The relationship between methamphetamine use and increased dental disease.
BACKGROUND
Methamphetamine (MA) use has been linked anecdotally to rampant dental disease. The authors sought to determine the relative prevalence of dental comorbidities in MA users, verify whether MA users have more quantifiable dental disease and report having more dental problems than nonusers and establish the influence of mode of MA administration on oral health outcomes.


METHODS
Participating physicians provided comprehensive medical and oral assessments for adults dependent on MA (n=301). Trained interviewers collected patients' self-reports regarding oral health and substance-use behaviors. The authors used propensity score matching to create a matched comparison group of nonusers from participants in the the Third National Health and Nutrition Examination Survey (NHANES III).


RESULTS
Dental or oral disease was one of the most prevalent (41.3 percent) medical cormorbidities in MA users who otherwise were generally healthy. On average, MA users had significantly more missing teeth than did matched NHANES III control participants (4.58 versus 1.96, P<.001) and were more likely to report having oral health problems (P<.001). Significant subsets of MA users expressed concerns with their dental appearance (28.6 percent), problems with broken or loose teeth (23.3 percent) and tooth grinding (bruxism) or erosion (22.3 percent). The intravenous use of MA was significantly more likely to be associated with missing teeth than was smoking MA (odds ratio=2.47; 95 percent confidence interval=1.3-4.8).


CONCLUSIONS
Overt dental disease is one of the key distinguishing comorbidities in MA users. MA users have demonstrably higher rates of dental disease and report long-term unmet oral health needs. Contrary to common perception, users who smoke or inhale MA have lower rates of dental disease than do those who inject the drug. Many MA users are concerned with the cosmetic aspects of their dental disease, and these concerns could be used as behavioral triggers for targeted interventions.


CONCLUSIONS
Dental disease may provide a temporally stable MA-specific medical marker with discriminant utility in identifying MA users. Dentists can play a crucial role in the early detection of MA use and participate in the collaborative care of MA users.
Shetty
Vivek
V
School of Dentistry, University of California, Los Angeles, Los Angeles, CA 90095-1668, USA. vshetty@ucla.edu
Mooney
Larissa J
LJ
Zigler
Corwin M
CM
Belin
Thomas R
TR
Murphy
Debra
D
Rawson
Richard
R
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D001294:Attitude to Health; D015142:Baltimore / Q000453:epidemiology; D002012:Bruxism / Q000453:epidemiology; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage / Q000009:adverse effects*; D009059:Mouth Diseases / Q000453:epidemiology*; D020380:Needs Assessment / Q000706:statistics & numerical data; D009909:Oral Health; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014076:Tooth Diseases / Q000453:epidemiology*; D014077:Tooth Erosion / Q000453:epidemiology; D014082:Tooth Fractures / Q000453:epidemiology; D016388:Tooth Loss / Q000453:epidemiology; D014086:Tooth Mobility / Q000453:epidemiology; D014098:Toothache / Q000453:epidemiology
D000697:Central Nervous System Stimulants; D008694:Methamphetamine