By dental student May Firoozmand

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©Daniel Kaesler/EyeEm/Getty Images Plus

The regular use of drugs can cause significant tooth damage and induce irreversible changes within the oral cavity. Methamphetamine, commonly referred to as 'crystal meth', is a highly addictive stimulant associated with increased energy levels, mental alertness, euphoria and elevated mood.1 However, one of the major concerns of methamphetamine use is that it causes the most extensive tooth damage in an extremely short period of time, as shown in Figure 1. According to the NHS Foundation Trust of Surrey, UK, methamphetamine use is on the rise and is becoming an ever-increasing problem in the UK that should be addressed.2

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Fig. 1 Effects of meth mouth

What are the oral complications associated with methamphetamine use?

Oral health is neglected in drug users, hence oral problems are among the most prevalent diseases related to drug abuse especially with methamphetamine.

Multiple cavities, untreated tooth decay, irreversible tooth mobility and missing more than six teeth is a common clinical picture among methamphetamine users.1 'Meth mouth' is a common term that encompasses a group of recurring clinical signs and symptoms associated with methamphetamine use and are outlined below.

Bruxism

Methamphetamine users tend to be more anxious, paranoid and are more prone to clench or grind their teeth, a condition known as bruxism. Bruxism whilst using methamphetamine is a result of hyperactive facial muscles which weakens and accelerates the wearing away of healthy dental tissues.3

Xerostomia

Xerostomia, also known as dry mouth, is common among methamphetamine users. Methamphetamine reduces the flow of saliva and causes vasoconstriction by stimulating alpha adrenergic receptors within the salivary gland. Methamphetamine is known to also decrease the pH of saliva which increases the risk of dental erosion. Xerostomia can cause difficulties in speaking, swallowing, gives rise to a burning mouth sensation and an unpleasant taste in the oral cavity. Xerostomia also increases susceptibility to fungal infections such as candidiasis, cheilitis and glossitis.3 Saliva is an extremely important component of the oral cavity as it plays a role in remineralising the tooth enamel surface, reduces the population of bacteria in the mouth and neutralises acids in the mouth that cause tooth decay.3

Tooth decay

Poor oral hygiene, following a diet rich in carbohydrates and an increased sugar intake all contribute to tooth decay. All these factors lead to the accumulation of plaque on tooth surfaces which is colonised by acidogenic bacteria. These bacteria continue to metabolise sugars into acids which decreases the pH in the mouth, making the teeth more prone to erosion and decay.3 Caries commonly occurs on the interproximal and buccal smooth surfaces of teeth, the cavities are usually v-shaped in the cervical areas and tend to progress coronally.3

Staining of the teeth

Smoking methamphetamine leads to discolouration of the enamel and weakens its overall structural integrity. An initial sign of 'meth mouth' is yellow discolouration, rapid deterioration of enamel and flaking of it from the underlying tooth structure. With repeated use of the drug, greyish-brown or blackened stains occur, decay can appear until the gum line and the dentition at this later stage is usually non-restorable.4

Periodontitis

Methamphetamine is known to significantly increase levels of bacterial lipopolysaccharides secreted by macrophages which leads to periodontitis.4 Methamphetamine can significantly weaken the immune system and can lead to inflammatory processes that involve the periodontal tissues.

Gum disease

Meth users are more prevalent to gingival bleeding and deep periodontal pockets.

Administration of methamphetamine

Methamphetamine can be administered in various ways: smoking, swallowing, snorting and intravenous injections and with each a different risk arises.1

The transmission of infectious diseases through the bloodstream is increased whilst using intravenous injections. Injectors tend to experience unbearable clenching and grinding of the teeth. Inhaling methamphetamine poses a risk to the respiratory tract or lungs due to significant strain. Smokers are seen to be more susceptible to severe dental problems due to the direct contact harmful chemicals have with the oral cavity whilst smoking.5

Treatment of meth mouth

Dental extractions are still the most common treatment option for methamphetamine users. However, a more preventive approach should be considered as we need to raise awareness among the public to prevent edentulism due to substance abuse.

As dental professionals we have the responsibility to give clear and simplified oral health instructions; offer good dietary advice which includes mealtimes and the effects sugar has on the dentition; and educate the public on good brushing habits that should be implemented in their daily lives.3

Routine intra-oral examinations and comprehensive record keeping is crucial for dental patients who are methamphetamine users.3 As dental professionals it is important to have the knowledge and understanding of the typical symptoms and signs of substance abuse which will allow one to detect drug addiction in a patient early on before the changes are irreversible and the damage is too extensive.