“…Individuals with heavy substance use are at increased risk for poor oral health for a variety of reasons, including limited access to dental care (Johnson, Hearn, & Barker, 2008; Khocht, Schleifer, Janal, & Keller, 2009; Sheridan, Aggleton, & Carson, 2001; ter Horst, Molendijk, Brouwer, & Verhey, 1996), poor dietary (Laslett, Dietze, & Dwyer, 2008; Morio, Marshall, Qian, &Morgan, 2008; Titsas and Ferguson, 2002) and oral hygiene habits (Barbadoro, Lucrezi, Prospero, & Annino, 2008; Friedlander, Marder, Pisegna, & Yagiela, 2003; Morio et al, 2008), negative attitudes about oral health and health care (Robinson, Acquah, & Gibson, 2005), and direct physical effects of the substance on oral health. There are several mechanisms by which drugs can directly affect oral health, including increased xerostomia (dry mouth) due to hyposalivation (lack of salivary flow), poor diet and self-care leading to higher rates of dental caries, enamel erosion, and periodontal disease (Friedlander et al, 2003; Hamamoto and Rhodus, 2009; Morio et al, 2008; Versteeg, Slot, van der Velden, & van der Weijden, 2008).…”