A case presentation of managing “Meth mouth”

Methamphetamine drug abusers often suffer from rampant caries, tooth wear and periodontal disease. Management usually involves multiple extractions, but rarely, complex treatment has been attempted.

Introduction

Methamphetamine users usually suffer from poor dental health, characterised by rampant caries and periodontal disease. Management of these cases is usually challenging and goes beyond dental clinical management. All efforts to help the patient stop the drug habit are crucial for the long term success of any dental treatment undertaken.

Methamphetamine users suffer from xerostomia, rampant caries, poor periodontal health and tooth wear. The pattern of caries progression is characteristic as it always appears to begin on buccal surfaces of posterior teeth and proximal surfaces of anterior teeth.  Most “Meth” users usually compensate for the xerostemic effects by consuming soft drinks instead of water. Most cases of “Meth” abuse have been managed through extractions but rarely, further complex treatment has been attempted.

Case details

A 40yr old male presented with 24 retained  roots, four residual crowns, and only one pulp cavity that was not exposed. The patient had no pain or symptoms except when probing into the pulpal cavities. Diagnoses of caries, chronic periapical periodontitis and chronic marginal gingivitis were made.

He had a 4 year history of YABA abure (a Methamphetamine) a heavy smoking (6 packs a day) history for 20yrs. Brushing was also irregular, sometimes a few weeks would pass before he would brush.

Treatment plan
  1. Periodontal therapy.
  2. Composite restorations of tooth number 15; porcelain crown for tooth 16 after completion of endodontic treatment and postcores.
  3. Teeth 17, 36, 37, 46 and 47 were extracted because of perforations of the pulp floor and polyps. The patient underwent root canal treatment for the remaining residual roots.
  4. Placement of an overdenture followed all the treatments and soft tissue healing.
  5. Home care regimen including brushing with fluoridated toothpaste three times a day while avoiding soft drinks. In addition, rinsing with an over-the-counter mouthwash containing chlorhexidine was recommended.

After a 1 year follow-up, it was revealed that the patient had stopped his drug abuse habit and cut down smoking to 2 packs a day. Coronal restorations of 5 teeth had failed due to secondary caries.

secondary caries caused restorations to drop out
Figure 7. Frontal intra-oral view of 1-year follow-up. Note that five fillings fell out as a result of secondary caries. However, the rampant caries has been controlled.

Reference:

Panpan Wang, Xinmei Chen, Liwei Zheng, Lan Guo, Xin Li, Simin Shen, Comprehensive dental treatment for “meth mouth”: A case report and literature review, Journal of the Formosan Medical Association,
Volume 113, Issue 11, 2014, Pages 867-871, ISSN 0929-6646, https://doi.org/10.1016/j.jfma.2012.01.016.
Keywords: dental caries; dentistry; drug abuse; methamphetamine; meth mouth

 

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.