"Meth mouth" on NPR--any comments?

[OldPsychDoc]

I'm a psychiatrist with extra training in addictions. Wondering if any of you heard this story, and if you all had any comments/experience?

http://www.npr.org/templates/story/story.php?storyId=4793417

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[jdcinza13]

I'm not an expert by any means, but I have seen this in some shadowing at the homeless shelter dental clinic here in Phoenix. Nothing you can really do in the advanced stages, but early on, the best thing to do is quit...I guess it's easier said than done.

 

[Dr.SpongeBobDDS]

I'm a psychiatrist with extra training in addictions. Wondering if any of you heard this story, and if you all had any comments/experience?

http://www.npr.org/templates/story/story.php?storyId=4793417

By the time they get around to seeing a dentist, it is often too late. It is sad to to make dentures for 20 and 30 somethings but the removable pros clinic at my school is no stranger to young people.

 

[gryffindor]

Yup, I treated a patient with "meth mouth" in my residency from start to finish. Came in October, got him cleared & scheduled for general anesthesia in March, he got full mouth extractions, he healed up nicely with no teeth. Then I restored him with complete upper & lower dentures delivered in June. He was one of the most thankful patients I had all year and was uber excited about his new dentures. Down the line he will get some implants so help retain them better.

The patient was 40 something years old and was very motivated to turn his life around. Prior to meth, he was in school & working. Lucky for him, his parents were very supportive throughout the dental surgery, coming to stay with him after the full mouth exo. He belonged to a support group and had a sponsor and it sounded like he was doing really well. He did say that once all of the infected & grossly carious teeth were finally out of his mouth, his overall health began improving despite the fact he had no more teeth (the pt. was also a diabetic & HIV).

 

[toofache32]

Whatever happened to that guy "FullOsseousFlap" who was always ranting about this?

 

[ItsGavinC]

By the time they get around to seeing a dentist, it is often too late. It is sad to to make dentures for 20 and 30 somethings but the removable pros clinic at my school is no stranger to young people.

So true. I screened a patient in their early 30s this week who claimed to have quit, but the obvious damage was already done.

A patient in my practice is 24 and will be getting complete dentures. It's becoming more and more commonplace it seems.

 

[tx oms]

I don't know why people make such a big deal about "meth mouth". There are lots of people who have a similar mouth and don't do meth. I like the way we blame the meth for their problem. No one gives a sober **** mouth person the same out. To me, meth mouth is akin to "pregnancy mouth" or "genetics mouth".

Bottom line: brush your teeth, and don't give me excuses about why your teeth are so bad when I am pulling them all out.

 

[dientesfuertes]

I don't think I've heard anyone using meth mouth as an "excuse" for why all their teeth are rotten. The reason it is a "big deal" is that it is an oral health problem that is affecting a large part of the population. If dental professionals don't make a big deal about it, then who will? If we just act like it isn't a problem, then people really do have an excuse (i.e., 'Well, nobody ever told me that smoking meth would hurt my teeth.")

 

[toofache32]

I don't think I've heard anyone using meth mouth as an "excuse" for why all their teeth are rotten. The reason it is a "big deal" is that it is an oral health problem that is affecting a large part of the population. If dental professionals don't make a big deal about it, then who will? If we just act like it isn't a problem, then people really do have an excuse (i.e., 'Well, nobody ever told me that smoking meth would hurt my teeth.")

I think TXOMS isn't saying that meth mouth isn't a problem. It's just no bigger deal than any other reason you have **** mouth.

I think it's used as an excuse....they're always looking for an excuse. The most common one I hear is, "my diddy had soft teef and so I inherited my soft teef from him." Translation: "My diddy ain't never even heard of a toothbrush, and so he ain't never taught me no oral hygiene."

 

[Jediwendell]

Seen it. Have edentulated a sixteen year old girl for it. It can happen with any drug that rids a person of their will to do things like brush their teeth, bathe, etc. It is also compounded by the xerostomia that you see with many drugs and the fact that meth and oxycontin tend to be used by people in rural, depressed areas where there is a lot of consumption of Mountain Dew type products. Not sure about the grinding thing that they are talking about. Lots of people grind their teeth and don't get caries from it.

 

[aphistis]

I think TXOMS isn't saying that meth mouth isn't a problem. It's just no bigger deal than any other reason you have **** mouth.

I think it's used as an excuse....they're always looking for an excuse. The most common one I hear is, "my diddy had soft teef and so I inherited my soft teef from him." Translation: "My diddy ain't never even heard of a toothbrush, and so he ain't never taught me no oral hygiene."

"Inherited"? Wow, you must work with an unusually well-educated patient population.

 

[RaiderNation]

Wow. I have to say that I am astonished. An article on NPR that is actually interesting and not complete liberal slander. Absolutely amazing.

 

[dentwannabe]

I don't know why people make such a big deal about "meth mouth". There are lots of people who have a similar mouth and don't do meth. I like the way we blame the meth for their problem. No one gives a sober **** mouth person the same out. To me, meth mouth is akin to "pregnancy mouth" or "genetics mouth".

Bottom line: brush your teeth, and don't give me excuses about why your teeth are so bad when I am pulling them all out.

hey man i wouldnt be so pro-brushing teeth if i were you.

after all, your income depends on people not taking care of their teeth, so u can yank em out!

heehawr, it sux to be u in such a complicated position.

 

[Energon]

I am currently in the process of treating a patient with "meth mouth". My patient was a meth addict for about 20 years prior to seeking treatment. Due to his history of drug abuse, he is also succiptible to grand mal seizures. He seized in my chair about 6 months ago.

Nonetheless, it is a very interesting case which I am about to complete in september.

The thing to remember is, most drug abusers do not seek dental care. As a result, their dential condition is terrible by the time a dentist actually sees the patients.

 

[Energon]

I am currently in the process of treating a patient with "meth mouth". My patient was a meth addict for about 20 years prior to seeking treatment. Due to his history of drug abuse, he is also succiptible to grand mal seizures. He seized in my chair about 6 months ago.

Nonetheless, it is a very interesting case which I am about to complete in september.

The thing to remember is, most drug abusers do not seek dental care. As a result, their dential condition is terrible by the time a dentist actually sees the patients.

 

[jk5177]

It seems that meth mouth affects mainly the maxillary in the couple of pictures I cam across? Is this a meaningful observation?

 

[Geezer99]

It seems that meth mouth affects mainly the maxillary in the couple of pictures I cam across? Is this a meaningful observation?

Baby-bottle rot has a similar pattern, supposedly because the lower lip protects the bottom teeth from the constant bathing in milk/juice. Probably the same thing going on when you smoke meth? Of course AMMD's patient looks like he has some nice prosthetics on his lowers. Apparently porcelain stands up pretty well to the hydrochloric acid.

 

[Energon]

Baby-bottle rot has a similar pattern, supposedly because the lower lip protects the bottom teeth from the constant bathing in milk/juice. Probably the same thing going on when you smoke meth? Of course AMMD's patient looks like he has some nice prosthetics on his lowers. Apparently porcelain stands up pretty well to the hydrochloric acid.

Oh, sorry, I forgot to mention that is a PFM (#21-28)bridge I made for him. However, he did have a prior bridge (22-26) which had held up pretty well. However, the torque on his teeth was way too much for the pontic expanse and #21 & 28 were in need of restoration as well, so I treatment planned him for the bridge with more abutments. I had also treatment planned him for a maxillary bridge, however, due to lack of funds, he has decided to go with an RPD. He still has decent roots on # 6 and 11 and so I am going to put survey crowns on them, and give him an RPD replacing the other missing teeth.
I wish I could have done the case fixed/fixed, it would have been really great, but our school suddenly skyrocketed their prices and the poor guy got screwed over.

But yes, a well done fixed prosthesis does seem to hold well against meth abuse

 

[joel4sale]

Join a HMO clinic in the mountaines like I do and you will see meth teeth at least few times a week (1 yesterday and 2 today). Most of them do admit use of meth/crack.

Meth is not a excuse for not brush. Quick re-cap for those who forgot: Meth does reduce saliva flow, Meth user usually drink EXTENSIVE soda (seems like mountain dew is the most popular among them here) because mouth felt dry and booster high, reduce blood flow to gingiva...list goes on. Smoking crack also cause extensive damage to enamel.

Poor oral hygiene usually (not all the time) result in massive occlusal and interproxmal decay, starting molars. Typical Meth teeth massive anterior facial, cervical and interproxmal decay (black and mush).

Just from what I see here: While the ultimate treatment often are immediate denture, meth user (ex or current) seems to be harder to numb, aneth wear out faster, EXTREMELY low pain tolerance (espceially females) -> always the one that call you every 2 day po crying on phone stateing it hurt more than before and want something stronger than the non-narc pain med that you prescribed (often conveniently allergic to codine and ibuprofen and only thing that work is Vicodin or Percocet).

It can be very rewarding to work on those actually trying to sober up or GREAT PAIN IN A$$ to work on those questionable ones....



Just my very biased 2 cents...

 

[joel4sale]

The thing to remember is, most drug abusers do not seek dental care. As a result, their dential condition is terrible by the time a dentist actually sees the patients.

Actually lot of them they do......many of them just want ext. Whatever you do, they will call you on friday afternoon and state extreme pain at the TOOTH YOU WORK ON or extraction site and demand pain med (ofcourse only vicodin/percocet work on them)

Even for immediate denture ones, they would want to ext teeth "one at time" cuz they want to hold down to their root stumps that's left or they are "afraid of dental work" and try to milk you long time for pain med.

 

[joel4sale]

Baby-bottle rot has a similar pattern, supposedly because the lower lip protects the bottom teeth from the constant bathing in milk/juice. Probably the same thing going on when you smoke meth? Of course AMMD's patient looks like he has some nice prosthetics on his lowers. Apparently porcelain stands up pretty well to the hydrochloric acid.

baby bootle rot out incisors mostly while the decay uniformly destroy those teeth. Many times posterior teeth much less damage as front ones.

meth teeth pretty much give you FACIAL/BUCCAL/Interprox. on anterior and decay concentrate on cervical third. While posterior teeth sees somewhat less damage, posterior teeth usually pretty beat up too.


But good observation, it DOES seems meth does do more damage on maxillary anterior than lower anterior (hence full upper denture/lower partial)

 

[Pelotari]

I'm only a pre-dent student, so please forgive my ignorance on this.

Clinically this is very interesting and all, but from a business standpoint how do you get paid? How do you cover the expense of the material / lab work / surgery for patients such as these? I may be going out on a limb here, but I suspect that some of these folks don't or can't hold a steady job and/or are un-insured.

Just curious. Thanks.

 

[Bifid Uvula]

Here we make our Interns make out with the Meth Mouth patients... yummy memories!!!!

 

[joel4sale]

I'm only a pre-dent student, so please forgive my ignorance on this.

Clinically this is very interesting and all, but from a business standpoint how do you get paid? How do you cover the expense of the material / lab work / surgery for patients such as these? I may be going out on a limb here, but I suspect that some of these folks don't or can't hold a steady job and/or are un-insured.

Just curious. Thanks.

You are absoluly right, they usually can't hold a steady job. I often hear common such as "I tried working but 9 to 5 is just too much for me", or "I have to right to live the life style I wanted"........How can they afford a Immed Denture that cost easily over $3K?? ALL those people live on welfare, get their teeth fix on Medicaid. Each week they received a $250 check for unemployment and nearly all of their medical/dental are paid for by government. Ofcourse crowns and implants are not covered, but extraction, denture, filling, cleaning, prescription drugs are covered.

Few patient actually told me this: If you hold a job with minimal pay, that would give you slightly over $1K a month after tax sometimes less....and those job usually give employee crap or none insurance.

But if you are unemployed...you get food stamp (free food), dirt cheap rent (government-assising housing), most your dental/medical are free (pay by your medicaid tax). If you ever needed extra cash, call your dentist in tears and told him you have severe toothach but you can't come in (NSAID/Codine make you sick, Ultram not covered by your medicaid) so only thing the dentist can give you is vicodin which goes on stree for anywhere from $5 to $20 a tab.

Sorry if my tone is bit angry, it's lunch time now and I just spend 30 min listening to a meth patient bitching on how bad our government is not covering implant and she believe the reason she have mess up teeth because it took too long for her to get her medicaid dental approved. Later she throw a major fit when I told her I am not giving her any vicodin until I talked with her physician and parol officer.

 

[OldPsychDoc]

I'm only a pre-dent student, so please forgive my ignorance on this.

Clinically this is very interesting and all, but from a business standpoint how do you get paid? How do you cover the expense of the material / lab work / surgery for patients such as these? I may be going out on a limb here, but I suspect that some of these folks don't or can't hold a steady job and/or are un-insured.

Just curious. Thanks.

This was part of the point of the NPR story that prompted me to post here (lowly psychiatrist that I am to walk these Hallowed Halls of Enamel)--the story featured a dentist in the MN prison system who basically spends his whole damn day cleaning up these wrecked oral cavities, and the burden that this costly problem is placing on the public sector--prisons especially, where huge numbers of inmates have meth histories.

There is a special place in Heaven for that guy.

 

[tx oms]

This was part of the point of the NPR story that prompted me to post here (lowly psychiatrist that I am to walk these Hallowed Halls of Enamel)--the story featured a dentist in the MN prison system who basically spends his whole damn day cleaning up these wrecked oral cavities, and the burden that this costly problem is placing on the public sector--prisons especially, where huge numbers of inmates have meth histories.

There is a special place in Heaven for that guy.

Actually, in about nine hours I'll be in the friendly local prison treating meth mouth as well. I use a pair of pliers and a trash can.

 

[toofache32]

I use a pair of pliers and a trash can.

...while OMFSRES uses a pair of kneepads and a bottle of Scope.