Methamphetamine Users Have Increased Dental Disease

Abstract

Methamphetamine (MA) users are assumed to have a high burden of tooth decay. Less clear is how the distribution and severity of dental caries in MA users differ from the general population. Using a covariate-balancing propensity score strategy, we investigated the differential effects of MA use on dental caries by comparing the patterns of decayed, missing, and filled teeth in a community sample of 571 MA users with a subset of 2,755 demographically similar control individuals selected from a National Health and Nutrition Examination Survey (NHANES) cohort. Recruited over a 2-y period with a stratified sampling protocol, the MA users underwent comprehensive dental examinations by 3 trained and calibrated dentists using NHANES protocols. Propensity scores were estimated with logistic regression based on background characteristics, and a subset of closely matched subjects was stratified into quintiles for comparisons. MA users were twice as likely to have untreated caries (odds ratio [OR] = 2.08; 95% confidence interval [95% CI]: 1.55 to 2.78) and 4 times more likely to have caries experience (OR = 4.06; 95% CI: 2.24 to 7.34) than the control group of NHANES participants. Additionally, MA users were twice as likely to have 2 more decayed, missing, or filled teeth (OR = 2.08; 95% CI: 1.29 to 2.79) than the NHANES participants. The differential involvement of the teeth surfaces in MA users was quite distinctive, with carious surface involvement being highest for the maxillary central incisors, followed by maxillary posterior premolars and molars. Users injecting MA had significantly higher rates of tooth decay compared with noninjectors ( P = 0.04). Although MA users experienced decayed and missing dental surfaces more frequently than NHANES participants, NHANES participants had more restored surfaces, especially on molars. The high rates and distinctive patterns of dental caries observed could be used 1) to alert dentists to covert MA use in their patients and 2) as the basis for comprehensive management strategies.

Dental caries and periodontal disease among people who use drugs: a systematic review and meta-analysis

“…Seven studies [24,27,48,49,52,54,55] examined the relationship between the type of drug used and DMFT index among PWUD. Five studies were conducted in high-income countries [24,27,49,54,55], and two in a low middle-income country (India) [48,52]. The date of studies ranged from 2007 to 2016, and the sample sizes were between 8 and 571.…”

Factors Influencing the Use of Methamphetamine by Dental Patients in the United States

“…Brown et al, in a project published in the Journal of the California Dental Association, found that methamphetamine users had higher decayed, missing, and filled teeth (DMFT), and that the duration of use significantly increased this score. 50 Recent analysis of this demographic corroborates this finding, and adds to the current knowledge base by establishing that methamphetamine users were twice as likely to have untreated caries as a control group (non-users), and four times as likely to have "caries experience". The data published by this group also found, counter to the popular perception that smoking methamphetamine causes the most severe manifestations of "meth mouth", that injection users of MA had significantly higher rates of tooth decay compared with noninjectors.…”

Mechanisms underlying methamphetamine-related dental disease

“…These results differed from previous analyses, owing to the new definitions for meth use types and the covariates for which the overall multiple linear regression controlled. 9 In addition, we investigated using DMFT so that comparisons with NHANES control participants were possible, and we found that study participants 35 years or younger averaged 6.9 DMFT, those who were 36 to 54 years averaged 8.03 DMFT, and 55 years or older averaged 17.01 DMFT, regardless of the method or the reported frequency of meth use (Figure 2). Levels of DMFT were all significantly different between age groups ( P < .0001).…”

“…We and our colleagues 9 have previously described the details of the overall study design and settings. In brief, we recruited a broad community sample of 571 people from Los Angeles County in California who used meth over a 2-year period.…”

“…7,8 We clarified the differential rates and patterns of dental disease in people who used meth by means of comparing them with demographically similar control participants selected from participants in the National Health and Nutrition Examination Survey (NHANES). 9 A logical next step was to examine the various explanations of the mechanisms of the meth mouth condition.…”