1. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Meth Mouth Dental Issues in Methamphetamine Abusers Medical Case Management Clinical Conference Christina Eaton, MPH Delta AETC

2. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org The Relationship Between Methamphetamine Use and Increased Dental Disease J Am Dent Assoc, Vol 141, No 3, 307-318 Vivek Shetty, DDS, DrMedDent Larissa J. Mooney, MD Corwin M. Zigler, MA Thomas R. Belin, PhD Debra Murphy, PhD and Richard Rawson, Ph

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5. What is Meth Mouth? Destruction of the teeth and gums directly resulting from methamphetamine abuse Indirect consequence of methamphetamine abuse – Neglected or forgotten brushing & flossing while high or when coming down

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7. Forms on teeth when starches & sugars interact with bacteria present in mouth Plaque is removed with brushing BUT re-forms within 24 hours If stays longer than 2-3 days can harden into tartar 7 1. PLAQUE : Soft, sticky, fussy deposits on tooth

8. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org 2. Calculus/Tartar/Stone : Hard deposits on tooth

9. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org 9 1. PLAQUE : Soft, sticky, fussy deposits on tooth 2. Calculus/Tartar/Stone : Hard deposits on tooth 3. Periodontal Pocket: Due to bone & Ligaments destruction

10. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org PERIODONTAL POCKET: When Periodontitis cause bone destruction. P. Pocket Healthy gum & Bone

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14. How Does MA Use Cause Tooth Decay? MA use causes blood vessels to constrict (shrink) Blood vessels in mouth can not feed teeth and gums Repeated shrinking causes vessels to die – Inhibits bodys ability to repair itself Dental tissue starves and breaks down

15. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org How Does MA Use Cause Tooth Decay? What is xerostomia? 1.Calcium breakdown 2.Dryness in the mouth 3.Small cracks in the teeth 4.Bad breath 5.Gum recession

16. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Xerostomia Saliva breaks down acids in the mouth MA use blocks the brain mechanism causing salivation Acids build up and eat away at tooth enamel MA can stay in the body for 8+ hours – Sustained reduction in saliva = rapid bacterial growth

17. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org How Does MA Use Cause Tooth Decay? Self Treatment for Xerostomia Carbonated drinks are often craved to counteract the effects of dry mouth – Provides food for bacteria, creating more acid – Insufficient saliva to counter decreased pH – Acid eats away at tooth enamel

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20. Which method of MA use results in the highest rates of dental disease? 1.Smoking 2.Snorting 3.Injecting

21. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org How Does MA Use Cause Tooth Decay? Prevailing belief – Smoking > IV or snorting 2000 report in Peridontology – Snorting > IV 2010 Study – IV > Smoking or Snorting Why? – IV MA users have higher level of addiction

22. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org How Does MA Use Cause Tooth Decay? Bruxism (Teeth grinding & clenching) – Caused by drug-induced hyperactivity – Puts large amounts of unnatural pressure on tooth – Creates small fractures in enamel, exposing dentin layer or pulp of the tooth – Exacerbates TMJ disorders

23. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Which subset of MA users more often reports having TMJ problems? 1.Males 2.Females

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27. Counseling Your Clients Plan for dental care before getting high Reminder notes to brush and floss Keep extra toothbrush and travel sized toothpaste in backpack, car, etc if will not return home

28. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Counseling Your Clients Brush daily Use soft bristle brush and toothpaste that contains fluoride Fluoride best defense against tooth decay

29. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Moment of Truth: I floss….. 1.Everyday 2.A few times a week 3.Sporadically 4.With my fingernails 5.What is flossing?

30. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Counseling Your Clients: Flossing Floss on a regular basis – once a day Dont floss right before or after oral sex Check teeth and gums often for early signs of decay and gum disease

31. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Counseling Your Clients Drink water not soda to keep mouth moist When high try to drink 64 oz (8 glasses) a day

32. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Counseling Your Clients Suck on sugar-free candy like lemon drops to help produce saliva See dentist every six months for a routine cleaning and check-up

33. DELTA REGION AIDS EDUCATION AND TRAINING CENTER deltaaetc.org Summary Dental disease is a distinguishing marker of MA use MA users often have current dental problems & unmet oral health needs MA contributes to dental problems by causing xerostomia and bruxism Counsel clients to keep up with dental health and drink plenty of water if continuing MA use

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