a dialog that promotes trust, we ensure the patient feels safe in our care. Approximately 50% of general dentists provide their patients with nicotine cessation information, but fewer provide information about alcohol or other substances. It is important for the dental professional to have broad-based knowledge regarding substance use disorders because a patient suspected of this disorder can be a challenge. Clinically, it is important to avoid drug treatment interactions or behavioral outbursts in the dental office and further support the patient as they attempt to become drug-free. Many times, the dental office can serve as a safe and non-threatening source of cessation assistance. Creating referral protocols may help our patients find appropriate professional treatment.

Most scientists consider addiction to be a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.3 There are implications for oral health professionals in identifying and managing the patient who is abusing substances. Management issues relevant to delivery of oral care include:

  1. Identifying potential drug interactions, during oral care, with substances used.
  2. Offering drug abuse cessation information.
  3. Dealing with the erratic behavior of a patient who arrives at the oral care appointment while under the influence of drugs or alcohol.24
  • Intended Audience:

    Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, Dental Assisting Students, Office Managers

  • Date Course Online:

    Jul 31, 2017

  • Last Revision Date:

    Apr 15, 2024

  • Course Expiration Date:

    Apr 14, 2027

  • Cost:


  • Method:


  • AGD Subject Code(s):


  • Technical Requirements:

    Stable internet connection and the latest version of browser and device software are recommended.

Learning Objectives

Upon completion of this course, the dental professional should be able to:

  • Differentiate between a social user, substance abuser and addict.
  • Describe four stages of substance abuse.
  • Explain the differences between physical and psychological dependence.
  • Identify the various sources of nicotine.
  • Identify the addiction process for alcohol, prescription medication and illegal drugs.
  • Recognize various oral conditions that may be present with chronic nicotine, alcohol, prescription medication and/or illegal drug use.
  • Identify commonly abused prescription and illegal drugs.
  • Identify various clinician/patient communication strategies for various addictions.
  • Use resources to support patients who are interested in cessation.


  • P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
  • Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.  Only sound evidence-based dentistry should be used in patient therapy.

Please Note:

  • Louisiana Dentists: This course has been approved by the Louisiana State Board of Dentistry to fulfill the mandatory opioid management CE requirement.

Note:  Registration is required to take test.


Conflict of Interest Disclosure Statement

  • Ms. Frese reports no conflicts of interest associated with this course. She has no relevant financial relationships to disclose.
  • Ms. McClure reports no conflicts of interest associated with this course. She has no relevant financial relationships to disclose.

Patricia Frese is Professor Emerita of the University of Cincinnati Blue Ash College Cincinnati, Ohio. She has been in education since 1980. She is a 1976 graduate of the dental hygiene program at Raymond Walters College (now UC Blue Ash). S...

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Submission Information

Academy of General Dentistry (AGD) Submission For credit transfers to appear in your AGD account in real time, make sure to add your AGD membership number in the field provided on the “Share Your Test Score” page.

CE Broker For all states that use CE Broker for licensure, “proof of completions” are electronically reported the first of every month. If a course was taken in November, the “proof of completion” will be submitted the beginning of December.


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Approved PACE Program Provider


Nationally Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.

8/1/2021 to 7/31/2027

Provider ID# 211886


AADH Approved Program Provider

Procter & Gamble is designated as an approved Provider by the American Academy of Dental Hygiene, Inc. #AADHPGC (January 1, 2024-December 31, 2025). Approval does not imply acceptance by a state or provincial Board of Dentistry. Licensee should maintain this document in the event of an audit.