"METH MOUTH" MAKES MARK

SIKESTON, Mo. - When children drop in for a dental checkup or cleaning, Dr.
Gail Redman usually ends the appointment with her familiar reminder to
brush and floss regularly. But she recently added something new: "Whatever
you do, don't do meth."

The unusual advice, rarely heard in a dentist's office, is the result of
Redman's seeing more and more cases of a disturbing dental decay considered
a telltale sign of methamphetamine abuse. The condition, commonly known as
"meth mouth," leaves users' teeth black-stained, rotted and often
unsalvageable. It can advance so rapidly that patients even in their late
teens and early 20s have required full-mouth extractions.

Almost unheard of in urban areas, meth mouth is a growing problem for
dentists working in the nation's rural stretches, where meth has hit the
hardest. Already rural social services and law enforcement are dealing with
the drug's fallout, from families torn apart by addiction to the toxic home
labs where meth is made.

Now, rural dentists say meth is changing their jobs, too.

"There's never been a drug that's had such an extreme dental impact as
crystal meth," said Dr. Nancy Williams, a dental hygiene professor at the
University of Tennessee Health Science Center in Memphis, who lectures
around the country on drug abuse.

The decay is striking, dentists say. The cavities appear black, much darker
than the discoloration found on the teeth of smokers or other drug abusers.
The damage is focused along the gum lines. Extracting the brittle, broken
teeth is often the only option.

Little is known about what causes meth mouth. Few academic studies have
been done. Many dentists, especially those in cities where other drugs
dominate, are not even aware of the problem. "There may be a lot more of it
seen than recognized," said Dr. William Goebel, head of diagnostic
specialties at Southern Illinois University Edwardsville's School of Dental
Medicine.

Several factors are believed to contribute to the condition. Meth users
tend to suffer from poor oral hygiene and seem to prefer drinking sugary
sodas while high. The drug also dries up saliva, leaving the mouth without
a natural defense against cavities. Some dentists also blame the drug's
corrosive ingredients.

The results are difficult to miss.

"You can look at their teeth and tell, no doubt about it," said Matt
Fowler, an agent with a local drug task force.

"They smile and it's like, oh, my God," said Dr. James Russell, a dentist
in Ellington, Mo.

Russell said he tries to bring up the subject indirectly, gauging a
patient's reaction when he says that meth use might cause a bad interaction
with the numbing agent. "If you question them enough about it, they'll
usually fess up to it," Russell said.

Redman said she started seeing the condition about five years ago, but at
the time had no idea that it was related to an illicit drug.

Then her assistants began pointing out which patients were using meth, she
said. Today, she easily recognizes the decay pattern. And her hygienists
will note in a patient's file, "Meth?"

While many dentists run into meth mouth on a regular basis, it is the
youngest patients who stand out.

Dr. John Sauer, a dentist in Cape Girardeau, Mo., said he once diagnosed a
teenager's drug problem through her teeth. A 16-year-old went from just one
cavity to 18 cavities bunched along the gum line a year and a half later,
Sauer said. "I went to the mom and I asked her if she'd noticed anything
unusual about her daughter," Sauer recalled. The mother admitted to having
trouble controlling her daughter and later, in private, the teen admitted
to using meth, he said.

Carrie Gregory, a hygienist at Redman's clinic, saw a 14-year-old patient
last fall who she suspected of using meth after seeing his teeth marred by
multiple black cavities. Gregory said she decided to talk to the boy's mother.

"I felt bad after that," Gregory said. "But I wouldn't be doing my job if I
hadn't."

The rise in meth-induced cavities also has resulted in dentists tipping off
their local police narcotics unit, despite federal privacy laws that might
prohibit such disclosures.

Even decades in practice don't dull the shock of seeing meth mouth. Redman
said she's constantly amazed that people would use a drug that is so toxic.
Russell said 26 years of working on teeth didn't prepare him for this.

"To see the things we see," he said, "I would not have thought it possible."