Meth mouth is a colloquial term used to describe severe tooth decay and tooth loss as well as tooth fracture, acid erosion, and other oral problems that are often correlated with extended use of the drug methamphetamine. The condition is thought to be caused by a combination of side effects of the drug (clenching and grinding of teeth, dry mouth) and lifestyle factors (infrequent oral hygiene, frequent consumption of sugary drinks, as well as neglecting regular dental cleanings and preventive care), which may be present in long-term users. However, the legitimacy of meth mouth as a unique condition has been questioned because of the similar effects of some other drugs on teeth. Images of diseased mouths are often used in anti-drug campaigns. The condition is difficult to treat, and may involve fillings, fluoride to fight tooth decay and drugs that increase saliva for dry mouth, as well as oral hygiene instruction. It can be dangerous for active methamphetamine users to undergo dental surgery because of the cardiac problems that can result from the interaction of local anesthetic with the drug.
Signs and symptoms Methamphetamine (informally referred to as "meth") is a stimulant drug with a high potential for addiction in its recreational users. It incurs physical and psychological side effects that users find desirable. Other side effects (like bruxism and stimulant psychosis) can result in users neglecting their dental health, eventually leading to advanced tooth decay (caries) and gum infections. Further, a common side effect of stimulant drugs is xerostomia, which accelerates tooth decay. As of 2012, methamphetamine is the most discussed illegal drug in dental literature for its extensive effect on users' dental health. The teeth of some methamphetamine users appear to be dark and extensively eroded. The epithet "meth mouth" is the result of these superficial presentations of advanced tooth decay and gum infection. Caries often occur in the cervical regions of teeth, where the tooth surface narrows at the junction of the crown and the root; decay is primarily centered on the buccal (cheek) side of the teeth, and on tooth surfaces that are adjacent to incisors and canines. Eventually, the coronal tooth area (near the crown) can be affected by the decay and erosion. The dental caries of meth mouth often progress slowly, perhaps because their advancement is hindered by intermittent hygienic practices. The decay can lead to tooth fractures and severe pain. In some cases, teeth are permanently damaged and must be removed. Along with malnutrition and weight loss, the dental effects of methamphetamine use contribute to the appearance of premature aging seen in some users. Methamphetamine users sometimes experience soreness in the joint of the jaw and dental attrition (tooth wear) due to bruxism, a common side effect of stimulant drugs. This bruxism can occur continuously. Chronic use of the drug might also cause trismus, the inability to open the jaw. The effects of meth mouth are similar to those of Sjögren's syndrome, an autoimmune disease that causes a lack of saliva, which results in tooth decay.
Causes
The hypothesized causes of meth mouth are a combination of MA side effects and lifestyle factors which may be present in users:
Dry mouth (xerostomia) Clenching and grinding of the teeth (bruxism) Infrequent oral hygiene Frequent consumption of sugary, fizzy drinks Caustic nature of methamphetamine The dental effects of long-term methamphetamine use are often attributed to its effects on saliva. The reduction in saliva increases the likelihood of dental caries, enamel erosion, and periodontal disease. Although it is clear that use of the drug decreases saliva, the mechanism by which it does so is unclear. One theory is that the drug causes vasoconstriction (narrowing of the blood vessels) in salivary glands, decreasing salivary flow. This constriction is thought to be due to the activation of alpha-adrenergic receptors by both methamphetamine itself and norepinephrine, the levels of which are dramatically increased by methamphetamine use. These factors can be compounded by dehydration, which occurs in many methamphetamine users after drug-induced increases in metabolism. The characteristics of the saliva produced during use of the drug, which includes high protein content, may also contribute to the sensation of dry mouth. Long-term methamphetamine use can cause parafunctional habits, routine actions of a body part that are different from their common use, which can result in tooth wear and exacerbate periodontal diseases. One such habit that may affect the development of meth mouth is bruxism, particularly as the drug's effects wane and stereotypy occurs, a phase that is often referred to as "tweaking". This bruxism may be due to a drug-induced increase in monoamines. Other behaviors of long-term methamphetamine users that may cause or accelerate the symptoms of meth mouth are the failure to pay attention to oral hygiene and excessive food intake during binges, especially sugary foods; the drug's users often report strong cravings for sugar and consume large amounts of high-sugar beverages. The altered mental state that accompanies methamphetamine use lasts longer than that of some other common drugs, increasing the amount of time the user engages in drug-induced behavior. Hydrochloric acid is used in methamphetamine's manufacturing process, but academic reviews have not supported the idea that the acid contributes to dental decay. Speculation that oral consumption of the drug causes tooth decay by raising the acidity of users' mouths is also unsupported. Meth mouth is generally most severe in users who inject the drug, rather than those who smoke, ingest or inhale it.
Treatment
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