Meth mouth | |
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The mouth of a person with symptoms similar to those caused by long-term use of methamphetamine |
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 symptomatic to 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.
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. [1] Further, a common side effect of stimulant drugs is xerostomia, which accelerates tooth decay. [2]
As of 2012 [update] , methamphetamine is the most discussed illegal drug in dental literature for its extensive effect on users' dental health. [3] The teeth of some methamphetamine users appear to be dark and extensively eroded. [4] 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. [3] [5] Eventually, the coronal tooth area (near the crown) can be affected by the decay and erosion. [6] The dental caries of meth mouth often progress slowly, perhaps because their advancement is hindered by intermittent hygienic practices. [5] The decay can lead to tooth fractures and severe pain. [3] In some cases, teeth are permanently damaged and must be removed. [5] Along with malnutrition and weight loss, the dental effects of methamphetamine use contribute to the appearance of premature aging seen in some users. [1]
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. [5] This bruxism can occur continuously. [7] Chronic use of the drug might also cause trismus, the inability to open the jaw. [8]
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. [5] [6]
The hypothesized causes of meth mouth are a combination of MA side effects and lifestyle factors which may be present in users:
The dental effects of long-term methamphetamine use are often attributed to its effects on saliva. [4] 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. [4] [7] These factors can be compounded by dehydration, which occurs in many methamphetamine users after drug-induced increases in metabolism. [4] 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. [6]
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. [5] One such habit that may affect the development of meth mouth is bruxism, [5] particularly as the drug's effects wane and stereotypy occurs, a phase that is often referred to as "tweaking". [6] This bruxism may be due to a drug-induced increase in monoamines. [7] 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; [5] [6] 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. [1]
Hydrochloric acid is used in methamphetamine's manufacturing process, but academic reviews have not supported the idea that the acid contributes to dental decay. [10] [11] Speculation that oral consumption of the drug causes tooth decay by raising the acidity of users' mouths is also unsupported. [5] [6] Meth mouth is generally most severe in users who inject the drug, rather than those who smoke, ingest or inhale it. [3]
The damaging effects of meth mouth on the teeth and gums for the most part are irreversible, although, if treated at an early stage, they can be dramatically reduced through the habitual use of common hygienic practices; Under normal circumstances, the user will not seek a remedy until the damage has already begun to take control causing severe mouth pain and general discomfort. [5] Because many drug users lack the access to dental treatment, due to affordability and poverty, it is important to take medical precautions to prolong the lifespan of the mouth, and health in general. [5] [3] Those who are willing to seek dental treatment should seek professional advice as soon as possible if they are experiencing any painful symptoms relatable to meth mouth from abusing methamphetamine. [12] Providing dental treatment to individuals who use methamphetamine can be dangerous, because the potential combination of local anesthetic and methamphetamine can cause serious heart problems. [13] There is also an increased risk of serious side effects if opioid medications are used in the patient's treatment. [4]
Treatment of meth mouth usually attempts to increase the flow of saliva, halt tooth decay, and encourage behavioral changes.
Toothpaste with fluoride is very important to the restoration of dental health. [5] Prescription fluoride rinses can adequately treat the condition as well. [13] Sialogogues, drugs that increase the amount of saliva in the mouth, can be used to treat dry mouth and protect against dental health problems. Pilocarpine and cevimeline are sialogogues approved by the Food and Drug Administration (FDA) to treat low salivation caused by Sjögren syndrome and may have the potential to effectively treat dry mouth caused by methamphetamine use. [13]
There have not been any controlled studies on meth mouth, and several of its aspects are unclear. [11] Although the condition has been popularized by media coverage and case reports, no systematic studies have been conducted to conclusively tie methamphetamine use to symptoms that are commonly described as meth mouth. There are few ties between dental scholars and those who study drug use, and it can be difficult for dental researchers to find methamphetamine users to study. [14]
Whether the drug has a unique effect on dental health has been questioned by a few academics, who note that the long-term use of several other drugs sometimes causes dental problems. [15] Several academic reviews have contradicted this perspective, affirming meth mouth's status as a discrete condition. [3] [16] [17] In favor of its unique status, these reviews cite the differences between methamphetamine-caused caries and those that occur for other reasons, such as cocaine use, [3] [5] as well as the scope of the tooth decay found in some long-term methamphetamine users. [15]
According to the American Dental Association, meth mouth "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 bruxism (teeth grinding and clenching)". [18] As dry mouth is also a common side effect of other stimulants, which are not known to contribute severe tooth decay, many researchers suggest that methamphetamine-associated tooth decay is more due to users' other choices. They suggest the side effect has been exaggerated and stylized to create a stereotype of current users as a deterrence for new ones. [19]
Although most methamphetamine users lived in Asian countries in the early 2000s, [20] the use of the drug increased dramatically in other parts of the world in that decade. [14] In areas where use of the drug has become common, meth mouth is often widespread. [1] [21] The condition is expensive to treat and has strained public health resources, [22] [23] prompting concerns among dental authorities in several countries about the burden of treatment. [24] [25]
Images of meth mouth are usually considered disturbing and have been used in anti-drug campaigns, [26] even being placed on billboards. [27] The condition is often mentioned in media coverage of methamphetamine, [26] and it has been included in media portrayals of drug abuse in order to demonstrate the scope of the drug's effects or to provoke disgust in the audience. [28] [29] Opponents argue that the term is used to negatively stereotype methamphetamine users, and that it is falsely portrayed as inevitable or characteristic. [30]
The drama series Breaking Bad , which centers around the production of crystal meth, features a number of minor characters who have meth mouth. The series creator Vince Gilligan has said one of his regrets about the series is that one of the lead characters, Jesse Pinkman (played by Aaron Paul), had perfect teeth because he felt this was unrealistic, given the amount of meth the character consumed. [31]
Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.
Bruxism is excessive teeth grinding or jaw clenching. It is an oral parafunctional activity; i.e., it is unrelated to normal function such as eating or talking. Bruxism is a common behavior; the global prevalence of bruxism is 22.22%. Several symptoms are commonly associated with bruxism, including aching jaw muscles, headaches, hypersensitive teeth, tooth wear, and damage to dental restorations. Symptoms may be minimal, without patient awareness of the condition. If nothing is done, after a while many teeth start wearing down until the whole tooth is gone.
Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.
Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.
Xerostomia, also known as dry mouth, is a subjective complaint of dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause.
Dental sealants are a dental treatment intended to prevent tooth decay. Teeth have recesses on their biting surfaces; the back teeth have fissures (grooves) and some front teeth have cingulum pits. It is these pits and fissures that are most vulnerable to tooth decay because food and bacteria stick in them and because they are hard-to-clean areas. Dental sealants are materials placed in these pits and fissures to fill them in, creating a smooth surface which is easy to clean. Dental sealants are mainly used in children who are at higher risk of tooth decay, and are usually placed as soon as the adult molar teeth come through.
Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic condition of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be seen as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.
Fluoride therapy is the use of fluoride for medical purposes. Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. It is typically used as a liquid, pill, or paste by mouth. Fluoride has also been used to treat a number of bone diseases.
Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline (supragingival), or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.
Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental cavities are Streptococcus mutans (S.mutans) and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.
A sialogogue is a substance, especially a medication, that increases the flow rate of saliva. The definition focuses on substances that promote production or secretion of saliva rather than any food that is mouthwatering.
Methamphetamine is a potent central nervous system (CNS) stimulant that is mainly used as a recreational or performance-enhancing drug and less commonly as a second-line treatment for attention deficit hyperactivity disorder (ADHD) and obesity. It has also been researched as a potential treatment for traumatic brain injury. Methamphetamine was discovered in 1893 and exists as two enantiomers: levo-methamphetamine and dextro-methamphetamine. Methamphetamine properly refers to a specific chemical substance, the racemic free base, which is an equal mixture of levomethamphetamine and dextromethamphetamine in their pure amine forms, but the hydrochloride salt, commonly called crystal meth, is widely used. Methamphetamine is rarely prescribed over concerns involving its potential for recreational use as an aphrodisiac and euphoriant, among other concerns, as well as the availability of safer substitute drugs with comparable treatment efficacy such as Adderall and Vyvanse. Dextromethamphetamine is a stronger CNS stimulant than levomethamphetamine.
Fluoride varnish is a highly concentrated form of fluoride that is applied to the tooth's surface by a dentist, dental hygienist or other dental professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically.
Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.
Oral ecology is the microbial ecology of the microorganisms found in mouths. Oral ecology, like all forms of ecology, involves the study of the living things found in oral cavities as well as their interactions with each other and with their environment. Oral ecology is frequently investigated from the perspective of oral disease prevention, often focusing on conditions such as dental caries, candidiasis ("thrush"), gingivitis, periodontal disease, and others. However, many of the interactions between the microbiota and oral environment protect from disease and support a healthy oral cavity. Interactions between microbes and their environment can result in the stabilization or destabilization of the oral microbiome, with destabilization believed to result in disease states. Destabilization of the microbiome can be influenced by several factors, including diet changes, drugs or immune system disorders.
Biotene is an over-the-counter dental hygiene product currently marketed by Haleon. It comes in a number of forms, including toothpaste, mouthwash, and gel.
Tooth pathology is any condition of the teeth that can be congenital or acquired. Sometimes a congenital tooth disease is called a tooth abnormality. These are among the most common diseases in humans The prevention, diagnosis, treatment and rehabilitation of these diseases are the base to the dentistry profession, in which are dentists and dental hygienists, and its sub-specialties, such as oral medicine, oral and maxillofacial surgery, and endodontics. Tooth pathology is usually separated from other types of dental issues, including enamel hypoplasia and tooth wear.
Prenatal dental care is the care of the oral cavity during fetal development. The woman’s body is subject to hormonal changes leading to several physical changes in the oral cavity during pregnancy. Some of these changes may cause tooth decay, erosion and periodontal health changes.
The Challacombe scale is a widely used diagnostic medical tool designed to produce a clinical oral dryness score (CODS) which quantifies the extent of dryness of the mouth, with the aim of making a decision of whether to treat or not, and to monitor its progression or regression.
Artificial saliva or salivary substitutes refer to a synthetically produced liquid that mimics the natural secretion of saliva. It is designed as a symptomatic relief for xerostomia, a condition characterised by dryness in the mouth and is available over-the-counter. The efficacy of artificial saliva in a systematic review of clinical trials indicates that all evaluated products reduce xerostomia symptoms, but the comparative effectiveness remains unclear due to study inconsistencies and potential biases. Side effects are uncommon, but users should take precautions against possible side effects such as allergic reactions.
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