The abuse of both licit and illicit substances by the general population affects at least one in ten people. Research shows that the oral healthcare worker has at least the same prevalence of substance abuse, perhaps even higher. The emergence of prescription drug abuse is one of the most worrying and dangerous aspects for the healthcare worker, due to ease of access to such drugs. According to the United Nations, prescription drug abuse is amongst the top three practices of substance abuse. We have an obligation to incorporate the evidence of substance abuse among oral healthcare professionals in our undergraduate dental curricula in order to combat this phenomenon. As the stress of daily survival in single practitioner practices increase, so will the danger of substance abuse. This may lead to impairment of the healthcare worker and ultimately loss of registration. It will take a combined effort from organised dentistry and academic institutions to establish a national strategy to ensure we address this important issue at undergraduate level and provide support at practitioner level. This paper will deal with substance abuse and the implications of impairment it holds for the oral healthcare worker.