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28 September 2018
Tik teeth and meth mouth - a dentist’s worst nightmare

(Published - 28 September 2018)

In recent years, Professor Sudeshni Naidoo and colleagues at the University of the Western Cape Faculty of Dentistry noticed an increase in young adult patients with severe rotting teeth at the Tygerberg Oral Health Centre.

“Ordinarily, caries or holes in the teeth form in the fissures and pits of the teeth,” says Naidoo. “Instead, these patients were presenting with caries on the smooth surfaces of the teeth leading eventually to total destruction of the tooth.”

Methamphetamine or tik causes serious mouth and teeth problems commonly known as "meth mouth". It presents as extensive tooth decay and gum disease. Once it begins, it is virtually impossible to stop — and in many cases it leads to multiple tooth extractions.

Tik has double the potency of cocaine and is extremely addictive. It’s used in many ways — swallowed, snorted, injected and smoked. But smoking this substance is the most dangerous way, as it provides quicker access to the brain and bloodstream, says Professor Naidoo.

The use of tik affects the actions of the salivary glands, inhibiting saliva secretion and causing a dry mouth, or xerostomia. Saliva is the primary defence in fighting bad bacteria in the mouth and protecting the teeth. Other than their role in breaking down starches and fats in our diets, the enzymes in saliva – which is 99 percent water – also keep the mouth moist, buffered, and in a state of homeostasis; that is, a pH balance with just the right amount of acid in the mouth.

Why tik has this effect is up for debate. One theory, explains Professor Naidoo, is that the drug causes a narrowing of the blood vessels in salivary glands, decreasing the flow of saliva. Others argue that the use of the drug affects those parts of the brain that control the salivary glands.

Whatever the reason, Professor Naidoo says, to counteract the very dry mouth, tik users often consume vast amounts of sugary, fizzy drinks. With no or very little protective saliva in the mouth, this creates the perfect acidic conditions for rapid wear and tooth decay by weakening surface enamel of teeth.

To make matters worse, tik users often grind their teeth as a result of drug-induced hyperactivity, anxiety and nervousness. This causes accelerated tooth wear.

Furthermore, they lose interest in basic personal and dental hygiene. A tik ‘high’ can last for days; users don’t bother brushing their teeth for extended periods causing plaque to accumulate and the bacteria to continue metabolising sugars into acids. The acidic environment often leads to erosion, and when mouth pH drops below critical levels, tooth decay is the result.

The condition of meth mouth is vastly under-researched. Although studies of the effects of methamphetamine use on teeth exist in international literature, none have been conducted in a sample of any decent size. Naidoo and Dirk Smit, a dentist at Tygerberg Hospital who is also a specialist in community dentistry, recruited a sample of over 300 Cape Town patients between the ages of 21 and 29, making it the largest study of its kind.

“Some 98 percent of methamphetamine patients seen across the provinces come from this city,” says Naidoo.

Their study not only confirms the harmful effects of tik use on oral health, but also highlights impediments to treatment.

“Patients usually come to the clinic because of pain,” Naidoo says. “But by that stage, most of the teeth are already badly decayed and need extraction or several sessions to repair. And often once the pain is gone, the bigger problem is that patients simply don’t turn up for repeat appointments.”

Combating a social nightmare such as tik use requires buy-in from government, industry and society.

“Education is key to the problem. Not only in communities, but also the education of other health care workers (nurses, social workers and medical practitioners) to be able to recognise the oral signs of methamphetamine use.”

This, she says, will encourage referrals to dentists and, hopefully, to drug treatment centres. And perhaps seeing images of a ‘meth mouth’ might go a long way to putting anyone off drug use for life.