|Year : 2015 | Volume
| Issue : 1 | Page : 87-90
Meth abuse and oral health
Deviprasad Makonahally1, Vaibhav Gupta2, Pushpanjali Krishnappa2
1 Western Mass Hospital, Dental Clinic, Holyoke Health Centers Inc., Westfield, Massachusetts 01085, USA
2 Department of Public Health Dentistry, M. S. Ramaiah Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||19-Mar-2015|
Dr. Vaibhav Gupta
Department of Public Health Dentistry, M. S. Ramaiah Dental College and Hospital, MSRIT Post, MSR Nagar, Bengaluru - 560 054, Karnataka
Source of Support: None, Conflict of Interest: None
Methamphetamine abuse is spreading its roots in India due to its widespread appeal, ease of manufacture and low cost compared with other stimulant drugs. Methamphetamine-induced caries is a characteristic finding among methamphetamine abusers. Thus, it is important to understand the typical clinical manifestations inclusive of cervical and proximal caries, elicit proper case history and develop a comprehensive treatment plan to help patients in a complete rehabilitation. We present a series of cases of "meth" abuser for dental professionals to help ensure successful treatment and prevention of disease progression.
Keywords: Caries, meth abuse, methamphetamine, oral hygiene
|How to cite this article:|
Makonahally D, Gupta V, Krishnappa P. Meth abuse and oral health. J Indian Assoc Public Health Dent 2015;13:87-90
| Introduction|| |
Oral health means much more than healthy teeth.  The World Health Organization defines oral health as a "state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity." 
Oral cavity is challenged by a constant barrage of invaders - bacteria, viruses, parasites, fungi. Notably dental caries and periodontal diseases predominate among the ills that can compromise oral health.  It also gets affected by unhealthy diet, bad oral hygiene practices, tobacco chewing, drug abuse, etc., which lead to various oral diseases and predominantly dental caries, periodontal diseases and erosion. Some antidepressant drugs are abused for experiencing feel of high and sense of alertness, one of which is methamphetamine, which is used primarily in the treatment of attention deficit disorder with hyperactivity (in children over 6 years of age and in adults), exogenous obesity (in children over 12 years of age and in adults) and narcolepsy (an off-label or investigational use).  It can be consumed by dissolving in water or alcohol or taken orally, intranasally, by smoking or injection.  Meth is easily accessible and is considered the "poor man's cocaine" because the cost per gram is similar, but the longer-lasting effects of meth give it a reputation as a cheaper high.  The negative effects of this drug are extreme and far-reaching. Not only is the user's life and health affected by meth, but children, the environment, and society at large are harmed as well.  The World Health Organization reports 35 million people worldwide use methamphetamine.  For all of these reasons, the National Association of Counties has called meth our nation's most serious drug problem.  The national finding report by the U.S. National Survey on Drug Use and Health stated that nearly 10.4 million people (4.3% of respondents), people aged 12 years old and older, used meth at least once in their life.  India is rising in the ranks as a supplier and also growing as a consumer of meth.  Currently, no literature is available stating meth drug abuse in India.
Meth was first synthesized in Japan in 1919 by Akira Ogata using reduction of ephedrine using red phosphorus and iodine. One of the early uses of Meth occurred in World War II by Allies and Axis troops under the name Pervitin. Nazis widely used it as a stimulant. Adolf Hitler received shots of Methamphetamine as a medication for Parkinson's diseases.  Meth is also known by other names like Ice, Tick tick, Spoosh, Yellow bam, Crink etc. 
Mechanism of action
Meth acts by releasing high levels of central nervous system neurotransmitters dopamine.  Elevated levels of dopamine contributes to deleterious effects on nerve terminals in the brain. Long-term use can have a negative effect on cognition and learning and lead to Parkinson's disease. However,  discussed the effects of prescribed meth medication on children undergoing treatment for attention disorders or narcolepsy. The short-term effects include intensified emotions, euphoria, increased alertness, insomnia, hyperactivity, decreased appetite, increased respiration and hyperthermia thus it is most commonly consumed by teens, people who want to lose weight, young professionals trying to get ahead, blue collar workers to be able to work overtime. The long-term effects can include psychological (but not physical) addiction and dependence, cardiovascular events and stroke, immunomodulation, hypertension, weight loss, violent behavior, anxiety, confusion, paranoia, auditory and visual hallucination, mood disturbances and delusions (e.g. the sensation of insects creeping on the skin), all of which may contribute to homicidal or suicidal thoughts and actions. 
Various authors have described a distinctive pattern of caries. The caries are located specifically on the buccal smooth surface of the teeth and the interproximal surface of anterior teeth, resembling that observed in early childhood caries. , The teeth of meth users have been described as "blackened, stained, rotting, crumbling, or falling apart." Often, the teeth are in such disrepair that they are unsalvageable and must be extracted. Meth users commonly experience drug-induced cravings for high-calorie carbonated beverages and report consuming large quantities of carbonated sugary soft drinks to relive dryness of mouth.  Furthermore, long-term users are not concerned about their general and oral hygiene. Additional risk factors include the acidic composition of meth and the drug's capacity for increasing motor activity, such as excessive chewing, tooth grinding and clenching, all of which contribute to the destruction of a compromised dentition. These risk factors predispose meth users to extensive caries, a condition that has been termed "meth mouth." However, a more descriptive and grammatically appropriate description is "methamphetamine induced caries." ,
| Case Reports|| |
Following are some cases relating meth abuse with oral health. First author himself performed the clinical examination for all the cases and has obtained consent from patients prior to seating in dental chair, for oral exam, separate ones of photography (to use their photographs for academic purpose), specifically for local anesthetic and different procedures. All patients have been informed that they would be part of study relating drug abuse and oral health (esp. Teeth).
Case report 1: Poor oral hygiene in meth abuser
A 24-year-old female patient who had reported for dental treatment at Huntington health center, Huntington, MA, USA in 2012, was found to have multiple dental caries. Medical history revealed 2 years of Methamphetamine abuse (started at age 18 years) in the form of snorting and smoking. Simultaneously she started consuming huge quantities of soda (2 L/day) because of dry mouth. During these 2 years there was aggressive increase in dental caries. Patient shifted from meth to cocaine at age of 20 years due to medical issues including loss of appetite. Clinical examination revealed multiple grossly decayed teeth and removable partial dentures [Figure 1].
Case report 2: Poor oral hygiene in meth abuser
A 44-year-old male patient reported for regular dental checkup at Western Mass Hospital Dental Clinic, Holyoke Health Centre, Westfield, MA, USA, was found to have multiple decayed teeth. Medical history revealed 5 years of Methamphetamine abuse, to increase alertness and work for late hours. Because of dry mouth while using Meth patient started drinking lot of soft drinks. Clinical examination revealed poor oral hygiene along with numerous grossly decayed teeth and severely inflamed gingiva [Figure 2].
Case report 3: Poor oral hygiene in prescription meth, nonsoda drinker
A 19-year-old patient reported with 13 years history of Methamphetamine use at Western Mass Hospital Dental Clinic, Holyoke Health Centre, Westfield, MA, USA, was found to have multiple dental caries. At age six, patient was diagnosed for attention deficit hyperactivity disorder, and prescribed Methamphetamine as a medication and still patient is on medication. Clinical examination revealed moderately to poor oral hygiene with multiple gross decayed teeth, root canal treated upper anterior teeth with a crown and needs extractions, restorations and partial dentures [Figure 3].
Case report 4: Good oral hygiene in meth abuser
A 28-year-old female patient reported with chief complaint of pain in lower left molar region at Huntington health center, Huntington, MA, USA in 2012, was found to have few decayed teeth. Medical history revealed Methamphetamine abuse since 4 years. Initially she used to snort 1 g meth every 12 h, later she started injecting 1 g at a time 4-5 times a day as a weight loss therapy. Because of dry mouth and bad taste patient used to brush 5-6 times a day, started using chewing gums and sucking on the mint and consumed lots of the flavored water and tea throughout the day. Clinical examination revealed no. 17 and no. 38 are grossly decayed and enamel caries with respect to tooth no. 2, 15, 18, 20 and no. 31. Overall patient had good periodontal health and very good oral hygiene as compared to case 1, 2 and 3. Restorative treatment provided for enamel caries and no. 17 and no. 38 were extracted [Figure 4] and [Figure 5].
| Dicussion|| |
Four case series are reported related to oral health status of patients consuming meth either on prescription or as a drug of abuse. Mean duration of meth abuse was 5 years. Common factor identified amongst the four cases was meth abuse, but variations with respect to, method adopted to quench xerostomia was observed between cases. Case 1, 2 and 3 used soft drinks/soda added to poor oral hygiene which was evident by severely inflamed gingiva and numerous grossly decayed teeth. These findings are supported by extensive literature linking meth consumption with poor oral health. ,,, Whereas case four despite being on meth had good oral hygiene and good periodontal health and few carious lesions which were not extensive. The patient also had the habit of chewing gum, consuming tea, mint and the flavored water. Now the question, that emerges, is "Is poor oral health amongst Meth abusers is due to meth induced xerostomia compounded by poor oral hygiene." These findings suggest that dry mouth is one of the effects of meth abuse which could be detrimental to oral health. Case 4 demonstrated that good practices can prevent this depleted oral health. Though the evidence is weak to arrive at any conclusions, we can use this information to educate patients on meth for therapeutic reasons to maintain good oral hygiene and good practices to relieve xerostomia. Similarly we dental professionals can use this information to identify or predict if a patient with depleted oral health reports to be meth abuser and act promptly. Nevertheless we can contribute in establishing the association between meth abuse and oral health by conducting analytical studies with large number of cases.
| Conclusion|| |
The abuse of methamphetamine is currently a serious problem in the United States and is spreading its roots in India due to its widespread appeal, ease of manufacture and low cost compared to other stimulant drugs. Thus it is important for dental professionals to understand the typical clinical manifestations inclusive of cervical and proximal caries, elicit proper case history and develop a comprehensive treatment planto help patients in complete rehabilitation including cessation sessions, thus enabling him to have improved quality of life and reduce implications on his family. Behavior modification must be incorporated to obtain sustainable results. Due to the inherent weakness of case series (last approach in evidence-based medicine), we would suggest conducting analytical studies to add to existing literature regarding meth and its effect on oral and general health.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]