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Meth Mouth

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Overview

Methamphetamine Use and Oral Health (Meth Mouth)

Dental health care professionals should be aware that methamphetamine use is widespread in the U.S. The allure of this drug is that it is cheap, easy to make and the high lasts much longer than crack cocaine (12 hours versus one hour for cocaine). As well as being a potent central nervous system stimulant that can cause permanent brain damage, methamphetamine use has also been associated with severe oral health effects. Dental professionals should be aware of methamphetamine’s oral health effects and the treatment considerations for users of this drug.

Street names for Methamphetamine
Meth, Speed, Ice, Chalk, Crank, Fire, Glass, and Crystal

Drug description
Methamphetamine can be smoked, snorted, injected or taken orally. Typically, it is a bitter tasting powder that readily dissolves in beverages. Another common form of the drug is a clear, chunky crystal. This is the form known as "ice" or "crystal meth" and it is smoked in a manner similar to crack cocaine. Methamphetamine can also be in the form of small, brightly colored tablets. The pills are often called by their Thai name, yaba.

Mechanism of action
Methamphetamine stimulates release and blocks re-uptake of neurotransmitters called monoamines (dopamine, norepinephrine and serotonin) in the brain. Several areas of the brain are affected: the nucleus accumbens, prefrontal cortex, and striatum.1

Cerebral effects
By altering the levels of neurotransmitters in the brain, methamphetamine causes feelings of pleasure and euphoria. Methamphetamine is a neurotoxin and potent stimulant, which can also cause cerebral edema and hemorrhage, paranoia and hallucinations. Short-term effects include insomnia, hyperactivity, decreased appetite, increased respiration and tremors. Long term effects can include psychological addiction, stroke, violent behavior, anxiety, confusion, paranoia, auditory hallucination, mood disturbances, and delusions1. Methamphetamine use can eventually cause depletion of monoamines in the brain, which can have an effect on learning. 2, 3

Systemic effects
With high doses there may be an increase in both systolic and diastolic blood pressure due to cardiac stimulation. In addition, methamphetamine may produce arrythmias. Other systemic effects include: shortness of breath, hyperthermia, nausea, vomiting and diarrhea.

IMAGE: Example of "Meth Mouth"
Courtesy of
Robert D. Thomas, D.D.S
.

Oral effects
The oral effects of methamphetamine use can be devastating. Reports have described rampant caries that resembles early childhood caries and is being referred to as "meth mouth." 4, 56 A distinct and often severe pattern of decay can often be seen on the buccal smooth surface of the teeth and the interproximal surfaces of the anterior teeth.4

The rampant caries associated with methamphetamine use is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high calorie, carbonated beverages and tooth grinding and clenching.4, 5, 6

IMAGE: Example of "Meth Mouth"
Courtesy of
Robert D. Thomas, D.D.S
.

Methamphetamine use
According to the 2010 National Survey on Drug Use and Health,8 methamphetamine use is declining (from an estimated 731,000 past month users in 2006 to 353,000 in 2010). The average age of new methamphetamine users aged 12 to 49 in 2010 was 18.8 years, which was not significantly different from corresponding 2002 to 2009 estimates.8 Traffickers have aggressively targeted rural areas in an effort to escape law enforcement, and most use is found in the western, southwestern, and midwestern U.S.

What the dentist should be on the look out for:

  • Unaccounted for and accelerated decay in teenagers and young adults.
  • Distinctive pattern of decay on the buccal smooth surface of the teeth and the interproximal surfaces of the anterior teeth.
  • Malnourished appearance in heavy users, because methamphetamine acts as an appetite suppressant.  

What dental health-care providers can do when they suspect methamphetamine use:

  • Complete a comprehensive oral examination that includes taking a thorough dental and medical history.
  • Express concern regarding the dental findings.9
  • If the patient is receptive to a medical consult, have the phone number of a local physician, clinic or substance abuse rehabilitation facility available and be familiar with their protocol, so that the patient can be told what to expect.9
  • Use preventive measures such as topical fluorides.
  • Encourage consumption of water rather than sugar-containing carbonated beverages.
  • Be cautious when administering local anesthetics, sedatives or general anesthesia, nitrous oxide, or prescribing narcotics.
  • Take opportunities to educate your patients about the risks associated with methamphetamine or any illicit drug use.

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The Journal of the American Dental Association

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Additional Resources

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Endnotes

  1. U.S. National Institute on Drug Abuse. NIDA for Teens. Mind over Matter: Teaching Guide. Available at: http://teens.drugabuse.gov/mom/teachguide/TG-Meth.pdf (July 29, 2005)
  2. Daberkow DP, Kesner RP, Keefe KA. Relation between methamphetamine-induced monoamine depletions in the striatum and sequential motor learning. Pharmacol Biochem Behav. 2005 May;81(1):198-204. (July 29, 2005)
  3. Belcher AM, O'dell SJ, Marshall JF. Impaired Object Recognition Memory Following Methamphetamine, but not p-Chloroamphetamine- or d-Amphetamine-Induced Neurotoxicity. Neuropsychopharmacology. 2005 Nov; 30(11): 2026-34
  4. Shaner JW. Caries associated with methamphetamine abuse. J Mich Dent Assoc. 2002 Sept;84(9):42-7.
  5. McGrath C, Chan B. Oral health sensations associated with illicit drug abuse. Br Dent J. 2005 Feb 12;198(3):159-62.
  6. Howe AM. Methamphetamine and childhood and adolescent caries. Aust Dent J. 1995 Oct;40(5):340.
  7. U. S. Drug Enforcement Administration. Methamphetamine: a growing domestic threat. Available at: http://www.fas.org/irp/agency/doj/dea/product/meth/threat.htm (July 29, 2005)
  8. U.S. DHHS, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Results from the 2010 National Survey on Drug Use and Health. Available at: http://www.samhsa.gov/data/NSDUH/2k10Results/Web/HTML/2k10Results.htm (March 30, 2012)
  9. Venker D. Crystal methamphetamine and the dental patient. Iowa Dent J. 1999 Oct;85(4):34.

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