|Over 12 million people age 12 and older
reported that they have used methamphetamine at least once i their
lifetime.+ Meth has been identified as one of the MOST
destructive substances to affect oral health in recent years.
The rampant decay seen in meth mouth is can be
attributed to lack of a user's concern about oral hygiene combined with
drug induced dry mouth, teeth grinding and a craving for carbohydrates
One of the hallmarks of chronic drug abuse
to see some real big teeth problems.
It can be described as blackened, stained, rotting,
crumbling or falling apart teeth. Often, the teeth cannot be saved
and must be extracted.
The oral problems all start with methamphetamine
manufacturing. The primary compound is anhydrous ammonia, and it
includes some very corrosive substances, like red phosphorus,
lithium from batteries, and muriatic acid. Mix all those together and
you have some pretty caustic stuff.
There are several ways to use methamphetamine:
|If injected intravenously, it causes no dental
|Nasal snorting, causes some enamel problems because
the substance goes down to the posterior nasal pharynx, drains in
the back of the throat and bathes the teeth with corrosive
|Chronic meth smokers have teeth rotted to the
gumline. "If you see extensive erosive enamel in relatively
young people, you have to raise the question of whether meth is
involved. There are plenty of reasons why teeth decay, however drug
users' teeth literally corrode away. " Ether, benzene,
Freon and paint thinner are extreely dangerous materials used in
meth that affect dental health. It also
|Many meth users also have
cutaneous manifestations — excoriations and sores on the face,
arms, and legs. "What happens is they have visual, auditory,
olfactory, and tactile hallucinations. They feel like there are bugs
under their skin, so they scratch. Part of it may also be an
allergic or chemical reaction. If you see corrosion of the enamel
along with skin changes, the index of suspicion has to be
|Behavioral changes you might also see include
depression and paranoia. |
|The demographic is a Caucasian male or female,
typically between 19 and 30. |
For more pictures of Meth Mouth:
Meth Mouth Pictures
Meth Mouth ADA Handout
The red flags for alcohol/drug abuse include the
following observable symptoms:
- Tremor, perspiring, tachycardia
- Slurred, rapid speech
- Dilated or pinpoint pupils
- Persistent cough
- Gray-stained plaque buildup on teeth
- Large number of cracks on teeth
- Skin lesions on face, arms, and legs known
as formication. The sometimes characteristic scabbing that you
see on meth addicts (particularly their arms) is caused by
formication. There is a feeling of "ants crawling" on the arms and
legs and "biting" them so they pick at the area sometimes breaking
the skin and leaving numerous scabs. It comes from the fact that
ants inject formic acid when they bite. (David
- Unexplained weight loss
- Inflamed, eroded nasal septum
- Track marks/injection sites
pattern as the black decay...large number of cavities...after a year
of use, dentures are the only option for many users!
- Frequent falls, unexplained bruises, or
- Non-responsiveness to treatment for diabetes,
elevated blood pressure, or ulcers
- Frequent hospitalizations
- Prescription drug-seeking behavior
- Marked change in habits, friends
- Increased sensitivity to noise
- Poor hygiene...body odor (possibly a chemical
- Irregular heartbeat
- Chest pain
- Elevated temperature and excessive seating
- Shortness of breath
- Nausea, vomiting, diarrhea,
- Dry mouth
- Blurred vision
- Dilated pupils
- Intense paranoia
- Suicide talk/attempt, depression
- Possible auditory and visual hallucination
- Impaired perception in thought process
- Occasional episodes of sudden and violent
- Tendency to become compulsive
- Increase in physical activity levels...Possibly "high strung".
- The sores on the arms are
from something called "formication" . The feeling that ants are
crawling on them and biting them. They pinch at the area causing
bleeding to bruising.
Our obligation in a dental office is to encourage
medical evaluation. You don't have a legal responsibility to report drug
use, but the patient will benefit if you try to facilitate an
intervention. Since we are in an area where methamphetamine use is
widespread, it doesn’t hurt to admonish every patient to avoid its use.
Research shows that brief interventions by professionals that may be as
simple as admonitions not to start or continue to use a substance or to
decrease the amount and frequency of use can be very effective. You may
also ask some questions, and if they admit drug abuse, call the
local treatment center.
Meth and cocaine use can negatively interact with
dental drugs. For that reason, dentist should be cautious when
administering local anesthetics, sedative, general anesthesia or nitrous
oxide or when prescribing narcotics .+
1. Have you ever felt you should cut down on
your drinking or drug use?
2. Have people annoyed you by criticizing or complaining about
your drinking or drug use?
3. Have you ever felt bad or guilty about your drinking or drug
4. Have you ever had a drink or drug in the morning to steady your
nerves or to get rid of a hangover?
5. Do you use any drugs other than those prescribed by a
6. Has a physician ever told you to cut down or quit use of
alcohol or drugs?
7. Has your drinking/drug use caused family, job or legal
8. When drinking/using drugs, have you ever had a memory loss?
1. When did you first use alcohol/drugs on your
own, away from family/caregivers?
2. How often do you use alcohol/drugs? Last use?
3. How often have you been drunk or high?
4. Has your alcohol/drug use caused problems with your
friendships, family, school, community? Have your grades slipped?
5. Have you had problems with the law?
6. Have you ever tried to quit/cut down? What happened?
7. Are you concerned about your alcohol/drug use?
1. Do you know/suspect your child is using
alcohol or other drugs?
2. Has your child's behavior or mood changed significantly in the
past six months: sneaky, secretive, isolative, assaultive,
3. Has your school, community or legal system talked to you about
4. Has there been a marked fall in academic/extracurricular
5. Have you noticed a change in your child's friends or peer
group, or found any drug paraphernalia?
6. Do you believe an alcohol/drug assessment might be helpful?
Source: Iowa Health System
Another danger of drug abuse: cavities,
The first signs of meth use is
to the teeth.
"Meth mouth". The
toxic and caustic
ingredients involved in the making of the meth—which includes
anhydrous ammonia (farm fertilizer), lithium (from batteries),
and lighter fluid, among other ingredients which
are very acidic causing
very aggressive erosion of enamel; decay formation; destructive
to both tooth structure and restorative materials and damages to
gums and oral tissues. The oral effects of methamphetamine use
can be devastating. The acidic nature of the drug and dry mouth. Meth mouth
|great deal of tooth decay-
distinctive caries pattern often seen on the cheek side, smooth
surface of the teeth and the in between surfaces of the anterior
teeth due to acidic nature of the drug.
Crank decay invariably
starts at the gum line - it eventually spreads around the entire
causes the vessels that supply blood to oral tissues to shrink
up. Reduced blood supply causes tissues to break down. With
repeated shrinking, the blood vessels don't recover and tissues
|cracks in the teeth...because
the drug can make them feel anxious or nervous, causing them to
clench or grind their teeth|
dries out the salivary glands.....it
reduces the amount of protective saliva around the teeth
calorie carbonated beverages...Meth
users are notorious for trying to treat "cottonmouth" with lots
of sugary soda.|
|poor oral hygiene-Meth
users are not likely to floss, brush and rinse when high.|
Back in the '60s, methamphetamine was called
speed or crank. Other street names for it are crystal, meth,
speed, chalk, blue
cheer, ice, glass, or blue. Meth is popular in the Midwest today
because it is inexpensive and easily manufactured with
over-the-counter ingredients. 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).
Meth is used in pill or powdered form, and can
be injected, snorted, or smoked or taken orally. 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. Even a first-time user can become
addicted, and can experience damage to their body that can never
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.
After the first hit, users get a surge of energy
and confidence, and can go for long periods without eating or
sleeping. As the hit wears off, they can feel jittery, anxious,
and paranoid for days, hearing voices and having hallucinations.
In the most common hallucination, users feel "crank
bugs" crawling on their skin. Depression and suicidal
tendencies are frequent symptoms of withdrawal.
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.
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
Physical effects of long-term use include body
odor, corroded teeth, open sores from scratching, sleeplessness,
extreme weight loss, blurred vision, convulsions, and irreversible
damage to the blood vessels of the brain that causes strokes.
Methamphetamine User Profile
Traditionally, methamphetamine use
has been most pronounced among males between the ages of 19 and 40.
Methamphetamine use is increasing among college students and young
professionals involved in the club scene or participating at rave
|Adolescents and college kids,
looking for that powerful high and a good time
|High-achieving high school
and college students wanting to cram more hours
into the day |
|Women who love the way meth
takes away their appetite |
|Moms looking for a way to “do
it all” really fast |
|Long-haul truck drivers
needing to stay awake |
|Professionals under pressure
to do more and more (e.g., lawyers, CPAs in tax
season, medical residents on night call)
|Gay men looking to kick up
the sexual thrill to a new high |
|The bored, lonely, angry,
depressed: looking for a way to feel better
|It could be almost ANYBODY
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. 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 we will look out for:
|Unaccounted for and accelerated decay
|Distinctive pattern of decay on the buccal
smooth surface of the teeth and the interproximal surfaces of
the anterior teeth. |
|Malnourished appearance |
|Complete a comprehensive oral examination
that includes taking a thorough dental and medical history.
|Express concern regarding the dental findings|
|If the patient is receptive to a medical
consult, have the phone number of a local physician, clinic or
substance abuse rehabilitation facility, inform you what to
expect at this facility|
|Use preventive measures such as topical
|Encourage consumption of water rather than
sugar-containing carbonated beverages. |
|Caution will be used when administering local
anesthetics, sedatives or general anesthesia, nitrous oxide, or
|Education about the risks associated
with methamphetamine or any illicit drug use****|
speed and extent of decay from meth use is largely dependent on
the user's habits and the frequency of dental visits. A lot of
times our only choice is to extract the teeth and give them full
upper and lower dentures.|
ionomer restoratives with fluoride release for recovering
partial dentures because if more teeth are lost another tooth
can easily be added to the denture. #|
Impact, November, Volume 33, Number 10
General and oral health
implications of cannabis use.
Cannabis, commonly known as marijuana. There are
three main forms of cannabis: marijuana, hash and hash oil, all of
whichcontain the main psychoactive constituent delta-9-
Cannabis is most commonly smoked, however it can be added to foods.
THC from cannabis enters the bloodstream and exerts its effects on
the body via interaction with endogenous receptors. Cannabis
almost every system of the body, particularly the
cardiovascular, respiratory and immune systems. It also has acute
and chronic effectson the mental health of some users.
Cannabis abusers generally have poorer oral health than
non-users, with an increased risk of dental caries and periodontal
diseases. Cannabis smoke acts as a
carcinogen and is associated with dysplastic
changes and pre-malignant lesions within the oral mucosa.
Users are also prone to oral infections, possibly due to the
immunosuppressive effects. Dental treatment on patients intoxicated
on cannabis can
result in the patient experiencing acute anxiety, dysphoria and
psychotic-like paranoiac thoughts. The use of local anaesthetic
containing epinephrine may seriously prolong tachycardia already
induced by an acute dose of cannabis.Oral health care providers
should be aware of the diverse adverse effects of cannabis on
general and oral health and incorporatequestions about patients'
patterns of use in the medical history.
Cho CM, Hirsch R, Johnstone S. Canibus and
oral health Aust Dent J. 2005 Jun;50(2):70-4.
Losing Teeth Latest Meth
Use Side Effect
Jeffery Lotshaw flossed regularly. He brushed faithfully,
sometimes four or five times in a day.
All that care makes his condition seem incomprehensible -- at the
age of just 33, Lotshaw's grin is toothless. His teeth all broke
apart, tarnished with yellow and black. "Before I started doing
meth, I didn't have a cavity in my head," .
The growing use of highly addictive methamphetamine throughout the
country is creating a prominent scar on an increasing number of
users-- rotting, brittle teeth that seem to crumble from their
Methamphetamine can be made with a horrid mix of substances,
including over-the-counter cold medicine, fertilizer, battery acid
and hydrogen peroxide. Together, the chemicals reduce a user's
saliva, which neutralizes
acids and physically clears food from the teeth.When the
saliva isn't flowing, the bacteria build up a lot faster,"
Meth users also may neglect their teeth, or moisten their dry
mouths with high-sugar drinks, and anxiety caused by the drug
prompts them to grind their teeth, which speeds decay. They're
rotting teeth, missing teeth, rotting way into the gums,". Lotshaw
has been drug-free for more than five months, but there's nodenying
what is to blame for his empty mouth.
By MATT SEDENSKY Associated
Press Writer Originally published February 5, 2005, 2:03 PM EST
Meth's Sexual Effect
At a recent task force meeting on the epidemic of methamphetamine
use in Appalachia, Gov. Phil Bredesen winced when a federal
prosecutor described the illegal drug as an aphrodisiac. Doctors and
government officials don't like to talk much about it, but there is
an obvious reason people get hooked on methamphetamine: sex.
Meth eventually destroys the sex drive, but for a short while it can
boost sexual appetite and performance more powerfully than drugs
such as cocaine, doctors say.
Use of the addictive drug can cause brain damage, violent
behavior and hallucinations, and exposure to the potentially
explosive vapors during the manufacture of meth can cause
respiratory problems, headaches and nausea. In many gay clubs in
New York City and elsewhere, meth is often injected, putting
users and their partners at risk for HIV, hepatitis C and other
sexually transmitted diseases.
Sex is the No. 1 reason people use it. The effect of an IV
hit of methamphetamine is the equivalent of 10orgasms all on top of
each other lasting for 30 minutes to an hour,with a feeling of
arousal that lasts for another day and a half,.
The effect doesn't last long. After you have been using it
about six months or so you can't have
sex unless you are high. After you have been using it a little bit
longer you can't have sex even when you're high. Nothing happens.
It doesn't work." Meth and other stimulants initially "rev up
the dopamine nervous system in the brain. They rev it up and burn
A National Institute on Drug Abuse survey on drug use and health in
2002 found that 12.4 million Americans at least 12 years old -- or
about 5 percent of the population -- had tried meth at least once in
"All substance abuse is frequently marketed as enhancing sex life or
making you more attractive or a better social companion," said John
Walters, the drug czar for President Bush. But he added that buying
meth as an aphrodisiac is "buying under false pretenses." "Hair
falls out. Teeth fall out," Walters said. "That's not sexy."
By BILL POOVEY Associated
Press Writer December 3, 2004, 1:51 PM EST Mothers Against
Addicts Pose Dental Risk
Drugs such as cocaine,
methamphetamine and ecstasy have been shown to have dangerous
interactions with common dental anesthetics. These, in turn,
could cause major hypertensive episodes or other health
problems. Heavy drinkers could have liver problems that could make
it dangerous to use certain pain relievers, such as acetaminophen.
The signs to look for drug use include severe tooth decay,
gum disease, mouth sores, ulcers, stained teeth and broken teeth
from drug- induced grinding.
In 2002, an estimated 22 million Americans-
almost 10 percent of the population-suffered from chemical
dependence or abused drugs, alcohol or both,
(according to the latest statistics from the Substance Abuse and
Mental Health Services Administration of the Department of Health
and Human Services) Illicit drug use is
highest among adults 18 to 25 years old, with more than 20 percent
reporting they use drugs. Nineteen and a half million
Americans-8.3 percent of the population ages 12 or older- reported
using illicit drugs; 54 million reported participating in binge
drinking in the previous 30 days; and 15.9 million considered
themselves to be heavy drinkers.
AGD Impact, Dec 2003, Vol. 33, No. 9
|+Dental notes Winter 2005 1/06 pg 1
RDH November, 2002 Author(s)
: Cathy Hester Seckman, David
Weis, MD, director of the Powell Chemical Dependency Center in Des
Sources for additional information include the
• The Iowa Health System's Community Initiatives in
Healthcare program offers a toolkit to health care providers that
includes a 19- minute video which describes how to approach, talk to,
and help suspected drug users. Also in the toolkit are sample brochures
and in- office aids such as posters, information cards, and signs. The
kit can be ordered at the Iowa Health System Web site, www.physi
• The Department of Education offers a free guide,
"Growing Up Drug- Free: A Parent's Guide to Prevention" by
calling (877) 4ED-PUBS. The full text of the 46-page publication is at
• Other resources include the American Council for
Drug Education, (800) 488-DRUG, www. acde.org; the National PTA Drug and
Alcohol Abuse Prevention Project, (800) 307-4782, www.pta. org; the
National Institute on Drug Abuse, (301) 443-1124, www.nida. nih. gov;
and Partnership for a Drug-Free America, (212) 922-1560, www.
'Meth Mouth' Strains
Dr. Peterson web information being used
Visit these links at the National Institute on Drug Abuse Web
Find Out More
February 06, 2008
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