DEALING WITH ADDICTION: METH PUNISHES USERS' MOUTHS

Member Center Dentists Work To Correct Devastating, Unique Oral Effects Of Drug

Dr. Melinda Anderson remembers the day vividly.

Six years ago, she was a 25-year-old dental student at Loma Linda
University in California, and a 20-year-old man came into the
university believing he might have chipped a tooth.

"He might just as well have been sucking on radioactive materials,"
she said last week as she took a break between patients at her Las
Vegas practice. "What had been done to his mouth was that toxic. I
couldn't believe what I was seeing."

Anderson recalled that most of the teeth on the right side of the
patient's mouth were broken off at the gumline. His gums were
pus-streaked. Teeth that remained were twisted and either black stubs
or a strange grayish-brown. And they had a bizarre texture that was
more like ripened fruit than hard enamel.

"I was so confused by what I was seeing that I immediately went to an
instructor," she said. "I couldn't believe someone so young literally
had to get what remaining teeth he had extracted. When I described
what I found ... the instructor simply said, 'Oh, he has to be a
methamphetamine user.' "

The oral effects of methamphetamine, an addictive drug commonly made
with household products or over-the-counter medicines, are so
devastating and so unique that the condition is now known in medical
circles as meth mouth.

In a few months, use of the drug can turn a healthy set of teeth into
a rotting mess. But the physical pain often associated with dental
problems seldom is experienced by meth users, according to
clinicians, largely because the nerves in their teeth die quickly.

Recovering meth addicts often need emergency care, and the American
Dental Association says the problem is growing dramatically.

Although meth mouth does turn up in private dental practices, the
condition is more often seen in dental clinics in jails and prisons.

With federal studies showing that Nevada leads the nation in use of
the drug, it comes as little surprise that corrections officials
worry that the dental budget for the state's inmates will be
expensive for taxpayers.

Statistics indicate that methamphetamine already is causing the
dental budget in the correctional system to soar.

Current budget numbers show $2.1 million spent for dental care, up
from $1.3 million four years ago.

The etiology of the meth mouth seen in a growing number of inmates is
simple: Use of the drug inhibits saliva production, which exposes
teeth to bacteria that cause cavities.

In self-treating their "dry mouth," addicts drink sugared sodas --
Mountain Dew, according to dentists, is the preferred drink -- which
spurs decay. The highly addictive nature of methamphetamine causes
many users to halt most hygienic practices, including brushing their teeth.

Because meth makes users feel anxious or nervous, they regularly
clench and grind their teeth, which often leads to cracks in the
enamel. When the drug causes vessels that supply blood to oral
tissues to shrink up, the tissues die, a sure path to the worst kind
of gum disease.

"The mouths of the addicts we see in prison often aren't pretty,"
said Dr. Jeff Lissy, the state's top dentist in the correctional
system. "Many of the inmates didn't take care of their teeth before
they started meth, so use of the drug is just one more assault on
their dental care."

Nevada's prison population has increased from 10,500 to 12,500
inmates over the same time frame that the dental budget has
increased. Lissy estimates that 40 percent of the dental budget goes
toward treating meth addicts.

Because there is no statistical breakout for the reasons inmates are
being treated for dental problems, Lissy said, he can't be exact
about costs of treating meth mouth.

"We hope to have a computer system in place next year that can help
us get that information," he said.

Lissy said he believes far more extractions are performed and
dentures made because of inmates with meth mouth.

Criminal justice officials believe half of those convicted of
criminal activity in the state have a link to methamphetamine. Men
and women often commit burglaries and robberies to get the money to
feed their addictions.

Gov. Jim Gibbons has called the fight against methamphetamine
addiction "the colossal struggle of our times."

The funding he has proposed goes largely to law enforcement and
rehabilitation programs. None of the money he has proposed toward
fighting the drug is slated to go toward treating meth mouth in inmates.

Dr. Edward Herschaft, a dentist with the University of Nevada School
of Dental Medicine, said an increasing number of dental emergencies
in the university's clinic are caused by meth mouth.

"Methamphetamine is causing a huge public health problem in the Las
Vegas Valley," he said.

Methamphetamine can be swallowed, snorted, smoked or injected. In the
short term, it produces a rush.

In less than a year, however, a person will experience fatigue,
irritability, anxiety, confusion, violent rages, sleeplessness and
depression. Users can become psychotic and experience paranoia, which
can lead to homicidal or suicidal thoughts.

Lissy said the farther away inmates get from methamphetamine use, the
more they worry about their appearance.

"They realize that they're disfigured, that it might be even more
difficult for them to get a job when they get out," he said.

He stressed that prison dentistry consists of providing "necessary
and adequate" care -- extractions and fillings are most common -- but
not providing dentistry for cosmetic purposes.

Implants are the best alternative for those who have lost all their
teeth, according to Anderson, the Las Vegas dentist, but the price is
prohibitive: at least $50,000 for a full set.

Anderson estimates that a conservative cost estimate for extractions
and the subsequent placement of dentures is about $3,000 to $5,000.

Dr. Matthew Messina, a Cleveland-based consumer adviser to the
American Dental Association, puts the cost closer to $10,000.

"The big problem is that if you get dentures when you're in your 20s,
your bone dies and you're no longer able to have dentures when you're
older," Anderson said. "So you either go with no teeth or somehow
must be able to afford implants."

Last week, Anderson was ending her work day at the On Site Dental
mobile clinic parked behind Paris Las Vegas. The mother of a
2-year-old son was tired after a day of "too many extractions." She
works on meth mouth patients at On Site Dental on a pro bono basis.

Although On Site Dental treats many gaming employees, she stressed
they aren't the patients who come to her with meth mouth.

Anderson, whose husband, Shawn, is also a dentist, said she wants "to
help people with this addiction, but you don't feel like you're doing
that much with extractions."

"There's not much we can do until we get them off this stuff, until
we show people that it's foolish to even try it.

"It's going to take all of us in the community to work and solve this
meth problem," she said. "Almost all of us know someone who has been
involved with this. From the way I see people needing help with their
teeth, I'm not sure we've seen the worst of this yet."