BackgroundMethamphetamine, a highly addictive sympathomimetic stimulant, is currently widely abused worldwide and has been associated with devastating effects on oral health, resulting in the term “meth mouth”. However, “meth mouth” pathology is primarily based on case reports with a lack of systematic clinical evaluation. Therefore, we have conducted a systematic study to investigate (1) the pharmacological impact of methamphetamine on oral health with regard to saliva function, including the parameters saliva flow rate and total saliva production (ml/5 min) and the buffering capacity of saliva; (2) the contribution of the symptoms of bruxism and muscle trismus to potential oral health damage.MethodsWe assessed the data of 100 chronic methamphetamine abusers and 100 matched-pair comparison participants. Primarily, we conducted an anamnesis with all methamphetamine abusers with regard to saliva dysfunctions, jaw clenching and pain in the temporomandibular joint. Subsequently, in the first part of the clinical enquiry, we tested the saliva flow rate and the total saliva production (ml/5 min) by using the sialometry method and the buffer capacity of saliva by determining the pH-value. In the second part of the clinical enquiry, we evaluated bruxism symptoms with respect to generalized tooth attrition, dentine exposure and visible enamel cracks and examined a potential muscle trismus by measuring the maximal opening of the mouth.ResultsThe majority of methamphetamine abusers reported a dry mouth (72 %) and jaw clenching (68 %). Almost half of all methamphetamine abusers experienced pain in the temporomandibular joint (47 %). With regard to the clinical findings, methamphetamine abusers showed significantly lower total saliva production (ml/5 min) (p < 0.001), lower pH-values of their saliva (p < 0.001) and more bruxism symptoms (p < 0.001). However, we found no relevant trismus symptoms on comparing the two groups (p > 0.05).ConclusionsThe sympathomimetic effects of chronic methamphetamine abuse may lead to dry mouth and extensive bruxism and therefore can increase the risk for caries decay, periodontal lesions and tooth wear. Furthermore, a significant decline of saliva buffer capacity in methamphetamine abusers may trigger the risk for dental erosions. Methamphetamine abusers and practitioners should be aware of these symptoms.

The increasing abuse of the street drug crystal meth (methamphetamine) in many countries worldwide has resulted in a growing demand to treat patients who have acquired a methamphetamine-related disorder. The results of a systematic literature search which led to the consensus-based recommendations by the Working Group of the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin - ÄZQ) are presented. Pharmacological treatments were reviewed in 58 out of the 103 publications included. They were mainly randomized controlled trials (RCT). Despite increased research activities, none of the medications studied demonstrated a convincing and consistent effect on abstinence rates, despite some having an impact on craving and retention rates or symptom control. In addition, as yet there is no sufficient evidence available for dopamine analogue treatment ("substitution") after the initial withdrawal-period. Methamphetamine-related, post-acute persistent or comorbid syndromes such as methamphetamine-associated psychosis (MAP), depressive syndromes, anxiety, and sleep disorders are usually treated in a symptom-oriented manner. Risks of interactions with methamphetamine have to be taken in account when prescribing medications with doubtful efficacy. Further research is warranted.

Based on our results, we recommend a specific prevention and therapeutic concept including educational campaigns for MA users and specialized dental care for CM patients.

SUMMARYBackground: Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad.

Zusammenfassung Auch Deutschland ist mittlerweile von der Verdr?ngung des d-Amphetamines durch das N-Methamphetaminhydrochlorid in seiner hochkonzentrierten Form ?Crystal-Meth? in bestimmten Drogenszenen betroffen. Es ist mit einer vermehrten Behandlungsnachfrage zu rechnen. Diese ?bersichtsarbeit fasst die Erfahrungen anderer L?nder, auch mit der Amphetaminsubstitution, zusammen.

With the further increasing abuse of stimulants like methamphetamine the number of patients with induced psychosis will escalate. Specific settings for treatment will be required to address the addiction as well as the psychosis.

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ZusammenfassungEinleitung: Auf Entgiftungsstationen werden Patienten mit einer Suchterkrankung sowie Psychosen aufgrund kurzer Aufenthaltsdauern häufig nicht durch sonst als wirksam evaluierte Psychoedukationsgruppenangebote erreicht. Zielsetzung: Evaluation der Patientenzufriedenheit mit einem psychoedukativen Kurz-Gruppenangebot (drei Module) für Patienten mit Suchterkrankung sowie Psychose während der stationären Entgiftung. Methode: Befragung mittels eines Fragebogens. Ergebnisse: Die Ergebnisse zeigen positive Beurteilungen durch die Patienten. Unter anderem wird der Austausch mit anderen Patienten als positiv erlebt. Diskussion: Es ergeben sich lediglich die erwarteten Probleme durch die offenen Gruppen sowie die geringe Belastbarkeit der Patienten.