Identifying Meth Patients in Your Practice Sandra Nagel Beebe, RDH, PhD Southern Illinois University Carbondale November 7, 2007

Presentation Overview Brief background “meth” profile Brief background “meth” profile Dental Considerations Dental Considerations Final Thoughts Final Thoughts

Typical User Lure of Meth Truck drivers “Rush” like never before Truck drivers “Rush” like never before People fatigued Dopamine release  pleasure People fatigued Dopamine release  pleasure Dieters Followed by euphoria Dieters Followed by euphoria White collar workers Acutely alert & perky White collar workers Acutely alert & perky Athlete prior to games Feeling invincible, Strength & Athlete prior to games Feeling invincible, Strength & Thrill seekers energy, Confidence Thrill seekers energy, Confidence Students study session Intensified sexual desire/ Students study session Intensified sexual desire/ Increases sexuality satisfaction Increases sexuality satisfaction 90% become repeat user’s 90% become repeat user’s

Effects on the Mind & Body Anxiousness **Heightens libido & risky False sense of sexual behavior False sense of sexual behavior confidence & power Disorganized lifestyle confidence & power Disorganized lifestyle Moodiness & irritability Skin looses luster & Nervousness elasticity (Ages quickly) PanicDecreased resistance to Severe depression illnesses Heart rate increased Heart rate increased Increase in body temp  Increase in body temp  possible brain damage possible brain damage Liver damage, Convulsions, Liver damage, Convulsions, Stroke, & Death Stroke, & Death

Signs Signs Short – Term Effects ~Acne, sores (formication) ~Convulsions ~Dry, itchy skin ~Hallucinations~Insomnia ~Increased heart rate ~Intense high ~Loss of appetite ~Weight loss ~Loss of teeth ~Paranoia ~Violent behavior Long- term Effects ~Brain damage ~Hallucinations ~Heart Attack/Stroke ~Liver, Kidney, & Lung Disorders Lung Disorders ~Lowered resistance to illnesses ~Malnutrition ~Permanent psychological problems problems ~Poor coping abilities

Visible Signs-- Aggression Aggression Dilated pupils Dilated pupils Hallucinations Hallucinations Long periods of sleeplessness Long periods of sleeplessness Unnecessary movements Unnecessary movements Unpleasant, strong chemical body odor Unpleasant, strong chemical body odor Seizures /convulsions Seizures /convulsions Increased body temperature (sweating) Increased body temperature (sweating) Impaired / rapid speech Impaired / rapid speech Excessive talking / babbling Excessive talking / babbling

Dental Meth Concerns ~ What What draw’s draw’s your your attention? attention?

Problems Associated with Meth Ingredients Corrosive ingredients  cause skin burns: Corrosive ingredients  cause skin burns: ~ Lithium ~ Muriatic & sulfuric acid ~ Lithium ~ Muriatic & sulfuric acid ~ Ether ~ Red phosphorus & lye ~ Ether ~ Red phosphorus & lye 3 Method’s of Use: 1) Smoking = Heated  Vaporized & swirl in mouth = 1) Smoking = Heated  Vaporized & swirl in mouth = Irritate & burn oral tissue’s, sores, & infection; Irritate & burn oral tissue’s, sores, & infection; Causes: Vapors on tooth enamel Causes: Vapors on tooth enamel 2) Snorting = Caustic substances in nasal passages 2) Snorting = Caustic substances in nasal passages  drainage back of throat & teeth with corrosives  drainage back of throat & teeth with corrosives Causes: Chemical damage to teeth Causes: Chemical damage to teeth Injecting = No direct impact on oral health 3) Injecting = No direct impact on oral health

Dental Caries: Location: Facial gumlines Location: Facial gumlines Root surfaces Root surfaces Maxillary anterior interproximals Maxillary anterior interproximals Patient claims tooth rots from inside out Patient claims tooth rots from inside out WHY ?? Reduction of blood supply; WHY ?? Reduction of blood supply; Shortage of vessels Shortage of vessels Less Nutrition Less Nutrition Spreads quickly  May need extraction Spreads quickly  May need extraction Costly repairs Costly repairs Smoker’s or Snorter’s display most oral effects ; most oral effects ;

Typical ”Meth Mouth” Decay

Lesions: Bruxism: Smoker’s present with Grinding lesions / burns on lips, Worn abraded surfaces lesions / burns on lips, Worn abraded surfaces gingiva, oral mucosa or Roots only remain gingiva, oral mucosa or Roots only remain hard palate Cause: hard palate Cause: Snorter’s –burns back of throat Anxiety & hyperactivity Snorter’s –burns back of throat Anxiety & hyperactivity ** (Decreased ability to fight infections & heal) Erosion: Trisma: Erosion: Trisma: Caused by chemical residues Cause: Anxiety, Caused by chemical residues Cause: Anxiety, from smoking--Questionable Nervousness, from smoking--Questionable Nervousness, Paranoia Paranoia Staining: Staining: Decalcification & Blackened discoloration at gingiva discoloration at gingiva

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Canine Canine Anteriors

Fractured Teeth: Fractured Teeth: Users are more anxious & nervous Users are more anxious & nervous Cause: Cause: Constant clenching/grinding Constant clenching/grinding Develop cracks  fracture Develop cracks  fracture Severe attrition Severe attrition Unnatural wear patterns Unnatural wear patterns TMJ: TMJ: Malocclusion Malocclusion Missing teeth Missing teeth Pain Pain Cause: Cause: Association due to lack of tooth structures Association due to lack of tooth structures

Anesthesia Considerations Interaction of drugs & anesthetics with epinephrine Interaction of drugs & anesthetics with epinephrine Cause: Possible Hypertensive episode Cause: Possible Hypertensive episode Heart arrhythmia Heart arrhythmia Medical emergency Medical emergency Pain Blockage due to meth Pain Blockage due to meth Caution for writing prescriptions Caution for writing prescriptions

Observable “Trigger” Signs for User Unaccounted for & accelerated decay (especially teenagers & young adults) Unaccounted for & accelerated decay (especially teenagers & young adults) Decay pattern (interproximal anterior teeth & buccal surfaces) Decay pattern (interproximal anterior teeth & buccal surfaces) Malnourished appearance (heavy users) Malnourished appearance (heavy users) Root tips for posterior teeth Root tips for posterior teeth …if suspect meth user: …if suspect meth user: Discuss findings & Educate Discuss findings & Educate If receptive  refer for physician, clinic, or abuse center If receptive  refer for physician, clinic, or abuse center Use preventive measures (fluoride/varnishes) Use preventive measures (fluoride/varnishes) Recommend: WATER not sugar carbonated sodas Recommend: WATER not sugar carbonated sodas Cautious with anesthesia, sedatives, general anesthesia, nitrous oxide, & narcotics Cautious with anesthesia, sedatives, general anesthesia, nitrous oxide, & narcotics

Remember!!! If a patient is under 18 years of age, If a patient is under 18 years of age, You are a mandatory reporter You are a mandatory reporter Contact: Contact: State’s Attorney for county Department of Social Services (DSS) Department of Social Services (DSS) Law enforcement officers Law enforcement officers

Tweaker’s in the Office Regular meth user’s Regular meth user’s Behave or react violently Behave or react violently Might NOT slept days, irritable & paranoid Might NOT slept days, irritable & paranoid If also using alcohol or other drugs = danger intensified If also using alcohol or other drugs = danger intensified Unpredictable behavior Unpredictable behavior First appear normal – But First appear normal – But Eye movements 10 x’s faster, Voice slight quiver Jerky movements

Safety Tips with Tweaker’s 1. Keep distance. (If to close, perceived as threatening) 2. No bright lights. (Paranoid & lights could lead to reacting violently) 3. Slow your speech, lower your voice. 4. Slow movements. (Paranoid & misunderstand) 5. Hands be visible. (Feel threatened & become violent) 6. Keep Tweaker talking. (If silent, may be dangerous. Paranoid thoughts possibly occurring to become delusional)

Results of Meth Mouth Loss of self-esteem Facial structure loss Nutrition / Speech / Healing Decalcification Decayed teeth Decalcification Decayed teeth Gingivitis / Perio Root tips Gingivitis / Perio Root tips Bruxism Trisma Bruxism Trisma TMJ Edentulous TMJ Edentulous High Cost for Repairs High Cost for Repairs (Fillings, Crowns, Bridges, Implants, Dentures) (Fillings, Crowns, Bridges, Implants, Dentures)

Thank you. Contact information: Sandra Nagel Beebe, RDH, PhD Clinical Instructor Dental Hygiene Southern Illinois University Carbondale