Dentists don’t know exactly what causes the distinctive pattern of tooth decay called “meth mouth.”

The ring of cavities around the gum line was something Dr. K. Mark Anderson, a professor with the University of Tennessee Health Science Center, saw when he worked as a dentist at Tucker Unit, an Arkansas prison that houses inmates with addictions.

“It is very widespread,” Anderson said.

“It tends to involve almost all or most of the teeth.”

And that is with an early stage of meth mouth. Often, the inmates had only nubs for teeth.

The American Dental Association attributes meth mouth to a combination of factors based on behavior spurred by the drug and bodily reactions to it. But the direct cause and effect has not been determined in a scientific study for fairly simple reasons. First, few people addicted to methamphetamine seek regular dental care. Secondly, ethics gets in the way of monitoring people taking the drug.

It’s hard to know how differently the teeth are affected whether someone snorts, smokes or injects the drug. That’s just one of the mysteries of meth mouth.

Anderson said he thinks the pattern of decay is caused by some sort of chemical erosion, bad hygiene, dry mouth and diet.

“Patients that are using meth tend to have a second drug of choice, which is Mountain Dew,” he said. “Their diets are terrible and highly carcinogenic. They are sucking down very, very sugary drinks, probably food as well that accelerates the process. It is a combination of factors.”

Pinpointing a specific chemical as a culprit is difficult because there is more than one way to make the drug.

The pattern of decay around the gum line is different from the typical cavities that occur on the biting surfaces and grooves of the teeth. It is similar to what would be expected in an oral cancer patient whose saliva glands have been damaged by radiation, he said, noting that saliva has a cleansing and anti-decay purpose.

Meth mouth doesn’t take years to develop. People in their 20s end up with nubs for teeth.

Chronic dry mouth occurs soon after regular use of the drug, Anderson said, so the teeth don’t get cleansed biologically — or manually for that matter.

A scarlet letter

Users on a 24-hour or two-day binge rarely make time to brush their teeth, said Nancy Williams, a UTHSC professor and dental hygienist who has studied the correlations between addiction and oral health. Meth mouth might as well be a scarlet letter, she said, because it holds people back even if they are able to go into recovery.

“Meth mouth is so well known now,” she said. “Employers know if somebody kind of looks like a meth head. They don’t want to employ that person.”

The department of dental hygiene and occupational therapy at UTHSC College of Allied Health once got a grant to restore the smiles of recovering addicts at a halfway house in Memphis. But in most cases, it was too late to save teeth.

“Usually, it just meant extracting some teeth and putting in dentures,” Williams said.


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