Dental Caries: Meth mouth, or crank decay, is commonly observed in methamphetamine users. The cause of meth mouth is multifactorial. Meth users commonly experience drug-induced cravings for high-calorie carbonated beverages. As a result, soft drinks containing high amounts of sugar and caffeine are often consumed to prolong the high and assuage the cravings. Reports indicate that Mountain Dew™ is commonly ingested by meth users; as much as several liters per day. The drug produces extreme xerostomia, reducing the amount of protective saliva and buffering capacity around the teeth. As a result of these behaviors, the oral bacterial levels can drastically increase, exacerbating the decay. The caustic nature of the drug, poor oral care and high sugar diet result in increased decay. This devastation can occur rapidly in as little as one year. Conventional dental treatment is frequently of little value. Often, the caries are so significant and rampant that full-mouth extractions are indicated (Figure 13).
Figure 13. Oral Condition of a Crystal METH Abuser. “METH Mouth”
Periodontal Disease: Methamphetamine users have an increased incidence of periodontal disease. The drug causes vasoconstriction of the vessels that supply blood to the oral tissues. With repeated use of the drug and repeated vasoconstriction, the blood vessels are permanently damaged and the oral tissues die. In addition, lack of proper daily oral hygiene further exacerbates the declining periodontal health.
Bruxism: Methamphetamine can cause users to feel anxious and nervous, resulting in clenching and grinding of the teeth. Signs of bruxism, including fractures of the teeth and severe attrition, are common. The vasoconstriction can also affect the vitality of the teeth, increasing the likelihood of enamel fractures.
Oral Ulcers and Infection: Oral ulcerations and infections are common among methamphetamine users. When smoked or snorted, the caustic ingredients of the drug bathe the oral cavity and irritate and burn the oral tissues. This leads to significant oral ulcerations and infections. This is also brought on by the severe dry mouth that accompanies the use of meth. Xerostomia is caused by the vasoconstriction and reduction of salivary gland function. The tongue and lining of the mouth can become raw and irritated without the surfactant action of saliva. This can lead to secondary infections and limited ability to speak and eat.17
Local Anesthesia and Sedation: The clinician must be sure the meth patient has not used several days prior to deep sedation and dental injections need to be closely monitored.
For more advanced clinical information about the oral implications of meth abuse, please see the following course on dentalcare.com: Methamphetamine: Implications for the Dental Team.