BOSTON — A routine dental visit can reveal more than cavities, according to dentists advocating for early substance-use screening.
A 28-year-old patient at a community clinic shared with his dentist that he had been taking prescription pills from a friend to manage stress after losing work during the COVID-19 pandemic. The disclosure came after a standard question from a new screening tool, turning a simple dental exam into a discussion about mental health and substance use.
“Patients often see their dentist more regularly than their primary care provider,” said one dental professional involved in pilot programs. “That gives us a rare chance to spot early signs of stress, substance use, or mental health challenges — if we are willing to look.”
Dentistry has played a complex role in the opioid crisis, with dental procedures often being a first point of opioid exposure. Advocates say dental visits could also serve as structured entry points for prevention, education, and referral.
Recent data highlight the urgency. The 2024 National Survey on Drug Use and Health found that 58.3% of Americans aged 12 and older used tobacco, alcohol, nicotine, or illicit drugs in the past month. A 2025 JAMA study reported that nearly 20% of adolescents experienced a major depressive episode in the prior year, and 40% received no mental health care. In Massachusetts, adolescent alcohol and drug use exceeds the national average, while only 10% of individuals with substance-use disorders receive specialized treatment.
Pilot programs integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into dental visits have shown promise. With basic training, dental teams can identify at-risk patients and connect them to behavioral health counselors — many of whom had never been asked about substance use in any health care setting.
Federal legislation, including the SUPPORT Act and the 21st Century Cures Act, has authorized over $10 billion to address the opioid epidemic. Experts suggest some of these funds could support dental clinics, expanding training, referral partnerships, and early intervention programs.
Practical barriers remain. Dentists face limited time and busy schedules. Experts recommend a mix of financial incentives, like reimbursable insurance codes, and professional recognition or continuing-education credits to encourage adoption. Streamlined screening tools and electronic prompts can further integrate the process into routine care.
“Substance use directly affects oral health, from decay to infection to missed appointments,” said the pilot program coordinator. “Training dentists to recognize early warning signs improves patient care and strengthens connections between oral, medical, and behavioral health.”
The story of one patient illustrates the impact: he did not just need a procedure — he needed someone to notice. Advocates argue that extending dentistry’s preventive mindset to include substance-use screening could save lives and reduce stigma around seeking help.