Substance use in orthodontics: asking difficult questions

Substance use among adolescents is an increasing public health concern with clear implications for orthodontic treatment and oral health. Consequences may include poor oral hygiene, reduced compliance, and compromised treatment outcomes. As clinicians who routinely treat adolescents, orthodontists are ideally positioned to recognize early risk behaviours. This article explores the impact of substance use on orthodontic care, reviews available screening tools, and discusses their practical implementation and current challenges. Incorporating validated screening into orthodontic assessments can strengthen safeguarding, facilitate timely intervention, and support comprehensive, patient-centred care. CPD/Clinical Relevance: Integrating substance use screening tools into orthodontic practice enables clinicians to identify and respond to risk behaviours in adolescents, reinforcing safeguarding duties, contributing to fairer outcomes and enhanced overall wellbeing.