Edward E. Herschaft, DDS, MA


October 03, 2011

Meth Addiction: Neglected Dental Care: Case Report

A 31-year-old woman of European ancestry with stage I hypertension (systolic blood pressure: 142-158 mm Hg) presented to the dental clinic saying, "My teeth hurt when I grind and clench them and it is time to get them all fixed." The patient had an 8-year history of daily substance abuse by inhaling MA, a 15-year, 1-pack/day cigarette habit, and no desire to quit either practice. Her medical history was negative for HIV, hepatitis B virus, and hepatitis C virus.

Intraoral soft tissue examination revealed dry mucosal surfaces and a 1.0 x 0.75-cm sessile mass in the left buccal mucosa adjacent to the commissure. This lesion was consistent with a clinical diagnosis of traumatic fibroma. The maxillary and mandibular dentition exhibited some dental restorations and multiple missing or severely decayed and stained teeth. Decay and staining was especially prominent on the labial surfaces of the maxillary anterior teeth. This finding mimicked "baby bottle decay" seen in infants and children (Figure 1).[11]

Figure 1a. Anterior and posterior maxillary and mandibular dentition with labial and buccal smooth surface caries and missing teeth. b. The gingival tissue is smooth, firm, nonhemorrhagic, and hypertrophic. Images courtesy of Jonathan Rothbart, DMD.

Numerous problems affecting the oral cavity of someone addicted to MA (xerostomia, bruxism, caries) act cumulatively to result in the condition known as "meth mouth." Radiographic findings supported the clinical dental observations of rampant cervical and interproximal caries (Figure 2).

Figure 2a. Maxillary occlusal view showing rampant caries, coronal tooth loss, missing teeth, and smooth, firm, nonhemorrhagic, hypertrophic gingival tissue. b. Panoramic radiograph exhibiting missing teeth and rampant caries in the maxillary and mandibular dentition. Images courtesy of Jonathan Rothbart, DMD.

In this patient, loss of vertical dimension resulted from the advanced destruction of coronal tooth structure and numerous missing teeth in both dental arches. Radiographic findings supported the clinical dental observations of cervical and interproximal rampant caries and also revealed that the mandibular central incisors were actually retained deciduous teeth O and P.


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