Archive for February, 2009

The Dangers of Meth

Posted in Uncategorized on February 23, 2009 by dukeslc

The American Dental Association shares this with us:

Methamphetamine Use and Oral Health (Meth Mouth)

Dental health care professionals should be aware that methamphetamine use is on the rise in the U.S. The allure of this drug is that it is cheap, easy to make and the high lasts much longer than crack cocaine (12 hours versus one hour for cocaine). As well as being a potent central nervous system stimulant that can cause permanent brain damage, methamphetamine use has also been associated with severe oral health effects. Dental professionals should be aware of methamphetamine’s oral health effects and the treatment considerations for users of this drug.

Street names for Methamphetamine
Meth, Speed, Ice, Chalk, Crank, Fire, Glass, and Crystal

Drug description
Methamphetamine can be smoked, snorted, injected or taken orally. Typically, it is a bitter tasting powder that readily dissolves in beverages. Another common form of the drug is a clear, chunky crystal. This is the form known as “ice” or “crystal meth” and it is smoked in a manner similar to crack cocaine. Methamphetamine can also be in the form of small, brightly colored tablets. The pills are often called by their Thai name, yaba.

Mechanism of action
Methamphetamine stimulates release and blocks re-uptake of neurotransmitters called monoamines (dopamine, norepinephrine and serotonin) in the brain. Several areas of the brain are affected: the nucleus accumbens, prefrontal cortex, and striatum.1

Cerebral effects
By altering the levels of neurotransmitters in the brain, methamphetamine causes feelings of pleasure and euphoria. Methamphetamine is a neurotoxin and potent stimulant, which can also cause cerebral edema and hemorrhage, paranoia and hallucinations. Short-term effects include insomnia, hyperactivity, decreased appetite, increased respiration and tremors. Long term effects can include psychological addiction, stroke, violent behavior, anxiety, confusion, paranoia, auditory hallucination, mood disturbances, and delusions1. Methamphetamine use can eventually cause depletion of monoamines in the brain, which can have an effect on learning. 2,3

Systemic effects
With high doses there may be an increase in both systolic and diastolic blood pressure due to cardiac stimulation. In addition, methamphetamine may produce arrythmias. Other systemic effects include: shortness of breath, hyperthermia, nausea, vomiting and diarrhea.

Oral effects
The oral effects of methamphetamine use can be devastating. Reports have described rampant caries that resembles early childhood caries and is being referred to as “meth mouth”.4,5,6 A distinct and often severe pattern of decay can often be seen on the buccal smooth surface of the teeth and the interproximal surfaces of the anterior teeth.4 

The rampant caries associated with methamphetamine use is probably caused by a combination of drug-induced psychological and physiological changes resulting in xerostomia (dry mouth), extended periods of poor oral hygiene, frequent consumption of high calorie, carbonated beverages and tooth grinding and clenching. Some reports have also speculated that the acidic nature of the drug is a contributing factor.4,5,6

Methamphetamine user profile
Traditionally, methamphetamine use has been most pronounced among males between the ages of 19 and 40.7 According to the 2003 National Survey on Drug Use and Health8, 12.3 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes (5.2 percent of the population), with the majority of past-year users between 18 and 34 years of age. Research funded by the National Institute on Drug Abuse (NIDA) found 2.8 percent of young adults (ages 18–26) reported the use of crystal methamphetamine in the past year during 2001–2002.9 These users were disproportionately white and male and live in the West. The study found Native Americans were 4.2 times more likely than whites to use the drug.

Traffickers have aggressively targeted rural areas in an effort to escape law enforcement, and most use is found in the western, southwestern, and midwestern U.S.

What the dentist should be on the look out for:

  • Unaccounted for and accelerated decay in teenagers and young adults.
  • Distinctive pattern of decay on the buccal smooth surface of the teeth and the interproximal surfaces of the anterior teeth.
  • Malnourished appearance in heavy users, because methamphetamine acts as an appetite suppressant.”

What dental health-care providers can do when they suspect methamphetamine use:

  • Complete a comprehensive oral examination that includes taking a thorough dental and medical history.
  • Express concern regarding the dental findings.10
  • If the patient is receptive to a medical consult, have the phone number of a local physician, clinic or substance abuse rehabilitation facility available and be familiar with their protocol, so that the patient can be told what to expect.10
  • Use preventive measures such as topical fluorides.
  • Encourage consumption of water rather than sugar-containing carbonated beverages.
  • Be cautious when administering local anesthetics, sedatives or general anesthesia, nitrous oxide, or prescribing narcotics.
  • Take opportunities to educate your patients about the risks associated with methamphetamine or any illicit drug use.11,12