Recommendations for the Dental Team
No other illicit drug’s oral effects have been so pronounced or have received so much attention as methamphetamine. When methamphetamine use is suspected, dental professionals need to document all relevant oral findings; provide appropriate and safe treatment; and encourage medical evaluation, intervention and follow-up as well as subsequent dental visits.
Many meth users fail to adequately care for their teeth or regularly visit the dental office. The dental team is urged to become educated on the signs and symptoms of meth use as well as the precautions required when treating a meth abuser. Conventional dental treatment is frequently of little value. The results of methamphetamine abuse may take up to two years after the patient has stopped using meth to manifest in the oral cavity.8,21
Treatment of meth mouth should include preventive measures, such as oral hygiene instruction, dietary restrictions, nutritional counseling, daily prescription fluoride treatments, remineralization therapies and products for xerostomia and oral lesions.9 Nutritional instructions should include the consumption of water and introduction of xylitol products in favor of sugar-laden carbonated beverages.
Fluoride varnish and glass ionomer self-adjusting materials containing fluoride may offer some protection until the patient is in recovery and enough time has passed to determine the outcome of use. Temporary crowns, bridges, and veneers can be utilized to give the patient a temporary “smile” until definitive treatment can be delivered. Each case must be evaluated individually. The amount of wear and micro-fractures on the teeth from grinding, the degree of periodontal involvement and severity of tooth decay has to be taken into consideration before determining treatment. At some point dental restorative care may include, as appropriate, extractions, amalgam/composite restorations, veneers/crowns, and/or partial/complete dentures.21
It is vital that the patient have a complete physical exam and evaluation of current drug use before dental treatment begins. Caution should be used when administering local anesthetics, sedatives, general anesthesia or nitrous oxide and when prescribing narcotics.36 These treatments could cause severe or fatal hypertensive episodes or cardiac arrhythmias. Methamphetamine abusers typically are resistant to local anesthetics, have an increased risk of adverse events related to drug interaction and are less able to metabolize local anesthetics than the general population. These patients will require a larger than normal dose of local anesthetic, without vasoconstrictors. If you are unsure whether a patient has taken meth within the last 24 hours, do not give local anesthetic as this could cause a severe reaction.26 Refer the patient for evaluation of drug use and consult with the health care provider prior to future appointments. For pain control in dentistry the first drug of choice is an anti-inflammatory such as ibuprofen.21 Use acetaminophen with caution as the user may have compromised liver function due to detoxification of meth and high body temperatures resulting from meth use.