METH'S UGLY CRUELTY STARES DENTISTS IN FACE

'Meth Mouth' Can Ravage Teeth And Gums In Just Months Of Use

From the moment on Thursday when the young man sat down in Dr. Richard
Stein's dental chair in southwestern Kansas and opened his mouth, Stein
says, he recognized the enemy.

This had to be the work, Stein concluded, of methamphetamine, a drug that
is leaving its mark, especially in the rural regions of the Midwest and the
South, on families, crime rates, economies, legislatures -- and teeth.

Unlike other drugs or candies or vices in most dentists' memories,
methamphetamine seems to be taking a unique and horrific toll inside its
users' mouths. In short stretches of time, sometimes just months, a
perfectly healthy set of teeth can turn a grayish-brown, twist and begin to
fall out, and take on a peculiar texture less like that of hard enamel and
more like a piece of ripened fruit.

The condition, known to some as "meth mouth," has been studied little in
academic circles and is unknown to many urban and suburban dentists, whose
patients are increasingly focused on cosmetic issues, the bleaching and
perfect veneers of television's makeover shows.

But other dentists, especially those in the open, empty swaths of land
where methamphetamine is being manufactured in homemade laboratories, say
they are seeing more cases.

These are the same towns, in some cases, that have wrestled in recent years
with shortages of dentists. They are places where dentists have struggled
to sell their practices as populations shrink, where new dentists have been
reluctant to settle out of fear that they will not get enough business to
make ends meet; and where political leaders have offered financial
incentives to lure young dentists to town. For good or ill, meth mouth is
creating more business.

Miles east of Stein's Dodge City office, in Independence, Kan., Dr. Cynthia
Sherwood said she, too, had seen such patients lately, including a mother
whose teeth had been transformed into "little black stubs" too painful to
brush, and who wound up losing all of her top teeth and six of her lower ones.

Among similar patients Dr. Charles Tatlock has seen in his New Mexico
office, he said, was one who, though only 17, needed dentures to replace
his suddenly decayed teeth.

And in Tennessee, Dr. Daniel Roberts gave up his ordinary practice not long
ago to handle a growing workload at 10 jails across the state, nearly a
third of whose prisoners, he estimates, appear to have teeth ravaged by
methamphetamine.

"This is the worst thing to come along in a long time," Roberts said the
other day. "At this point, I'm digging for roots. That's how I make my living."

Why are teeth so vulnerable?

Many dentists have their own hypotheses about what precisely causes the
condition.Dr. John Shaner, an associate professor at Creighton University
Medical Center School of Dentistry in Omaha, Neb., said he believes a
combination of factors, tied to the use of methamphetamine, leads to such
enormous damage.

The drug itself, a synthetic stimulant that can be manufactured just about
anywhere, causes dry mouth, Shaner said, and that, in turn, allows decay to
start because saliva is unavailable to help control bacteria in the mouth.
The drug also tends to leave users thirsty and craving a constant supply of
soda and sugary drinks, which spur the decay. Mountain Dew, he said, has
become the preferred drink of methamphetamine users. At the same time, with
the drug's highly addictive nature, many users simply stop doing what is
needed to take care of themselves, including the brushing of teeth.

Other dentists said they suspect the caustic ingredients of the drug itself
- -- whether smoked, injected, snorted or eaten -- contribute to the damage,
which tends to start near the gums and wander to the edges of teeth. Among
ingredients that can be used to make meth: red phosphorus found in the
strips on boxes of matches, lithium from car batteries, and pseudophedrine
from cold pills.

And then there were dentists who pointed to methamphetamine users' tendency
to grind and clench their teeth, driving on the frighteningly twisted and
tangled look of meth mouth.

Shaner said the issue may be little understood in many places -- even as
methamphetamine has spread from one coast to the other and from rural areas
into cities -- because it has been a problem that has had a chance to sink
in for longer in places such as Nebraska, Iowa and Missouri. Also, the
effects to teeth are often most obvious in pockets like prison populations.
He said he hopes to present information on the topic at an American Dental
Association conference next year.

Unwelcome business

If the man who sat in Stein's Kansas office last week, who readily admitted
to having used methamphetamine, gets all the work done that he needs --
X-rays, fillings, crowns and implants for the teeth now missing from his
mouth -- it will take numerous visits and the bill could run from $5,000 to
$7,000.

Most dentists, though, say this is hardly the growth industry any of them
would wish for. The patients are grim, their teeth grimmer. Many of these
young people, the dentists say, may end up with no teeth at all but with
dentures. Such devices, some in the business of dentistry had come to
believe, would soon be mostly relics of the past, even for elderly people,
in an age of water fluoridation and other technology.

"The real market for dentistry is in saving teeth, in helping people have
dental health," said Stein, 57. "But I've seen a lot. I'm not a drug
counselor, and I'm long past lecturing, but this is a sorry situation."

With the exception of a few formal studies, including one beginning in New
Mexico, meth mouth has so far been less a topic of academic analysis in the
dental industry than a matter for casual phone conversations and e-mail
exchanges between dentists in small places.

"The truth is, very little is known yet," said Dr. Stephen Wagner, who
specializes in dentures and implants in his private practice and who will
study 20 afflicted patients with Tatlock in coming months at the University
of New Mexico. "What I can tell you is what I have seen: It looks like
someone has taken a hammer to these teeth and shattered them."

One of the strangest truths of the condition, dentists said, is that
despite the truly grisly look, patients do not report suffering from as
much pain as one would expect. Or, these dentists say, they do not report
such pain while still using the drug.

While the condition has begun turning up in private practices, particularly
in emergency care and for recovering addicts, it is more prevalent in the
nation's jails and prisons.

Local sheriffs in Midwestern and Southern counties have complained about
skyrocketing dental costs in their jails because of it. In North Carolina,
dental workers in the Department of Corrections learned this month about
"meth mouth" during a training session, and starting in July, new prisoners
will be screened for signs of dental problems connected to the drug. --
NEW YORK TIMES STAFFER GRETCHEN RUETHLING CONTRIBUTED.

In N.C. Jails

In North Carolina, law enforcement officers broke up 322 labs last year and
expect to hit 500 to 700 this year. As more methamphetamine users are
arrested and convicted, prisons and some local jails are paying the cost of
meth mouth.

In Sampson County, the sheriff's department has already overshot its
$15,000 dental budget treating about five meth mouths a month, said Capt.
Kemely Pickett, jail administrator.

In Watauga County, Sheriff Mark Shook said that over the past year, he
brought twice the usual number of prisoners to a dentist for treatment of
meth mouth.

- -- ASSOCIATED PRESS