Methamphetamine: A Growing Crisis on

Spring 2020 / Section 206 By: Orlane Fontalvo & Karina Guzman

Dental Health

What is Methamphetamine?

2

According to the National Institute on Drug Abuse (NIDA), Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system.

▰ Other common names include: blue, crystal, ice, meth, and speed.

▰ People can take methamphetamine by:

▻ Smoking / Swallowing (pill).

▻ Snorting.

▻ Injecting the powder that has been dissolved in water/alcohol.

▰ The "high" from the drug both starts and fades quickly.

▰ The effects of the drug typically last from 6 to 12 hours.

▰ This can lead to long periods of poor dental hygiene. While high, users often

crave high-calorie foods, carbonated and sugary drinks.

https://www.dea.gov/galleries/drug-images/methamphetamine

3

A Growing Epidemic!

The American Dental Association (ADA) reports the following:

▰ Caries associated with use of methamphetamine is referred to commonly as

“meth mouth” or “rampant decay”.

▻ Often, the teeth cannot be salvaged and must be removed.

▻ Methamphetamine itself is also acidic.

▰ How does it affect the mouth?

▻ Bruxism, grinding/clenching, temporomandibular joint disorders,

myofascial pain, and trismus.

▰ Most Vulnerable Population?▻ Sex workers, sexual minorities, homeless, psychiatric patients,

suburban women, and pregnant women.

https://tenor.com/view/dentist-teeth-john-finlay-tiger-king-hartz-iv gif-16813299

Median pH = 4.87

1. The Relationship between Methamphetamine Use and Dental Caries and Missing Teeth

4

E. Marcia Boyer, Nancy Thompson, Tracy Hill et al.

https://www.rehabs.com/explore/meth-before-and-after-drugs/infographic.php

Introduction:

▰ Researchers conducted this study on newly entering inmates at the Iowa Medical Classification Center.

▰ Participants: 174 individuals.

Methods:

▰ Cross-sectional design. Collected between June and December of 1998 in Iowa.

▰ Materials: mouth mirrors, explorers and panoramic radiographs.

▰ The oral health of the inmates were measured by 3 variables: ▻ Total number of carious teeth▻ Total number of carious surfaces ▻ Total number of missing teeth

▰ For the study, incipient lesions (not into the dentin) were excluded.

Karina Guzman

5

Results

▰ There were 174 individuals in the study, with only one individual declining to

participate (99.4%).

▰ The effect of methamphetamine use on missing teeth was moderated by

race/ethnicity; while its effect on dental caries was moderated by race/ethnicity and

tooth brushing when on drugs.

▰ Covariate controls

▻ Demographics (sex, age, race/ethnicity and marital status)

▻ Sugar consumption (soda and non-soda sugars)

▻ Personal oral hygiene (tooth brushing frequency when on drugs)

▻ Professional dental care (number of years since last dental visit and reason

for last dental visit)

▻ Drug use (tobacco, alcohol, methamphetamine, marijuana and cocaine).

https://www.dentalcare.com/en-us/dental-research/media-library/image-video-168

6

What was reported:

▰ Users had significantly higher numbers of carious teeth, carious surfaces and missing teeth than those who had never used methamphetamine.

▰ (83.3%) ingested soda while on drugs ▻ Soda was consumed 3 or more times a day by

64.9% ▰ (82.8%) used multiple drugs

▻ 2 subjects did not use any drugs▻ 18 subjects used only 1 drug

▰ Other drugs that were used by more than half of the subjects: ▻ Tobacco (86.8%)▻ Alcohol (58.0%)▻ Methamphetamine (54.6%) ▻ Marijuana (52.3%) ▻ Cocaine (23.6%) ▻ Heroin (3.4%)

Results Cont...

https://jdh.adha.org/content/89/2/119#sec-3

Conclusion

7

https://www.deseret.com/2005/6/12/19897166/meth-mouth-ugly

▰ Based on a systematic review of methamphetamine use and other variables such as lack of professional care, oral hygiene, sugar consumption and other drugs, previous researches have not resolved this question.

▰ Methamphetamine use can cause some destructive dental caries due to its chemical components.

▰ Limitations to this study:

▻ Self-Reported Information

▻ The number of missing teeth attributed to dental disease, may have been overestimated. 

▻ The reason for teeth being absent was not ascertained. 

2. Sympathomimetic Effects of Chronic Methamphetamine Abuse on Oral Health: a Cross-Sectional Study

8

Introduction:

▰ This study was a cross sectional study, it was conducted in order to find out the

pharmacological impact of methamphetamine on oral health.

▰ The people in charged of this study were looking for the effects of

methamphetamine on:

▻ Saliva function: parameter saliva flow rate and total saliva production.

▻ Saliva buffering capacity.

▻ Bruxism

▻ Muscle trismus

Niklas Rommel, Nils H. Rohleder, Steffen Koerdt et al.

Orlane Fontalvo

https://www.northshoredentalwi.com/bruxism

9

Niklas Rommel, Nils H. Rohleder, Steffen Koerdt et al. Methods:

▰ This experiment was conducted on:

▰ 100 methamphetamine abusers were from an addiction clinic in Hochstadt,

Germany, and from the Department of addiction medicine hospital for

psychiatry, psychotherapy, psychosomatic medicine in Bayreuth, Germany that

had to consume methamphetamine for the minimum period of a year and not

have an increase consumption of other addictive drugs.

▻ The comparison group of 100 had similar characteristics such as same age,

gender but also comparable extraneous factors and where from the

department of oral and maxillofacial surgery in Munich, Germany and also the

dental surgery clinic in Augsburg, Germany.

https://www.wkms.org/post/dentists-say-meth-mouth-ugly-and-expensive#stream/0

Orlane Fontalvo 2. Sympathomimetic Effects of Chronic Methamphetamine Abuse on Oral Health: a Cross-Sectional Study

https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-016-0218-8

Criteria

11

Results▰ Majority of methamphetamine abusers reported:

▻ 72% reported dry mouth

▻ 68% reported jaw clenching

▻ 47% reported TMJ pain

▰ When comparing the comparison and experimental group these were the results:

▻ No relevant trismus information was found on either group.https://giphy.com/gifs/saliva-VQYS6AbHYbdsY

MA group

▰ Total saliva production (ml/5 min): 1.8 ml Saliva buffer analysis:

▻ 9% had a high buffer capacity with a pH of above 6,

▻ 11% had a medium high with a pH ranging from 6 to 5.5,

▻ 43% had a medium buffer capacity with a pH ranging

▻ 30% showed a low medium buffer capacity with a pH of 4.5 to 4

▻ 7% showed low buffer capacity with a pH of 4.

▰ Bruxism symptoms (n:100): 81 of MA abusers experienced symptoms

Control group

▰ Total saliva production (ml/5 min): 4.1 ml Saliva buffer analysis:

▻ 55% had a high buffer capacity

▻ 25% revealed medium high buffer capacity

▻ 18% had a medium buffer capacity

▻ 3% had a low medium buffer capacity

▻ but low was not revealed

▰ Bruxism symptoms (n:100): 39 of the control participants experienced symptoms

GRAPHS OF RESULTS

12

https://www.usnews.com/news/health-news/articles/2020-01-03/us-saw-big-rise-in-meth-fentanyl-use-in-2019

Conclusion

13

▰ The researchers concluded from the study that Methamphetamine abusers

have a significant lower saliva production which can result in in dry mouth

(xerostomia) when it is long term. These results can cause MA abusers to be

at risk for carious lesions, oral tissue infection or erosion.

▰ They concluded that sympathomimetic effects of methamphetamine abusers

lead to extensive jaw clenching with tooth wear(bruxism) and loss of enamel.

The study showed methamphetamine abusers had the worse saliva buffer

which favors erosion.

https://www.addictioncenter.com/drugs/meth/meth-mouth/

Importance to the Oral & Overall Health

14

• Methamphetamine plays a significant role on a patient's overall health, not only their oral health. We may treat a patient that could be experiencing side effects of methamphetamine and are not aware that it is due to the drug abuse.

• As Dental Hygienist we must educate patients with information that relates to their health and how methamphetamine affects it. It is also important to mention long term effects, according to Foundation of a Drug Free World, meth use can cause irreversible harm: increased heart rate and blood pressure; damaged blood vessels in the brain that can cause strokes or an irregular heartbeat that can, in turn, cause cardiovascular collapse or death; and liver, kidney and lung damage.

• It is very important to voice these effects because the long-term use can be lethal to a patient. It is our role to help our patients and provide them with guidance in order for them to live a healthy and better life. This information is significant us because while a patient is experiencing all the side effects of this drug, their last thought is their oral health, meaning it can not only affect their general health but also their oral health.

Role of the Dental Hygiene Profession

15

• As a dental hygienist it’s our job to educate our patients and perform preventive treatment. Communication with patients is a very important component for dental hygienist to receive the necessary information in order to understand why the patient is experiencing these complications, such as xerostomia, bruxism, rampant decay or “meth mouth”. 

• Studies have shown a high percentage of the abuser's report and or demonstrate these complications. We can advise the patient with several preventative treatments such as, more consumption of water for xerostomia patients; mouth guards to reduce bruxism and pulp involvement. Offer education about regular checkups and oral hygiene (e.g. flossing, interdental cleaning, and brushing with a fluoride toothpaste for 2 minutes at least twice daily).

• According to National Institute on Drug Abuse (NIDA), people who use methamphetamine - long term, may exhibit symptoms that can include significant anxiety, confusion, insomnia, mood disturbances, and violent behavior. This may display a number psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects creeping under the skin).

Reference

Boyer, E. M., Thompson, N., Hill, T., & Zimmerman, M. B. (2015, April 1). The Relationship between Methamphetamine Use and Dental Caries and Missing Teeth. Retrieved February 25, 2020, from https://jdh.adha.org/content/89/2/119

Grobler, S. R., Chikte, U., & Westraat, J. (2011). The pH Levels of Different Methamphetamine Drug Samples on the Street Market in Cape Town. ISRN Dentistry, 2011, 1–4. doi: 10.5402/2011/974768

How Long Does Meth Stay in Your System? (2020, February 27). Retrieved March 10, 2020, from https://www.drugrehab.com/addiction/drugs/crystal-meth/how-long-does-meth-stay-in-your-system/

Kittirattanapaiboon, P., Srikosai, S., & Wittayanookulluk, A. (2017, July). Methamphetamine use and dependence in vulnerable female populations. Retrieved March 10, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/28426546

Methamphetamine. (2019, March 26). Retrieved March 20, 2020, from https://www.ada.org/en/member-center/oral-health-topics/methamphetamine

Methamphetamines - Innovative Dentistry, Hard Truth, Methamphetamines, The Truth, Methamphetamines, Ballard Dental Arts, & Difficult Effects of Methamphetamines. (2016, November 9). Caring for Patients Who Abuse Methamphetamine. Retrieved April 14, 2020, from https://dimensionsofdentalhygiene.com/article/caring-for-patients-who-abuse-methamphetamine/

16

Reference

National Institute on Drug Abuse. (n.d.). What are the long-term effects of methamphetamine misuse? Retrieved from https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-are-long-term-effects-methamphetamine-misuse

Pabst, A., Castillo-Duque, J. C., Mayer, A., Klinghuber, M., & Werkmeister, R. (2017, October 30). Meth Mouth-A Growing Epidemic in Dentistry? Retrieved March 20, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806971/

Rommel, N., Rohleder, N. H., & Koerdt, S. (2016, May 26). Sympathomimetic effects of chronic methamphetamine abuse on oral health: a cross-sectional study. Retrieved from https://www.usnews.com/news/health-news/articles/2020-01-03/us-saw-big-rise-in-meth-fentanyl-use-in-2019

Shetty, V., Harrell, L., & Murphy, D. A. (n.d.). Dental disease patterns in methamphetamine users. The Journal of The American Dental Association, 146(12), 875–885. doi: https://doi.org/10.1016/j.adaj.2015.09.012

Short- & Long-Term Side Effects of Crystal Methamphetamine on the Body- Drug-Free World. (n.d.). Retrieved April 14, 2020, from https://www.drugfreeworld.org/drugfacts/crystalmeth/the-deadly-effects-of-meth.html

Turkyilmaz, I. (n.d.). Oral Manifestations of “Meth Mouth”: A Case Report. The Journal of Contemporary Dental Practice, Volume 11, pg.4. Retrieved from https://pdfs.semanticscholar.org/7eb8/ba6bfb94f6fa996004f2625e7cfe2f5b0376.pdf

“U.S. Saw Big Rise in Meth, Fentanyl Use in 2019.” U.S. News & World Report, U.S. News & World Report, 3 Jan. 2020, www.usnews.com/news/health-news/articles/2020-01-03/us-saw-big-rise-in-meth-fentanyl-use-in-2019.

17

Thank You!Any Questions ?