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06 Fall

Managing Meth In Your Practice

Jessica Saurino

Methamphetamine, also known as “crystal meth”, “ice”, “crank”, or “poor-man's cocaine”, has made its way east across the USA and is beginning to grow in popularity in Colorado. Dental care providers need to be aware of the signs and symptoms of meth use, its effects on oral health, and how to appropriately handle patients who are abusing this drug. Usually the entryway into the health care system for a meth abuser (termed “tweaker”) is the dental office. Oral effects present more quickly and tend to be more demanding than other health problems in tweakers because of the quick progression of oral disease in these patients. Many meth users will only present to a dental practice when their symptoms have become extremely painful and they can no longer eat or function normally.

The signs and symptoms of meth use can easily be confused with other drug effects. However, when combined with questioning and oral findings dental practitioners can isolate which patients may be using the drug. Meth abusers can present with sores on their skin from picking, dermatitis, weight loss, dark circles under the eyes, inflamed or bleeding nasal cavity, and/or elevated body temperature.


Meth Mouth
Patients presenting to their dental appointment while on meth, appear to be paranoid, extremely talkative, hyperactive, have rapid eye movement and noticeable sweating. Meth users have the potential to become violent or defensive quickly, especially when questioned, examined, when there are bright lights in their face or objects coming toward them that could be harmful. Needless to say, this presents some dangers to dentists and their staff. In order to alleviate some of the paranoia, try to keep your meth abuser talking and comfortable during the appointment. Periods of silence allow the tweaker to give in to their paranoid thoughts. Continue to make it clear during an appointment that you are trying to help the patient and that you are on their side.

“Meth Mouth"

“Meth Mouth” is the catching name for the oral destruction caused by meth. The oral manifestations connected to meth abuse will depend on the method of use of the drug. Tweakers that smoke meth will suffer the most severe dental consequences. This is next followed by those who snort it, and lastly, the least effected are the injection users. Meth is made of several noxious chemicals that weaken enamel and make it more susceptible to caries. In smokers, the effected area will be the maxillary anterior. Caries will be found both interproximally and on facial surfaces in the cervical third of the teeth. Meth snorters will have a higher incidence of cervical caries on buccal surfaces due to regurgitation of the noxious chemicals into the mouth from the back of the throat. Common dental finding in all meth users are wear facets or cracked teeth due to bruxing (meth makes tweakers clench and grind their teeth), rapidly spreading and penetrating caries on both common (interproximal) and unlikely surfaces (facial/buccal), periodontal disease and inflammation, and usually gross neglect of dental issues prior to seeking help. While high on meth, most users do not eat much, nor do they tend to brush their teeth. Consumption of high sugar/sticky sodas such as Mountain Dew is almost constant while tweaking to combat cotton mouth. For these reasons, the dental findings in a tweaker will be distinct from that of your typical patient population.

When a patient admits to a dental practitioner that they are abusing meth, it is necessary to give extra attention to discussing their treatment plan with the patient to ensure that they understand that without a drastic change in behavior, their dental health could deteriorate quickly. Talk with your patient about the possibility of quitting the drug use and give them contact information for a local treatment facility or help group. If your patient is unable to quit the meth use, talk to him or her about the things that they can be doing to lessen the oral effects of the drug. For example, suggest water drinking instead of sugary soda or ask them to increase their fluoride use or tooth brushing. In patients with a meth addiction you may be able to treat the current oral problems, but the oral problems will continue if you can not help the patient remove the cause of the caries and tooth fractures.