Navigating oral issues in patients with illicit drug usage

(This article deals only with methamphetamine also called locally as meth, crystal meth, ice, glass etc. The author selected this drug because meth use comes with extreme risk. This risk is extreme compared to most other drugs because of how drastically meth affects the brain.)

Illicit drug use poses a significant public health challenge, impacting various aspects of an individual’s well-being. Among these, oral health is often severely compromised. In such a scenario, drug addicts visiting the dental clinic is not going to be uncommon. One particularly harmful illicit substance is methamphetamine, which has become increasingly prevalent across the world. Known for its severe dental ramifications, including “meth mouth,” methamphetamine use can lead to a host of orofacial conditions that demand specialized attention from dental professionals.

A 22 year old woman before (L) and after 10 years of meth use (R) showing advanced aging, hollowed cheeks, tight lips, sores, drastic loss of teeth and vertical dimension at a mere 32 years of a ge. Source: Author Suzette Gomes, The Top 10 Worst Meth Transformations, Addiction Centre – your guide for addiction and recovery, USA.

Understanding Methamphetamine Use

Methamphetamine is a potent central nervous system stimulant with a high potential for abuse and addiction. It can be ingested in multiple ways: smoking, snorting, injecting, or taking orally. The drug stimulates the release and blocks the reuptake of neurotransmitters such as dopamine, norepinephrine, and serotonin in the brain, resulting in intense feelings of euphoria and pleasure.

The high (which causes the brain to feel intense pleasure) by meth use can last up to 12 hours. This can lead to long periods of poor dental hygiene. While high, users often crave high-calorie, carbonated, sugary beverages. In addition, they may grind or clench their teeth, all of which can harm teeth.

Overall Effects of Methamphetamine Use

In the short term, meth can cause

• shortness of breath
• nausea, vomiting and diarrhoea
• insomnia and hyperactivity
• decreased appetite
• tremors and
• trouble breathing.

Long term, meth can cause

• irregular heartbeats and high blood pressure
• stroke
• loss of ability to learn.
• violent behavior
• anxiety, confusion and paranoia
• hallucinations and delusions.

Oral Effects of Methamphetamine Use – Meth Mouth

The term “meth mouth” refers to the extensive dental decay associated with methamphetamine use. This condition manifests as rampant caries on the buccal smooth surfaces and interproximal areas of teeth. The extensive tooth decay is likely caused by a combination of drug-induced psychological and physiological changes resulting in dry mouth and long periods of poor oral hygiene. The drug itself is also acidic.

A typical meth mouth showing rampant caries on the buccal smooth surfaces and interproximal areas of teeth with gingival loss. Source: ADA

The decay pattern often resembles early childhood caries but progresses much more aggressively due to several factors:

1. Xerostomia: Methamphetamine induces dry mouth by stimulating adrenergic receptors that reduce salivary flow.
2. Poor Oral Hygiene: Users often neglect oral care routines leading to plaque accumulation and bacterial proliferation.
3. Dietary Choices: There is a tendency among users to consume sugary beverages to alleviate dry mouth symptoms.
4. Bruxism: Grinding and clenching teeth are common behaviors exacerbated by meth use.

These factors collectively contribute to rapid tooth decay and other complications such as

• gingivitis/periodontitis
• fractured teeth
• myofascial pain syndrome
•  temporomandibular joint disorders
• trismus (lockjaw),
• candidiasis (oral thrush)
• glossitis (tongue inflammation), and
• cheilitis ( lip inflammation).

Dental Care Implications

Dental professionals play a crucial role in identifying methamphetamine-related oral health issues through comprehensive examinations and detailed patient histories. With patients facing issues after tooth loss and infections, dental professionals are also ethically bound to treat such patients. Here are some key considerations:

• Recognizing Symptoms: Unexplained accelerated decay in young adults or teenagers could indicate possible meth use.
• Preventive Measures: Applying topical fluorides can help mitigate some damage while encouraging hydration with water instead of sugary drinks.
• Medical Consultations: If patients are open to it, referring them to medical professionals or substance abuse rehabilitation facilities can provide holistic care beyond dental treatment.
• Treatment considerations: The teeth of people addicted to methamphetamines are characterized by being blackened, stained, rotting, crumbling and falling apart. Often, the teeth cannot be salvaged and must be extracted, followed by artificial prostheses.
• Prosthetic options: Some individuals will only need a few crowns, dental implants or porcelain veneers to restore their teeth. However, other recovering addicts will need full dentures after all total extraction of non-restorable.

Note: Caution must be exercised when administering local anesthetics containing vasoconstrictors or prescribing sedatives/narcotics due to potential adverse interactions with methamphetamine.

Community Resources

Connecting patients with local resources for addiction treatment can significantly aid their recovery journey. Suggestiongs or Refererals to rehab centres can help the ones deep into this habit who want to to recover. Reception staff can have updated information on available rehab programs in the city or suggestions for for de-addiction services online.

Conclusion

Methamphetamine’s devastating impact on oral health necessitates proactive engagement from dental professionals who are often among the first healthcare providers able to identify signs of drug abuse through routine examinations.

By understanding the unique challenges posed by this illicit substance—ranging from severe caries formation to complex systemic effects—dental practitioners can better navigate treatment options tailored specifically for affected individuals while also facilitating access to broader medical support networks essential for comprehensive recovery efforts.