Moral panics rip through cultures, observed sociologist Stanley Cohen in 1972, whenever "experts" and the "right-thinking" folks in the press, government, and the clergy exaggerate the danger a group or thing poses to society.
Immigrants have been the subject of moral panics, as have alcohol, jazz, comic books, sex, street gangs, rock, video games, religious cults, white slavery, dance, and homosexuals. But in the United States, moral panics are most reliably directed at illicit drug users. No exaggeration or vilification directed their way is too outrageous for consideration.
For the last year, a moral panic about methamphetamine and its users has been gathering force, and last week it peaked as Slate's corporate sibling, Newsweek magazine, joined the crusade with a cover story. Calling methamphetamine "America's Most Dangerous Drug," the magazine also portrayed its use as "epidemic." In typical moral-panic fashion, Newsweek offered no data to anoint meth as the deadliest of drugs, nor did it prove its assertion that meth use is spreading like a prairie fire. Instead, the magazine relied almost exclusively on anecdotes from law enforcement officials, anti-drug politicians, and users (current and reformed) to stir up emotions against meth and meth-heads.
If you were to reduce the current moral panic to a single image, it would be a photo of a meth user whose gums are pus-streaked and whose rotting teeth—what teeth he still has—are blackened and broken. The affliction, tagged "meth mouth" in scores of articles, earns a prominent place in Newsweek's Grand Guignol coverage (see the picture in this Newsweek spread).
Although users have been snorting, smoking, injecting, and swallowing methamphetamine in great quantities for more than 40 years, the phrase meth mouth is brand new. It makes its first Nexis appearance in Investor's Business Daily as an unsourced one-liner in a Jan. 31, 2003, digest of news: "Methamphetamine's drying effect on saliva glands leads to tooth decay and gum disease, dentists say, a trend known as 'meth mouth.'"
More than two dozen different stories about meth mouth have appeared in Nexis since the IBD mention, but the majority of them fail to advance the story in any significant way. The better articles note, as IBD did correctly, that methamphetamine users suffer from dry mouth (xerostomia), which contributes to tooth decay and gum disease. Many of them also find that many users attempt to refresh their dry mouths with sugared sodas, which accelerates decay. The best articles explain that many meth-mouthers get that way because they've neglected brushing, flossing, and regular visits to the dentist. Such a regimen is almost always a prescription for tooth loss.
But most of the articles go off on tangents, blaming contaminants or the corrosive quality of meth itself. For instance, Minneapolis' Star Tribune (Jan. 6, 2005) writes that the "acidic nature of methamphetamine if it is smoked or snorted" plays a role (reprinted in shorter form). The St. Paul Pioneer Press (Jan. 6, 2005) finds that "acid in meth corrodes tooth enamel, letting decay-causing bacteria seep in."
The Kansas City Star (Jan. 26, 2005): "What causes the problems is the acid content in some of the ingredients used to make methamphetamine, including anhydrous ammonia, ether and lithium. The acid can decrease the strength of the enamel on the teeth." Nice try, Star, but anhydrous ammonia, ether, and lithium are not acids.
The AP (Feb. 2, 2005) points to contaminants as well: "Methamphetamine can be made with a horrid mix of substances, including over-the-counter cold medicine, fertilizer, battery acid and hydrogen peroxide"—chemicals that reduce saliva, which is needed to neutralize acids and clear food from the teeth. Later that same month, the AP (Feb. 21, 2005) says that "methamphetamine ingredients like hydrochloric acid and lye corrode teeth when users inhale the drug's smoke. The drug dries in users' mouths, drying saliva that would block the acid and letting food build up on the gums against the teeth."
The Albuquerque Journal (April 12, 2005) collects this artful anecdote from a local dentist: "Meth use is an emerging epidemic. ... It explodes people's teeth. It's like ice crystals forming in the crevices of rock, fracturing the teeth."
The New York Times(June 11, 2005) showcases the meth-mouth story on Page One: "Other dentists said they suspected that the caustic ingredients of the drug—whether smoked, injected, snorted or eaten—contributed to the damage, which tends to start near the gums and wander to the edges of teeth. Among ingredients that can be used to make meth are red phosphorus found in the strips on boxes of matches and lithium from car batteries."
The contaminant angle is complete misinformation. Dr. John R. Richards M.D., who studied tooth damage among 49 users in the late 1990s and co-wrote a paper on his finding for the August 2000 issue of the Journal of Periodontology, says users could consume pharmaceutical-grade methamphetamine and still lose their teeth.
The paper, titled "Patterns of Tooth Wear Associated With Methamphetamine Use," recorded the most dramatic tooth wear among methamphetamine users who preferred snorting meth over other means of administration. Frequent snorting of the drug inhibits blood flow to the arteries that service the top front teeth, the authors found, which weakens them. Also, most of study's subjects smoked tobacco, and the connection between smoking and bad teeth is well-known.
"Not all that much tooth damage could be caused in the short time methamphetamine is in your mouth," Richards says. He adds that upper teeth are more prone to drying than lower teeth. When meth users binge and pass out, they may sleep for a day or longer with their mouths open, further drying their uppers.
Richards calls neglect of basic hygiene the biggest cause of dental damage among users. "It's a lifestyle issue," he says.
None of the articles blaming "contaminated" methamphetamine for meth mouth cite any literature or authority, perhaps because it doesn't exist. Page 59 of this 1991 monograph from the U.S. National Institute on Drug Abuse surveys the scientific literature and finds examples of rare lead poisoning from bathtub meth (14 cases) but is silent on acids. Page 62 lists known organic contaminants in clandestinely made meth but concedes that no toxic reactions to the compounds have been reported.
The second press piece published on meth mouth should have served as a template for the reporters chasing the story. On April 5, 2004, the AP reported on meth mouth among inmates in North Dakota's state penitentiary. The peg for the story was that the prisoners were incurring gargantuan dental bills for you-know-what. From the AP story:
[Prison dentist Lonnie] Neuberger said he thinks there is a relationship between the chemicals in meth and tooth decay, but said there is little scientific evidence about the phenomenon.
Neuberger said malfunctioning salivary glands are another factor that causes tooth decay among meth users. The glands normally secrete saliva, which neutralizes acids present in the mouth and around teeth.
In meth users—partly because of the dehydration common because they do not drink enough fluids—salivary glands quit and swell shut.
The next sentence, also attributed to Neuberger, places the condition in a normalizing context:
The same thing often happens to the elderly because of inadequate hydration and side effects from medication. [Emphasis added.]
In other words, abstinent grandmothers and grandfathers, many of whom who couldn't spell methamphetamine if their lives depended on it, are sometimes victims of meth mouth!
The Merck Manual of Medical Information speaks articulately to the rampant tooth decay that follows salivary gland malfunction: "Because saliva offers considerable natural protection against tooth decay, an inadequate amount of saliva leads to more cavities—especially on the roots of teeth."
Many drugs—some of them in your medicine cabinet—inhibit saliva production. An AP story from October 1997, years before the meth moral panic set in, reports:
Hundreds of medicines that Americans take every day, from the country's most popular blood pressure pills to chewable vitamin C tablets, can cause serious tooth decay and gum disease, oral medicine experts told the American Dental Association.
One patient stuck his nitroglycerine tablets under his upper lip instead of under his tongue, where it was supposed to go. "And they ate a hole in his tooth," the AP writes. Nearly 20 percent of patients taking best-selling calcium channel blockers (Procardia, Cardizem, and Adalat) for high blood pressure and heart disease suffer gum swelling. Bacteria attack the inflammation, causing more swelling and serious gum disease ensues. Anti-epilepsy drugs, particularly Dilantin, and some amphetamines given to hyperactive kids cause similar swelling. Cyclosporin, which prevents organ rejection, can cause massive gum overgrowth.
The connections between drug abuse and tooth loss are established in the medical literature, even when the drug is booze. A recent study at the University of Buffalo found that alcohol abuse may lead to periodontal disease, tooth decay, and potentially precancerous mouth sores, but don't expect anybody to call it "Miller mouth."
Richards' paper has yet to be cited in a newspaper or magazine indexed by Nexis, perhaps because most reporters think of drug abuse in terms of criminal justice and moral panic. Had one journalist seriously considered covering meth mouth from a public health point of view, all he had to do is plug "methamphetamine and teeth" into PubMed, the free federal database, to find the Richards paper citation.
Give the New York Times an honorable mention for an April 12, 2005, story that discusses meth mouth from a public health point of view, stating that the poor dental and oral health of rural, ethnic, and disabled Americans has not improved since a surgeon general called attention to it in 2000 report. Thanks to the American Academy of Periodontology for providing the Richards article on short notice. Thanks to reader Jon Paul Henry for the moral-panic angle. Send e-mail containing an angle of your own to firstname.lastname@example.org. (E-mail may be quoted unless the writer stipulates otherwise.)