MyView: Meth: The loss of America's smile
May 16, 2016
I've made a few dentures in my time. I've supervised the fabrication of many more dentures by my students. But one set of complete dentures stands out in my memory: a set made about 15 years ago for a 22-year-old man. He was calm, well-nourished, and articulate. Unable to reconcile his appearance and demeanor with that of our usual denture patients, I blurted out, "What happened to your teeth?" A dental student and I were struck by the patient's straightforward, unemotional account of his methamphetamine addiction and subsequent recovery. Unfortunately, since that day, many, many patients with a history of meth use have come to the dental school seeking care for broken, missing, infected and/ or carious teeth. I hate methamphetamine and what it is doing to our patients.
If you do not share my grief, please read the December 2015 edition of the Journal of the American Dental Association. The cover story, "Dental Disease in Methamphetamine Users
," tells a graphic, urgent, evidence-based account of what is happening. According to the United Nations Office on Drugs and Crime there are an estimated 25 million abusers of methamphetamine worldwide. Methamphetamine exerts powerful effects upon behavior that cause patients to neglect almost everything else in their lives, including brushing their teeth. I have never seen anything, in all my years of practice — since 1981 — that can devastate dentitions as quickly and efficiently as methamphetamine. It seems to me, from the oodles of full-mouth X-rays I have reviewed in the past 15 years on new patients here at the school that meth use is not going away anytime soon. What are dentists doing about this? Not enough. No public service announcements, not enough organized lobbying, not enough community outreach programs. Are teeth our business? We need to put the word out about this nasty drug that not only decimates the oral health of our patients but destroys young lives and families.
The brilliant television series "Breaking Bad" gave us Walter White, a high school chemistry teacher who synthesized and distributed meth as a way to pay for his cancer treatments and give his family some financial security in the event of his passing. The show gave us an insider's view to the underworld of methamphetamine. Did it ever even hint at how it wrecks teeth? It glamorized methamphetamine, and only hinted at dental damage indirectly. How great would it be if the actor Bryan Cranston helped dentists create a clever public information spot for television?
So you believe that the methamphetamine problem does not exist in your practice. Not in your city or small town? Your mental image of the sunken-cheeked meth user is accurate, but this person is in the late stages of meth addiction. The person you may see in your office is likely to be, according to JADA, 30-something, but could be late adolescent or 20-something. Women and current cigarette smokers are affected disproportionately by using this drug. So, apparently, are African-American men. If you see smooth surface caries in someone who never had them before, consider the possibility that your patient may be using methamphetamine. Hold on to that thought if you observe anterior facial or interproximal caries where none previously existed. Rather than beginning an inquisition about recreational drug use, you may get farther along with a patient by simply asking, "What is happening to your teeth?" or "It looks like something has changed with your teeth," and waiting, staying absolutely silent, for five, six, seven seconds or more.
Conveying a sense of professional concern rather than moralizing is helpful if what you want is a frank discussion of your findings and to encourage your patient to return to your office, sooner rather than later. You may or may not have an impact, but you give a person an open door rather than one closed in their face with this approach. The patient may or may not admit to a habit. It is easier to pretend that drinking soda is the problem than to tell your dentist that you are partying hard.
The addiction is fierce and is intertwined with many behaviors that are almost impossible to quit. If your patient openly discusses recreational drug use, there is an opportunity to refer to a treatment program.
Dentists are in a "unique" position to do this early on and may have an impact when interventions can be most likely to contribute to good outcomes. Professional behavior requires that we care for vulnerable patients. From what I see nationally we are in the midst of a public health crisis. We must take action if we are, as a profession, to have any chance at helping people save their teeth. Just as we informed the public of the risks of smokeless tobacco with campaigns aimed at users, and just as we instituted caries risk assessment programs to educate patients about how diet and home care affect caries, we must put the word out about meth.
Our best hope for our patients and loved ones is that they never touch methamphetamine. Let's reach out to the youngest, most vulnerable members of our population: the junior high and high school students.
Listed below are some outstanding resources for dentists to use to educate themselves, their loved ones and their staff members. These materials may also be distributed to local schools for educational purposes.
It's a nasty drug.
Dr. Giusti is an associate professor in the Department of Dental Practice at the Arthur A. Dugoni School of Dentistry at the University of the Pacific.
Mouthhealthy.org; search for "methamphetamine."
"Crystal Meth: The Wrong Road," a film by Dr. Mitchell Goodis (also available in Spanish: "Metamfetamina: El Camino Equivocado"). This information may be used to fulfill education requirements in drug awareness programs in schools.
Mitchtv.net: a website with free resources for dentists, schools, and teachers.
"Meth: Kiss of Death," a TLC production and "Meth and Oral Health: A Guide for Dental Professionals," by Drs. Stephen Wagner and Charles Tatlock.