THIS COULD BE YOUR MOUTH ON METH

'Tina' Causes Some Users' Teeth To Loosen, Fall Out, Dentists Say

Michael's story is, tragically, almost a cliche now in gay circles. Michael
said his boyfriend became addicted to crystal meth last year.

The drug led to a predictable list of consequences: his boyfriend
disappeared for days at a time, lost his job, suffered extreme mood swings
and stopped eating and sleeping. Finally, he said, the drug led to their
breakup.

It is no surprise that crystal meth ravages lives. But there is another
consequence of meth use that some users may not know about - the drug's
impact on teeth, a condition known as "meth mouth."

Last week, a front-page report in the New York Times detailed how the drug
eats away at users' teeth and mouths. Much of what is known about "meth
mouth" is anecdotal, said Donald McVinney of the Harm Reduction Coalition.

All stimulants will impede saliva production, he explained. But the
difference between crystal and cocaine or crack is that because the high is
longer and more intense, the saliva shutdown in crystal users is more
pronounced. This may mean that a user's mouth can't break down bacteria, he
said.

Long-term users may experience receding gums, loosened teeth and gum
disease. Users' teeth can become gray, and their breath atrocious.

But the symptoms are not always this extreme. It is difficult for dentists
to know when a patient is using crystal meth, he said, especially since
most are reticent to admit it and a long-term user is unlikely to even go
to the dentist.

"It's not easy to identify a meth user in dental practice," said D.C.-based
dentist, Dr. John Hunter. About 85 percent of his clients are gay or
lesbian. He said only one or two patients admitted they were using.

"I talk to them about their symptoms," he said. "Very rarely a light bulb
goes off. The symptoms are common to other patients."

Dr. Gary Seiden, a dentist in Dupont Circle, said he's "savvy to crystal
behavior." About 20 percent of his patients are gay and about five percent
of those might be using crystal, he said. He sees crystal use among his
patients "pretty infrequently."

Teeth grinding and dry mouth are common symptoms of crystal use, he said.
When he does suspect drug use, he stays quiet. They're there for dental
help, not to be accused, he said.

"It's hairy bringing that up," Seiden said.

Even though long-term crystal use may damage users' teeth, dental care is
just about the last thing on a user's mind.

"If they forget to eat, why make an appointment to go to the dentist?" said
Sessa.

Rare In Private Practice

Dr. Sally Cram, a D.C. dentist and consumer adviser for the American Dental
Association, said she has not seen any crystal meth users in her practice.
Most likely, they would go for treatment at community clinics or hospitals.

"It's not real prevalent in private practice," she said.

Some users avoid dentists and other health care providers because they fear
being judged, said McVinney. He advises providers "not to shame, not to
lecture."

It's more productive if dentists can provide tips on oral hygiene and
educate themselves on drug use, he said. For example, because many users
get dehydrated and chew a lot of gum, McVinney suggests drinking Gatorade
and chewing sugarless gum.

Dentists can ask their patients if they've thought about ways to stop and
try to develop a rapport with the patient, he said.

"Once [someone] feels stigmatized, they're less likely to go for help," he
said. "The goal is to interrupt the downward spiral."

Jonathan, a recovering crystal user and D.C.-based artist who spoke on
condition that his real name be withheld, said he rarely visited the
dentist or doctor when he was using. Jonathan began doing crystal about
eight years ago; he's been sober for more than three. For three years, he
used everyday.

"I didn't have a lot of those severe symptoms," he said. However, he said
matter-of-factly, "I did become HIV positive."

Once, he visited the dentist after breaking a tooth. He didn't think he
could stay sober for the procedure so he left and didn't return. He fixed
his tooth six months ago.

Jonathan said he hasn't had any major trouble with his teeth, although
while he was using he only brushed his teeth when forced to.

Edward Liu, a health educator at the Whitman-Walker Clinic, pointed out
that not every user's teeth erode and fall out, although it does occur.

"We don't want to scare people," he said. "[But] we want people to realize
this could happen."