Edward E. Herschaft, DDS, MA

Disclosures

October 03, 2011

Etiology and Treatment of MA-Associated Dental Disease

A constellation of interrelated etiologies leads to "meth mouth." During the euphoric high of an MA experience, the user's nutritional support is often maintained exclusively with foods and carbonated beverages containing excessive amounts of high-calorie carbohydrates and sugar. Despite this marginal diet, the recreational MA user is not concerned with maintenance of good oral hygiene practices such as brushing and flossing the teeth.[12] Additionally, the psychomotor effects of the drug potentiate atypical muscle reactions manifesting orally as bruxism. The acidic, caustic nature of the chemicals used in the manufacture and production of MA may also contribute to the elevated rate of caries in these individuals. Ironically, a recent study indicates that higher rates of dental disease are associated with injected MA use compared with smoked or inhaled MA.[13]

Treatment of MA-Associated Dental Disease

It is important for the dental practitioner to recognize the difficulty in providing care for a patient who abuses MA. Although fluoride treatments, sialogogues and other adjunctive supportive therapies may be helpful in slowing the progression of oral hard and soft tissue pathology, long-term care often requires advanced restorative or prosthodontic treatment.

This patient verbalized several criteria for her dental treatment. She wanted the unnatural black color removed from her teeth, no missing teeth for an extended period during treatment, and a reasonable cost. Therefore, she was presented with 3 treatment options:

  • Option 1: Extraction of all maxillary teeth and restoration with a complete removable prosthesis. The mandibular treatment included restorative dental procedures, extraction of the anterior deciduous teeth, and restoration with a partial removable prosthesis.

  • Option 2: Extraction of nonrestorable maxillary teeth with extensive fixed restorations and a partial removable prosthesis. Mandibular therapy remained the same as in option 1.

  • Option 3: Full mouth reconstruction, in which the patient's bite would be opened with a splint. All nonrestorable teeth would be extracted and maxillary restoration accomplished with placement of selected implants and fixed prostheses. Endodontic therapy followed by fixed and removable prostheses were planned for the mandibular arch.

Because of financial constraints and the patient's refusal to seek help to discontinue her addiction to MA, option 1 was the plan agreed to by the patient and accepted as prudent by the treating dental faculty and student. Although the patient completed the proscribed treatment, she did not return for a 6-month posttreatment examination and was lost to follow-up.

The 21st century dentist is trained to recognize that problems in the oral cavity are often associated with a systemic etiology (eg, diabetes, cardiovascular disease, leukemia, nutritional deficiencies). Appropriate referral is required if dental therapy alone does not resolve the oral condition. Similarly, the dentist has the responsibility to refer a substance abusing patient for medical care and appropriate counseling as part of the treatment regimen to bring the patient back to a healthy oral and systemic status.

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