DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Meth MouthDental Issues in Methamphetamine Abusers
Medical Case Management Clinical Conference Christina Eaton, MPH
Delta AETC
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
The Relationship Between Methamphetamine Use and Increased Dental Disease
• J Am Dent Assoc, Vol 141, No 3, 307-318
• Vivek Shetty, DDS, DrMedDent• Larissa J. Mooney, MD• Corwin M. Zigler, MA• Thomas R. Belin, PhD• Debra Murphy, PhD and Richard Rawson, Ph
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
What is “Meth Mouth”?
• Destruction of the teeth and gums directly resulting from methamphetamine abuse
• Indirect consequence of methamphetamine abuse– Neglected or forgotten brushing & flossing while
high or when coming down
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
• Forms on teeth when starches & sugars interact with bacteria present in mouth
• Plaque is removed with brushing BUT re-forms within 24 hours
• If stays longer than 2-3 days can harden into tartar
7
1. PLAQUE : “ Soft, sticky, fussy deposits on tooth”
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
2. Calculus/Tartar/Stone : “ Hard deposits on tooth”
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org9
1. PLAQUE : “ Soft, sticky, fussy deposits on tooth”
2. Calculus/Tartar/Stone : “ Hard deposits on tooth”
3. Periodontal Pocket: “ Due to bone & Ligaments destruction”
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
PERIODONTAL POCKET: When Periodontitis cause bone destruction.
P. Pocket
Healthy gum & Bone
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
How Does MA Use Cause Tooth Decay?
• MA use causes blood vessels to constrict (shrink)
• Blood vessels in mouth can not feed teeth and gums
• Repeated shrinking causes vessels to die– Inhibits body’s ability to repair itself
• Dental tissue starves and breaks down
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
How Does MA Use Cause Tooth Decay?What is xerostomia?
1 2 3 4 5
20% 20% 20%20%20%1. Calcium breakdown2. Dryness in the mouth3. Small cracks in the teeth4. Bad breath5. Gum recession
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Xerostomia
• Saliva breaks down acids in the mouth
• MA use blocks the brain mechanism causing salivation
• Acids build up and eat away at tooth enamel
• MA can stay in the body for 8+ hours
– Sustained reduction in saliva = rapid bacterial growth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
How Does MA Use Cause Tooth Decay?Self Treatment for Xerostomia
• Carbonated drinks are often craved to counteract the effects of “dry mouth”
– Provides food for bacteria, creating more acid
– Insufficient saliva to counter decreased pH
– Acid eats away at tooth enamel
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Which method of MA use results in the highest rates of dental disease?
1 2 3
33% 33%33%1. Smoking2. Snorting3. Injecting
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
How Does MA Use Cause Tooth Decay?• Prevailing belief
– Smoking > IV or snorting
• 2000 report in Peridontology – Snorting > IV
• 2010 Study– IV > Smoking or Snorting
• Why?– IV MA users have higher level of addiction
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
How Does MA Use Cause Tooth Decay?
• Bruxism (Teeth grinding & clenching)
– Caused by drug-induced hyperactivity
– Puts large amounts of unnatural pressure on tooth
– Creates small fractures in enamel, exposing dentin layer or pulp of the tooth
– Exacerbates TMJ disorders
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Which subset of MA users more often reports having TMJ problems?
1 2
50%50%
1. Males2. Females
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
•Mike Myers (Austin Powers), Austin Powers in Goldmember
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Counseling Your Clients
• Plan for dental care before getting high
• Reminder notes to brush and floss
• Keep extra toothbrush and travel sized toothpaste in backpack, car, etc if will not return home
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Counseling Your Clients
• Brush daily
• Use soft bristle brush and toothpaste that contains fluoride
• Fluoride best defense against tooth decay
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Moment of Truth: I floss…..
1 2 3 4 5
20% 20% 20%20%20%1. Everyday2. A few times a week3. Sporadically4. With my fingernails5. What is flossing?
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Counseling Your Clients: Flossing
• Floss on a regular basis – once a day
• Don’t floss right before or after oral sex
• Check teeth and gums often for early signs of decay and gum disease
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Counseling Your Clients
• Drink water not soda to keep mouth moist
• When high try to drink 64 oz (8 glasses) a day
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Counseling Your Clients
• Suck on sugar-free candy like lemon drops to help produce saliva
• See dentist every six months for a routine cleaning and check-up
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Summary• Dental disease is a distinguishing marker of MA use
• MA users often have current dental problems & unmet oral health needs
• MA contributes to dental problems by causing xerostomia and bruxism
• Counsel clients to keep up with dental health and drink plenty of water if continuing MA use
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org
Name That Famous Mouth
DELTA REGION AIDS EDUCATION AND TRAINING CENTER • deltaaetc.org