Tooth and Consequences: How Alcohol Affects Your Teeth

By Kristen McGuiness 06/23/11

Drugs and alcohol can wreak havoc on our teeth and gums, so it's no surprise that many former addicts continue to dodge their dentists long after they've achieved sobriety. Let's face it, few people love getting drilled, especally at 8 am. But here are a few reasons you need to brave up.

Alcohol And Teeth
Meth mouth no more Thinkstock

Pamela is a tall brunette in her thirties with long wavy hair who now works in retail fashion in Beverly Hills. Hers has been a long road to sobriety—she’s what we call a low-bottom case—but escaping homelessness isn’t the only dream of hers that’s come true. Six months ago, the recovering addict underwent massive dental surgery to reinstate the six missing teeth she had lost before she got sober. “When I was using, my entire body was deteriorating—not just my teeth,” she says now. “By the end, it was just me behind a K-Mart in the San Fernando Valley, sitting on a few cardboard boxes behind some bushes with a warm bottle of vodka and some heroin. My entire body was covered head to toe in abscesses and my teeth had been rotting for some time. I’m not sure I even owned a toothbrush.”

Of course, as many newly sober people can attest, you don’t have to have been living in a cardboard box to be plagued by teeth issues in recovery. Consider Lisa, a Washington, D.C.-based insurance agent with a straight blonde bob and Ann Taylor wardrobe whose wild college days turned into a battle with alcoholism. When she went to the dentist a few months into her sobriety, she discovered that she had 14 cavities and severe periodontal disease. “Apparently, my partying had wreaked havoc on my teeth and gums,” she says.

“During my first 90 or so days, my teeth literally started falling out of my mouth. I can remember a few times having this crunchy sensation like I just bit into a shell or some sand and realizing it was my teeth."

According to Beverly Hills dentist Dr. Parimal Nagjee, Pamela and Lisa are far from the only addicts to grapple with such toothy issues. “Addicts or alcoholics often come in with terrible teeth,” Nagjee admits. “Alcoholics typically battle two issues: the alcohol irritates all the soft tissue in the mouth and it decreases the amount of natural saliva. In terms of the tissue, the skin of the mouth is very delicate and the alcohol is corrosive to the gums, cheeks and skin. It can affect the way the tissue cells divide, which is why people who drink heavily have a greater chance of getting mouth or throat cancer.”

It wasn’t difficult for low-bottom Pamela to realize there was a problem. “During my first 90 or so days, my teeth literally started falling out of my mouth,” she recalls. “I can remember a few times having this crunchy sensation like I just bit into a shell or some sand and realizing it was my teeth. I had no insurance so I would wait until I was in excruciating pain—as in running a fever or screaming all night in agony before I would go to a dentist.”

Dr. Jay B., a recovering addict who’s also an Orange County dentist, understands all too well. “First, I found out I needed Narcotics Anonymous and then I found out that they needed me,” he laughs. “Over the last 16 years, I have treated an enormous amount of people who needed severe dental work because when they were drinking and using, they didn’t make the time or effort—or didn’t have the financial means—to take care of their teeth.”

According to Dr. Jay, it’s the brutal combination of alcoholism with smoking that tends to cause periodontal disease—which, over the long run, can lead to tooth loss because of decay or cavities. As he explains it, “Your teeth are wooden posts buried in cement, but gum disease weakens the cement, causing instability for the tooth.”

Dr. Nagjee agrees, explaining that gum disease is the primary cause of tooth loss. “Gum disease causes teeth to get loose within the gum,” he says. “The gum erodes and can no longer support the teeth. Drinking, drugs, and smoking—all of which cause dry mouth, exacerbate this problem. Saliva is a natural healing property that helps to fight bacteria. When the mouth is dry, bacteria grows, which breaks down the gums, and jeopardizes the teeth.”

While no one would pine for teeth problems, Washington DC-based Lisa’s dental issues were “a real wake up call about what I was doing to myself”: she spent her first two years of sobriety battling the effects of her gum disease. “It made me see that my alcoholism wasn’t just about broken relationships and bad mistakes— it was also affecting my physical health,” she says. “Over that next year, I went to the dentist almost every month and, as I started taking care of my teeth—flossing and brushing—I realized I was learning again how to take care of myself emotionally as well.”

Of course, not everyone is so aware—particularly before they’ve embraced a healthier lifestyle—and Dr. Jay’s heard a great many alcoholics make excuses from the dentist’s chair. “A lot of people will tell me that gum disease runs in their family—that their grandfather had bad teeth—but really it’s their drinking that is causing the problem,” he says.

Yet just getting sober, finding a dentist and breaking out the floss doesn’t mean that tooth challenges are over. As anyone who’s ever had a drill shoved into his or her mouth can surely attest, pain management is a crucial aspect of dental work, and sober addicts—even those who never contemplated abusing painkillers in the past—are often advised to avoid the Percocet route if they can. According to Dr. Jay, heavy-duty painkillers are rarely necessary. Most of his patients are sober people who are in recovery and he’s learned that he doesn’t need to rely on narcotics for pain management. “If I could sum up my whole practice in two words, it would be Motrin 800,” he says. “I have found that 90% of my clients are fine with that. Usually about eight percent of them just want the Vicodin while only two percent actually need it.”

Dr. Nagjee concurs. Even when putting people under for procedures, he tries to stay away from anything that could trigger a relapse. As far as laughing gas goes, even that, he says is not the best. “I don’t use nitrous because I’m really sensitive to it,” he admits. “I can get accidentally high just from having it seep out into the environment while I’m working on a patient’s teeth. I think that anything that alters the brain function shouldn’t be used for people who are recovering.”

Dentists like Dr. Jay and Nagjee both agree that when you’re dealing with sober addicts and alcoholics, their recovery must come first or all the work will be for naught—particularly for those with severe dental problems, like former speed freaks.

Meth mouth has gotten its fair share of ink over the years and 42-year-old Tom knows just how real it is. The recovering artist’s thick brown hair and Honda motorcycle may make him appear far younger than he is but the years of hard living show up when he opens his mouth to smile: two of his front teeth fell out because of gum disease and decay. “When I got sober, my jaw was really damaged by all of the sleepless nights caused by meth consumption,” he says. “I would be up for 15 or 20 hours a day with sometimes no sleep at all—always moving my mouth and talking gibberish. My mouth was so ravaged by alcohol, malnutrition, and poor hygiene that I started losing teeth at 26.” 

So what, exactly, is going on inside the mouths of the former meth heads? According to Nagjee, “The decay gets severe within a very short period of time, and the problem is not only with the teeth but with the gums and soft tissues in the mouth. Meth users usually don’t care about their mouth so not only do they have a lot of bacteria but they’re also not doing a lot of cleaning or oral hygiene. Also, for meth smokers, the smoke is very corrosive, upbraiding the enamel to the point where the user will take their teeth down to the dentin, which is the softer tissue underneath the enamel. Once you reach that point, the tooth can decay very fast.”

“Speed speeds things up,” adds Dr. Jay. “You see 30-year-olds who have lost all of their teeth. I have worked on people—giving them new mouths—only to see them relapse, and with meth, it’s the worst because they can destroy in a year what it has taken years to build.”

Still, the rewards for dentists who work with addicts in recovery far outweigh the frustrations. Says Nagjee, “The first thing that dental work improves is someone’s self-esteem. For a lot of people, they’ve been afraid to smile so once they can, their confidence improves and they begin to feel good about themselves.”

Tom, who has had eight cavities, two root canals and two extractions during his seven years of sobriety, backs that theory up. “Missing my two teeth effects how I communicate with people,” he admits. “Because of the gaps that I have, it stops me from smiling, and for me, that’s my first instinct—to smile. I can’t wait to have that back.”

Kristen McGuiness is a freelance writer and regular contributor to The Fix who wrote previously about the 13th step and dreaming about drinking, among many other topics, She is the author of 51/50: The Magical Adventures of a Single Life

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