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 Overview
Methamphetamine Use and Oral Health (Meth Mouth)
Dental health care professionals should be aware that methamphetamine
use is on the rise 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.
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”.4,5,6 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. Some reports have also speculated that the acidic nature of the drug is a contributing factor.4,5,6
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Methamphetamine user profile
Traditionally, methamphetamine use has been
most pronounced among males between the
ages of 19 and 40.7 According to the 2003 National Survey on Drug Use and Health8, 12.3 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes (5.2 percent of the population), with the majority of past-year users between 18 and 34 years of age. Research funded by the National Institute on Drug Abuse (NIDA) found 2.8 percent of young adults (ages 18–26) reported the use of crystal methamphetamine in the past year during 2001–2002.9 These users were disproportionately white and male and live in the West. The study found Native Americans were 4.2 times more likely than whites to use the drug.
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.
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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."
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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.10
- 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.10
- 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.11,12
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ADA News
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The Journal of the American Dental Association
- For the Dental Patient: Methamphetamine Use and Oral Health (October
2005) | PDF file/54k 
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Additional
Resources
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Endnotes
- U.S. National Institute on Drug Abuse. NIDA for Teens. Mind
over Matter: Teaching Guide. Available at:
http://www.nida.nih.gov/PDF/MOM/TG-Meth.pdf (July 29, 2005)
- 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)
- Belcher
AM, O'dell SJ, Marshall JF.
Impaired Object Recognition Memory Following Methamphetamine,
but not p-Chloroamphetamine-
or d-Amphetamine-Induced Neurotoxicity. Neuropsychopharmacology.
2005 May 18; [Epub ahead of print]
(July 29, 2005)
- Shaner JW. Caries associated
with methamphetamine abuse.
J Mich Dent Assoc. 2002 Sept;84(9):42-7.
- McGrath
C, Chan B. Oral health sensations
associated with illicit drug
abuse. Br Dent J. 2005 Feb 12;198(3):159-62.
- Howe AM. Methamphetamine and
childhood and adolescent
caries. Aust Dent J. 1995 Oct;40(5):340.
- 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)
- U.S. DHHS, Substance Abuse and Mental Health
Services Administration,
Office of Applied Studies. National
Survey on Drug Use and Health. Available at:
http://oas.samhsa.gov/nsduh.htm (July 29, 2005)
- Iritani BJ, Hallfors DD, Bauer DJ. Addiction. 2007 July;102(7):1103-13.
- Venker D. Crystal methamphetamine
and the dental patient. Iowa
Dent J. 1999 Oct;85(4):34.
- Brunswick M. Meth
users can look forward to
gumming their food. Chicago Sun Times, January
10, 2005, on Drug Prevention
Network of the Americas Web site. Available at: http://www.dpna.org/resources/druginfo/methgums.htm
(July 29, 2005)
- CrystalNeon.org.
Hot Health Tips. Available
at: http://www.crystalneon.org/html/material/ (July 29, 2005)
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Photographs reproduced with permission of Stephen Wagner, D.D.S.
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