Meth mouth, or crank decay, is commonly observed in methamphetamine users.52 The typical presentation is the apple core pattern of tooth decay. Caries is seen in the deepest cervical portion of the tooth and progress apically and occlusally/incisally.36 A propensity score analysis estimated that methamphetamine abusers were twice as likely to have untreated caries, 4 times as likely to have any experience of caries, and twice as likely to have 2 or more decayed, missing or filled teeth, compared to a general dental population.67 The cause of meth mouth is multifactorial. Meth users commonly experience drug-induced cravings for high-calorie carbonated beverages.4,31 As a result, soft drinks containing high amounts of sugar and caffeine are often consumed to prolong the high and assuage the cravings.94 Reports indicate that Mountain Dew™ is commonly ingested by meth users; as much as several liters per day.94 The drug produces extreme xerostomia, reducing the amount of protective saliva and decreasing the pH thereby reducing the buffering capacity around the teeth.14,53,56,72 In one study of 100 methamphetamine users, 72% reported dry mouth. Additionally, concomitant drug use (cigarette smoking and/or alcohol consumption) can also exacerbate xerostomia.36 As a result of these behaviors, the oral bacterial levels can drastically increase, exacerbating the decay. The caustic nature of the drug, poor oral care and high sugar diet result in increased decay. This devastation can occur rapidly, in as little as one year. Conventional dental treatment is frequently of little value.13,28 Often, the carious lesions are so significant and rampant that full-mouth extractions are indicated (Figure 7). Prosthodontic reconstruction is also challenging due to the common loss of posterior support, secondary occlusal trauma, generalized erosion/attrition, and loss of vertical dimension of occlusion.36
Figure 7. Significant and rampant caries.