Mechanisms underlying methamphetamine-related dental disease

Case Report: Unusual oral cavity changes associated with methamphetamine abuse

Methamphetamine abuse is a growing global health concern, recognized for its highly addictive properties and severe effects on the human body. Commonly referred to as crystal, chalk, or ice, methamphetamine is a synthetic stimulant that can be administered in various ways. Methamphetamine abuse is associated with a spectrum of oral health issues known as "meth mouth," including rampant teeth caries, extensive occlusal tooth wear, periodontal diseases, xerostomia, bruxism, and poor oral hygiene. Despite the significant oral health impact, the exact pathogenesis remains unclear due to the limited number of reported cases and comprehensive studies performed. This case series details changes in oral and general health of different severity associated with methamphetamine abuse, highlighting unusual presentations such as the generalized decrease in teeth sensitivity, which can be associated with aseptic tooth pulp necrosis, hairy black tongue, rampant arrested caries, decreased periodontal inflammation, specific sunflower seed abrasions on antagonistic central incisors, pityriasis rosea skin lesion and palmar erythema. The clinical management was presented in detail and justified, which entails conservative dental, periodontal and oral mucosae treatments and highlighted the need for a comprehensive complex examination of these patients and financial consideration in treatment planning. This case series underscores the need to recognize the diverse oral and general health effects of methamphetamine abuse, which vary with duration and individual symptoms. Patients often withhold substance use, leading to delayed diagnosis until severe manifestations arise. Enhanced awareness among healthcare providers can improve diagnosis and management, offering valuable insights into underlying mechanisms and enabling better care for this high-risk population.

Pharmacological Treatments for Methamphetamine Use Disorder: Current Status and Future Targets

The illicit use of the psychostimulant methamphetamine (METH) is a major concern, with overdose deaths increasing substantially since the mid-2010s. One challenge to treating METH use disorder (MUD), as with other psychostimulant use disorders, is that there are no available pharmacotherapies that can reduce cravings and help individuals achieve abstinence. The purpose of the current review is to discuss the molecular targets that have been tested in assays measuring the physiological, the cognitive, and the reinforcing effects of METH in both animals and humans. Several drugs show promise as potential pharmacotherapies for MUD when tested in animals, but fail to produce long-term changes in METH use in dependent individuals (eg, modafinil, antipsychotic medications, baclofen). However, these drugs, plus medications like atomoxetine and varenicline, may be better served as treatments to ameliorate the psychotomimetic effects of METH or to reverse METH-induced cognitive deficits. Preclinical studies show that vesicular monoamine transporter 2 inhibitors, metabotropic glutamate receptor ligands, and trace amine-associated receptor agonists are efficacious in attenuating the reinforcing effects of METH; however, clinical studies are needed to determine if these drugs effectively treat MUD. In addition to screening these compounds in individuals with MUD, potential future directions include increased emphasis on sex differences in preclinical studies and utilization of pharmacogenetic approaches to determine if genetic variances are predictive of treatment outcomes. These future directions can help lead to better interventions for treating MUD.

Feasibility, acceptability, and perceived usefulness of a community-evidence-based harm reduction intervention for sexualized stimulant use among Mexican gay, bisexual, and other men who have sex with men

BACKGROUND

The use of stimulants and other substances with the purpose of enhancing, maintaining, and prolonging sexual activity is known as sexualized substance use. Also known as chemsex, this pattern of use has been mainly explored in high-income countries. The aim of this article was to assess the feasibility, acceptability, and usefulness of a community- evidence-based harm reduction intervention among Mexican gay, bisexual, and other men who have sex with men (gbMSM) adults who reported sexualized stimulant use in the past 6 months and who were not enrolled in any psychosocial treatment.

METHODS

The in-person intervention was designed in partnership with gbMSM who used substances. It consisted of 39 harm reduction strategies before, during, and after episodes of use. The components of the intervention were health and self-care, safety, and psychopharmacology. The intervention was delivered at a university campus, a public recreational space, and an HIV public clinic. Feasibility to deliver the intervention was assessed based on enrolment and completion rates; acceptability through a 28-item, 5-point Likert scale (140 max.) constructed and validated for the Mexican population with good reliability coefficients; usefulness through a 5-point Likert scale ("not useful"-"very useful") for each of the 39 strategies; and potential behavioral change by subtracting the likelihood of implementing each strategy minus the frequency of use of the technique before the intervention.

RESULTS

Participants (n = 19; recruitment rate = 35.2%; completion rate = 84.2%) rated the intervention as acceptable with a mean score of 121.6 (SD = 7.5). The highest potential for behavioral change was regarding the use of information about the half-life of stimulants, polysubstance use, and overdose prevention.

CONCLUSIONS

This intervention is feasible when provided within public health services where potential participants are already in contact. Harm reduction strategies need to surpass sexually transmitted infections prevention and HIV care and focus on substance use and mental health strategies.

Crystal methamphetamine and its effects on mental and oral health: A narrative review

The purpose of this comprehensive literature review is to present the available evidence on the effects of methamphetamine on mental and oral health, as well as provide an overview of the most widely used medical and dental care strategies in the management of meth mouth. For this purpose, PubMed and Google Scholar electronic databases were searched for relevant articles, yielding 115 search results, which were further scrutinized for their relevance, leaving 55 for a detailed review. The analysis of the gathered data indicates that a comprehensive patient-centered approach that takes into consideration the physical, mental, and social aspects is crucial for mitigating the detrimental effects of increasing methamphetamine use.

Mucocutaneous Manifestations of Recreational Drug Use

Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations. Signs of substance use disorder may include changes to general appearance, skin, and mucosal findings associated with particular routes of drug administration (injection, insufflation, or inhalation) or findings specific to a particular drug. In this review article, we provide an overview of the mucocutaneous manifestations of illicit drug use including cocaine, methamphetamine, heroin, hallucinogens, marijuana, and common adulterants to facilitate the identification and improved care of these patients with the goal being to connect this patient population with appropriate resources for treatment.

Correlates of poor oral health related quality of life in a cohort of people who use methamphetamine in Australia

OBJECTIVES

Methamphetamine use impacts oral health, but little is known about its impacts on oral health related quality of life (OHRQoL). In this study we examined OHRQoL in a cohort of people who use methamphetamine and assessed associations with sociodemographic, behavioural, psychosocial and dental service utilisation correlates. A secondary aim was to examine the relationship between methamphetamine route of administration and OHRQoL, to test whether smoking the drug is associated with reduced OHRQoL.

METHODS

Cross-sectional analysis was performed, using data from VMAX, a cohort of people who use methamphetamine at least monthly in Victoria, Australia (n = 194). Utilising the oral health impact profile (OHIP-14), we assessed three OHRQoL outcomes: OHIP-14 prevalence, OHIP-14 extent and OHIP-14 severity. Regression analyses examined associations between independent variables and the three OHIP-14 outcome measures.

RESULTS

A significant segment of the cohort (35%) reported poor OHRQoL. Overall, no statistically significant association was detected between methamphetamine route of administration and the three OHIP-14 outcomes. Participants living in rural areas, with moderate-to-severe self-reported depression and with methamphetamine dependence had significantly worse OHRQoL levels, which persisted after adjusting for other covariates.

CONCLUSION

Overall, VMAX cohort participants reported reduced OHRQoL levels. Our findings highlight the need for upstream interventions to improve the OHRQoL of people who use methamphetamine, with specific focus on those living in rural locations. Further research on the links between OHRQoL and mental health among people who use methamphetamine is required.

Altered dental plaque microbiota correlated with salivary inflammation in female methamphetamine users

Poor oral health is the most immediate and overlooked hazard of methamphetamine abuse in humans. Previous studies have reported methamphetamine-associated alterations in saliva microbiota, but the cause of methamphetamine-induced alterations in the oral microenvironment remains unclear. The present study aimed to investigate the alterations in dental plaque microbiota in methamphetamine users, and to explore their relationship with local immune inflammation in the oral cavity. This may provide new ideas on the development of methamphetamine-related oral microenvironment changes. Questionnaires and samples were obtained from 30 female methamphetamine users and 15 sex- and age-matched healthy controls. Microbial profiles of supragingival dental plaque were analyzed using 16S rRNA gene sequencing. Inflammatory factors in saliva were measured using enzyme-linked immunosorbent assay. Methamphetamine users had worse oral self-evaluation. Compared with healthy controls, methamphetamine users showed no differences in oral dental plaque microbial diversity but exhibited differences in the relative abundance of several microbial taxa. At the phylum level, a higher abundance of Proteobacteria and a lower abundance of Firmicutes were detected in methamphetamine users. Moreover, function prediction using the MetaCyc database showed that 33 pathways were significantly upregulated in methamphetamine users; Only the glycolytic (Pyrococcus) pathway was enriched in the C group. Importantly, salivary inflammatory factors showed complex significant associations with bacterial genera in methamphetamine users. Specifically, the genus Neisseria was positively correlated with IL-17 levels in saliva, and both were high in methamphetamine users. In contrast, the genus Streptococcus, with a lower abundance, was positively correlated with lower IL-10 levels. Overall, This study is the first to provide evidence for a link between altered dental plaque microbiota and salivary inflammation in methamphetamine users. Further elucidation of the interactions between methamphetamine use and oral microenvironment would be beneficial for appropriate interventions to improve oral health.

“(Meth) Will Hurt You and Hurt Your Teeth”: Teen, Parent, and Dental Practitioner Perspectives on Implementing Crystal Meth Use Prevention Messaging in the Dental Office Setting

Objectives

Crystal methamphetamine (“meth”) use among youth living in rural areas is higher than the national average. Given how drastically meth affects teeth (i.e., “meth mouth”), engaging dental professionals as one of multiple channels in rural areas to deliver meth prevention messaging is a novel approach. The objective of this research was to assess the feasibility and acceptability of incorporating meth use prevention messaging into dental visits with teenagers.

Methods

We conducted phenomenological, qualitative research with dental practitioners, teens, and parents/guardians in three communities in North Idaho, from 2015 to 2016. We recruited practitioners using a snowball sampling strategy and placed phone calls to dental practices and contacted teens and parents through schools, libraries, local sporting events, and word-of-mouth. Using NVivo 12-Plus, parent- and teen-specific codebooks and themes were developed from guides and transcripts. Transcripts of the dentists and hygienists were reviewed to ascertain the main ideas and themes.

Results

Overall, practitioner, teen, and parent participants viewed meth prevention messages delivered by dental professionals as acceptable and feasible. Compared to those in private practice, public health dental providers were invested in meth prevention and were eager to help. Barriers to overall acceptability and feasibility included hygienists' low self-efficacy to deliver a communication-based intervention, infrequency of dental visits impacting the ability to reach enough teens through this venue, and the fact that teens could feel “targeted” by providers. Teens also raised concerns about scary messages exacerbating preexisting dental visit anxiety. Facilitators included the following: dental practitioners already engaging in health education with their patients, parents, and teens seeing dental professionals as appropriate purveyors of antimeth messaging and support for increased meth prevention efforts given the impact of meth use in their communities.

Conclusions

Well-crafted, developmentally appropriate meth prevention messages would likely be well received by teens and supported by parents in dental offices. These data are being used to develop a novel, theory-based communication and behavioral strategy to integrate dental professionals into the delivery of messages aimed at preventing the initiation of meth use among rural Idaho teens.

Predictors of protein intake among people who inject drugs in Los Angeles and San Francisco, California

BACKGROUND AND OBJECTIVES

While inadequate nutrition can weaken the immune system and lead to negative health sequelae for vulnerable populations, little is known about nutritional intake among people who inject drugs (PWID). We aimed to quantify nutritional intake among PWID and to explore associations between protein intake and drug use.

METHODS

A cross-sectional design was used to analyze self-reported participant data. PWID were recruited from community settings in California in 2016/2017. Participants reported on food consumption per day for a 30-day period, from which a continuous protein intake variable was created.

RESULTS

Modal characteristics of participants (N = 937) were: white (42.5%), male (75.3%), healthy body mass index (BMI) (56.6%), and unhoused (82.9%). Less than 1% of participants met or exceeded recommended guidelines for protein intake (0.80 g/day/1 kg body weight). The final multiple regression model found protein intake to be significantly positively associated with older age, high school or greater education, frequency of opiate and marijuana use, while Latinx ethnicity was inversely associated with protein intake, adjusting for gender.

DISCUSSION AND CONCLUSIONS

Our study shows PWID are generally not underweight, yet they are grossly protein deficient, which can be harder to recognize. Poverty, homelessness, and other structural barriers likely contribute to this issue, which demonstrates the need for communities to provide more access to nutrient-rich food to PWID.

SCIENTIFIC SIGNIFICANCE

Our study demonstrates the novel findings that opiate and marijuana use frequency, but not stimulants (methamphetamine and cocaine) may increase preference for protein-rich foods among PWID.

Caring for Patients Using Methamphetamines: An Interprofessional Collaborative Approach

Methamphetamine use is increasing in the U.S. and in Missouri, as are the number of deaths associated with its use. Many systemic and mental health issues are associated with methamphetamine use or methamphetamine use disorder (MUD). Given the range of health issues associated with methamphetamine use or MUD, a collaborative approach to the care of patients can improve outcomes. This article provides an overview of a collaborative approach to caring for patients using or have used methamphetamine, from the perspective of the primary care, behavioral and dental clinician.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Illicit drug use and oral health

People with drug use disorders (PWDUD) have elevated prevalence of oral diseases, in particular dental caries (tooth decay), periodontal (gum) disease and xerostomia (dry mouth). When left untreated, these oral health conditions may progress and lead to tooth ache, abscesses and tooth loss, and in turn, to poor chewing functioning and digestion, dental aesthetic problems and reduced wellbeing. Illicit drug use may, per se, cause xerostomia, which in turn increases vulnerability for dental caries. However, the other main drivers of oral diseases and their progression-poor oral hygiene, frequent sugar intake and infrequent dental visits-can mainly be ascribed to the irregular lifestyle, poor economy and mental health problems that often accompany illicit drug use. Establishment of good oral health habits is essential in the dental care for PWDUD. Dental treatment is often comprehensive and challenging; because the patients may have extensive treatment needs but also difficulties adhering to preventive measures and dental appointments. An integrated care approach for PWDUD would likely benefit both their oral and general health.

Oral Microbiota Profile of Individuals Who Abuse Methamphetamine

The poor oral health condition of individuals who abuse methamphetamine (MA) is well known. The roles of the oral and fecal microbiomes in addiction and nervous system diseases have been the focus of many studies. However, changes in the microbiota composition of MA users have not been reported. This was addressed in the present study in 20 MA users and 14 sex-matched healthy subjects. Saliva samples were collected and high-throughput 16S rRNA sequencing and bioinformatic analysis were performed to evaluate oral microbiome profiles. The results showed that species richness was significantly lower in the MA group than in the control group. Bacterial taxa that are known to be related to oral diseases such as Negativicutes, Veillonellaceae, Veillonella, and Selenomonadales had higher relative abundance in the MA group than in the control group, and the relative abundance of Prevotella melaninogenica-a putative etiologic agent of periodontal disease-was also higher. Avoiding MA use and improving oral hygiene practices over a short term (i.e., during hospitalization for 2 weeks) did not alter the oral microbiota composition of MA users. Although the causal relationship between changes in oral microbiome profile and MA abuse remains to be determined, our results suggest that oral disease prevention and treatment strategies are important for MA users.

Nutritional and metabolic alterations arising from stimulant use: A targeted review of an emerging field

People with stimulant use disorders are usually underweight. Current accepted knowledge is that they are skinny because stimulants suppress appetite - they eat less. But is it that simple? Here we review the relationship between stimulant use, food intake, metabolism and body weight, and highlight key points that may challenge current knowledge: 1) Stimulants interact with the hormonal signals that regulate appetite including ghrelin and leptin, and can produce long-term alterations in the ability to monitor and compensate energy deficits. 2) The diet of people with stimulant use disorders might be characterised by altered nutritional geometry, rather than overall reduction of food intake. 3) Long-term changes in homeostatic signals and nutrient intake can produce metabolic deficits that contribute to unhealthy low weight. Based on this knowledge we advocate for increasing awareness about the nuances of stimulant-related nutritional and metabolic deficits among addiction clinicians, and increased research on the interaction between stimulant use, appetite signaling, and metabolic deficits.

Cocaine and methamphetamine: Pharmacology and dental implications

BACKGROUND

Epidemiological studies have shown that illicit drug use is a persistent and growing problem in our society. Methamphetamine and cocaine are at the top of the list of stimulants commonly abused. There is a need for a disease-targeted approach to the dental management of clients who use these drugs.

METHODS

A review of the literature was conducted to identify the most up-to-date information for the diagnosis and treatment of dental clients who abuse methamphetamine and cocaine. Databases in the University of Toronto library system were searched for peer-reviewed articles, written in English, and containing data relevant to clinical decision making. Textbooks were chosen from a list of reference materials provided by the National Dental Examination Board. All cited articles were published within the past 5 years.

RESULTS AND DISCUSSION

There is robust literature on the treatment of individual signs and symptoms associated with methamphetamine and cocaine use. However, there is a dearth of information on the comprehensive, client-centred oral health care that these individuals require.

CONCLUSION

This article reviews the best practices to guide the clinician from the initial oral diagnosis appointment to the maintenance of care, including the pharmacological actions of these drugs of abuse, the specific challenges faced in providing care for this client population, and scientifically based treatment considerations to maximize prognosis.

Oral manifestations in drug users: A review

Background

In the dental environment there is not much talk about the oral manifestations resulting from the use of drugs, because in general the issue of drugs is a very difficult subject to deal with. Therefore, the objective of this work is to understand what are the most obvious manifestations in the oral cavity and as the dentist can detect them.

Material and Methods

In order to carry out this bibliographical review, a scientific article search was made by consulting the PubMed database. The abstracts were read to recruit only what was consistent with the chosen topic.

Results

The 23 sources of information affirmed the relationship between a bad state of general health, and more in the specific, bad state of oral cavity.

Conclusions

The most relevant manifestations were: decay, loss of teeth and precancerous lesions. These manifestations were present in most of the cases studied. All this is a consequence of the drug and the lifestyle acquired by the drug users studied.

Key words:Drug, caries, meth mouth, periodontitis, xerostomia.

"Gave me a line of ice and I got hooked": Exploring narratives of initiating methamphetamine use

OBJECTIVE

This study explores factors associated with methamphetamine initiation based on the narratives from an online support group for methamphetamine users.

METHODS

We conducted a qualitative study of 202 first-person narratives submitted to an anonymous, online support group for methamphetamine users. The narratives were analyzed in the Dedoose qualitative software using Charmaz's adaptations to Glaserian grounded theory methodology.

RESULTS

Ten factors for initiating methamphetamine use emerged from our analysis and corresponded to three constructs from the Theory of Planned Behavior: attitude (needing energy to work, wishing to escape pain, wanting to have fun, and desiring a thinner body), subjective norms (ubiquity of methamphetamine use, yearning for closer relationships, and wanting to fit in), and perceived behavioral control (believing addiction is inevitable, feeling forced to fit in, and having no real control). Many participants described initiating methamphetamine use because they believed it would help them meet personal goals or needs. Other participants began using it out of curiosity, to develop relationships, and/or because of the drug's ubiquity in their social environments. Some users described how their perceived lack of control left them with limited ability to resist trying the drug.

CONCLUSIONS

Results from this study may aid public health researchers and interventionists seeking theoretically informed methamphetamine prevention programs.

Periodontal status of current methamphetamine users

BACKGROUND

Methamphetamine (MA) use is associated with extensive dental caries. The purpose of this study was to determine the prevalence and severity of periodontal disease in a convenience sample of MA users.

METHODS

In this cross-sectional survey, MA users were recruited with a combination of snowball sampling and street outreach techniques. Three dentists, trained and calibrated to the oral assessments used in the National Health and Nutrition Survey, measured and recorded the participants' attachment loss, probing depth, and gingival recession. Concomitant interviews elicited psychological, substance use, medication, and dietary habits associated with MA use.

RESULTS

Periodontal assessments were completed on 546 adults. More than 69% were cigarette smokers, and more than 55% were medium to high MA users. Classifying prevalence by means of the Centers for Disease Control and Prevention and the American Academy of Periodontology definitions, cigarette smokers and medium to high MA users had a high prevalence of periodontal disease. The defining features of the participants were being 30 years and older (average, 42.2 years) and having severe and moderate periodontitis.

CONCLUSION

This is the first study to the authors' knowledge to systematically examine periodontal disease in a large population of current MA users. MA users in a Los Angeles urban setting had a high prevalence and severity of destructive periodontal disease. The frequency of MA use had a minimal impact on the severity of periodontal disease.

PRACTICAL IMPLICATIONS

An MA user can be at high risk of developing periodontal disease. Knowing that behavioral factors, such as smoking and consuming sugary beverages, are more important than MA use will assist the clinician in managing the treatment of MA users.