Boston Dentist Screens for Addiction During Checkups

A 28-year-old man sat in Dr. Divya Upadhyay's dental chair, anxious about a toothache. When she asked a routine screening question about substance use, he froze—then finally exhaled.

"I've been taking pills from a friend just to calm down," he whispered. "I didn't know who to tell before it got worse."

That conversation happened because Upadhyay's Boston-area practice had started using a simple screening tool during routine visits. What began as a checkbox became a moment that could save a life.

The math is staggering: Nearly 60% of Americans used tobacco, alcohol, or illicit drugs in the past month, according to a 2024 national survey. Yet only one in 10 people with substance use disorders ever receives treatment.

Dentists see patients more regularly than primary care doctors do. That puts them in a unique position to notice early warning signs—if they know what to ask.

Upadhyay helped pilot a program at a community health center that trained dental teams to screen patients and connect them with behavioral health counselors. Many patients said no one in healthcare had ever asked them about substance use before.

The approach, called SBIRT (screening, brief intervention, and referral to treatment), takes just minutes. Electronic prompts and standardized questions make it realistic even in busy practices.

Dentists aren't counselors, but they don't need to be. They just need to ask the question and know where to refer patients who need help.

The Ripple Effect

When dental practices screen for substance use, they catch people who might never walk into a therapist's office or admit concerns to their doctor. The dental chair becomes a low-pressure space where someone finally feels safe to speak up.

Congress has authorized more than $10 billion to fight the opioid epidemic. Upadhyay argues some of that funding should support dental practices—training providers, creating referral networks, and offering insurance reimbursement codes similar to oral cancer screenings.

In Massachusetts, where teen substance use rates run higher than the national average, early intervention matters even more. Institutional dental clinics could pilot programs, refine the process, and create models that scale statewide.

The connection makes sense: Substance use directly affects oral health through decay, infection, and missed appointments. Training dental teams strengthens the link between oral, medical, and behavioral health.

Financial incentives like reimbursable screening codes could motivate dentists to participate. So could continuing education credits and professional recognition for providers who complete training.

Dentistry built its reputation on prevention—fluoride treatments, sealants, cancer screenings. This is simply extending that preventive mindset to another life-threatening condition.

Years later, Upadhyay still thinks about that patient who thanked her not for fixing his tooth, but for asking a question that gave him permission to get help before crisis struck.