November 19, 2008

Danger Signs

Dentists are among the first health professionals to spot indications of drug abuse

By Jacqueline Mitchell

Users of methamphetamine quickly develop extreme dental decay.

Dentists may not seem the likeliest of candidates to be on the frontlines of identifying drug abuse trends, but that’s what happened in the early 2000s, when practitioners in the Southwest alerted authorities to a potential epidemic of methamphetamine addiction.

Oral health is often a strong indicator of overall health. When the dentists there saw a sudden spike in patients showing extreme dental decay, with front teeth turned brown or black and breaking at the gum line, they suspected this was not just a product of bad oral hygiene.

The onset of decay had been rapid, between six and 12 months, and they suspected a dangerous cause: addiction to methamphetamines, a potent, cheap and highly addictive drug, said Paul J. Vankevich, D81, an assistant professor of general dentistry, in a recent lecture at the School of Dental Medicine on dentists and drug-abusing patients.

With more than 22 million Americans struggling with dependency on drugs or alcohol, dentists are key health professionals to spot signs of addiction among patients. “This is relevant to all of us practicing clinical dentistry today,” said Vankevich. “This is a special category of patients we are going to encounter whether we like it or not.”

One particularly problematic side effect of stimulants like methamphetamines and cocaine is severe dry mouth, or xerostomia. Without the continual flow of naturally antibacterial saliva, drug users are at increased risk of developing cavities. To relieve the dry mouth, and to sate attendant sugar cravings, users often consume large quantities of soda, which further contributes to decay.

The hyperactivity associated with stimulant drugs may take the form of teeth gnashing or grinding. Together, all these effects often result in a telltale pattern of extreme decay.

While drug use overall is on the decline in the United States, methamphetamine use and abuse has surged in recent years and may still be on the rise. Federal and local statistics describe a public health threat marching west to east across the country.

A derivative of amphetamine, a stimulant prescribed to combat fatigue, depression, obesity, narcolepsy and attention disorders, methamphetamine is relatively cheap and easy to concoct from household items, including cold medicine, iodine and ammonia.

Known as “meth,” “ice” or “crank,” the powerfully addictive drug can be snorted, injected, smoked or eaten, and the resulting high may last four to 12 hours, during which the user is unlikely to eat, sleep or hydrate, all of which contribute to poor oral health.

Despite the attention-grabbing side effects of methamphetamine abuse, Vankevich noted that far greater numbers of people die of tobacco-related illnesses than from drugs each year, and that tobacco is a gateway to substance abuse. “We need to engage diplomatically with our patients, conduct thorough exams and apply appropriate interventions,” he said.

Jacqueline Mitchell can be reached at

Article Tools

emailE-mail printPrint