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Clinical Summary

Methamphetamine-induced caries (MIC) is hypothesized to be caused by the combination of mental and physiologic side effects of methamphetamine (MA) use such as xerostomia (dry mouth), gingival inflammation, poor oral hygiene, and frequent ingestion of high-sugar carbonated beverages (for relief of dry mouth). The appearance of MIC is characteristically smooth and dark in color; caries tend to start near the gingiva and can progress to the complete destruction of the coronal portion of the tooth (see also Figs. 17.4 and 17.5). Patients with MIC may not experience dental pain because MA can block the expected odontalgia. In addition, MA users tend to clench or grind teeth (bruxism), resulting in severe dental wear patterns, trismus, cracked teeth, disorders of the TMJ, and myofascial pain.

FIGURE 6.67

Methamphetamine-Induced Caries. Rampant caries and heavy accumulation of dental plaque associated with methamphetamine use. (Photo contributor: J. Amadeo Valdez, DDS, MAS.)

Management and Disposition

Dental or oral surgical consultation is recommended. The teeth are usually in such disrepair that extraction is required. If dental abscesses are present, incision and drainage in conjunction with antibiotic therapy are indicated.

Pearls

  1. MIC resembles early childhood tooth decay (“baby bottle caries”).

  2. Users of MA may experience xerostomia, gingival inflammation, sugar cravings, and poor oral hygiene that exacerbate the patient’s oral condition.

  3. Patients with MIC may have an unexpectedly low amount of pain associated with the condition. As such, patients frequently present with severely advanced disease.

FIGURE 6.68

Methamphetamine-Induced Caries. Severe decay on the facial surface of the mandibular teeth and dental plaque accumulation in relation with methamphetamine use. (Photo contributor: J. Amadeo Valdez, DDS, MAS.)

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