Several studies show that despite poor oral health substance users fail to access dental care. This was confirmed locally by audit in 2005; 63% (n = 82) were not registered with a dentist and 72% had dental problems, of whom 83% were not receiving treatment.

To examine issues affecting substance users use of dental services.

To identify factors influencing whether substance users visit the dentist, in particular whether having a ‘regular’ dentist is important. Secondly, to compare this with perceptions of dental care staff.

A cross sectional survey was conducted across Norfolk & Waveney Mental Health Trust's Alcohol and Drugs Service and Norwich dental practices. 87 substance users participated, half of Norwich dentists (n = 67) and 66 reception staff from Norwich dental practices.

Participants reported high levels of dental problems, most commonly toothache (71%). Those having a dentist they normally saw were more likely to have visited the dentist in the previous year (X2 = 14.06, p < 0.01). The most common reasons for not receiving treatment were difficulty finding a dentist, difficulty keeping appointments and few available appointments. Dental staff acknowledged similar dental problems, but were more likely to think lack of motivation caused non-attendance. Drug use, substitute prescribing or duration in treatment did not influence frequency of dental visits. Dentists hi-lighted remuneration issues for providing services to substance users.

Having a ‘regular’ dentist could improve use of dental services. Examining capacity and revisiting payments for this group under the new dental contract could improve treatment rates.