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press box: Media criticism.

More Meth-Mouth MisinformationIt's everywhere, it's everywhere!

By Jack Shafer
Posted Friday, May 12, 2006, at 6:09 PM ET

Meth addict

My sarcasm was as gentle as a chain saw when I first criticized other journalists for their wrong, wrong, wrong descriptions of what causes "meth mouth"—the dramatic tooth loss experienced by many heavy methamphetamine users.

Quoting from the medical literature, I used my column of nine months ago to inform the press that contrary to their reports, meth mouth is not caused by the direct action of "acids" or "contaminants" found in the street drug, nor do the chemicals used in its preparation "eat" away at teeth or "corrode" them. The Minneapolis Star Tribune, the St. Paul Pioneer Press, the Albuquerque Journal, and the Kansas City Star received knocks from me, as did the Associated Press.

To review: The etiology of meth mouth is well understood. Methamphetamine use inhibits saliva production; loss of saliva exposes teeth to bacteria that cause cavities; many users treat their "dry mouth" (xerostomia) symptoms with sugared sodas, which only fuels the bacteria that cause cavities. Combine meth with poor oral hygiene, and soon you'll be ordering dentures. (See the Merck Manual of Medical Information for more about how saliva gland malfunction results in tooth decay and loss.)

But oh, my brothers, the press did not listen to my first report. So, in early November 2005, I goosed my snark to produce a second installment. In January 2006, I added a third. But still the press does not listen.

I come to today's episode with a new medical paper in hand to convince the ignorant of their errors. " 'Meth Mouth': Rampant Caries in Methamphetamine Abusers" from the journal AIDS Patient Care and STDS dismisses the "acid" and "contaminants" theories. The authors, J.W. Shaner, D.M.D., M.S.; N. Kimmes, D.D.S.; T. Saini, D.D.S., M.S.; and P. Edwards, D.D.S., M.S., write that "caries"—dentist lingo for cavities—"is a bacterially mediated disease." Their snarks set only to stun, they continue:

The primary organisms involved in this infectious process belong to a group functionally labeled Streptocooci mutans. The development of a carious lesion is a complex process involving acidogenic bacteria, poor oral hygiene permitting bacterial plaque accumulation to a cariogenic threshold, frequent exposure to refined carbohydrates which are metabolized by S. mutans in the plaque to produce acids, and inadequate saliva that normally serves to buffer any drop in pH at the enamel-plaque interface. Teeth exposed to extrinsic (mainly dietary) and intrinsic acid (gastric acid) develop erosion lesions resulting in a bulk stripping or dissolving of enamel and then dentin. This is frequently seen in long-term lemon suckers involving the facial enamel surface, and in patients with gastroesophageal reflux disorder and bulimia involving the palatal/lingual and occlusal surfaces.
As a further blow to the "contaminant" theory, patients taking prescription MA [methamphetamine] for narcolepsy or attention deficient hyperactivity disorder (ADHD) developed the characteristic carious lesions seen in MA abusers.

So, debate over. Spread the news. Meth causes meth mouth, not "acids" or "contaminants." The first institution that needs to acknowledge this fact is the American Dental Association, whose Web site currently carries this misinformation about meth mouth:

The rampant caries associated with methamphetamine use is attributed to the following: the acidic nature of the drug, the drug's xerostomic effect, its propensity to cause cravings for high calorie carbonated beverages, tooth grinding and clenching and its long duration of action leading to extended periods of poor oral hygiene. [Emphasis added.]

The next institution on my list is the Academy of General Dentistry, whose Web site asserts:

Another reason for the rapid decay of teeth is the caustic nature of the ingredients used to make meth. Ether benzene, Freon and paint thinner are just a few of the extremely dangerous materials to be used in creating meth.

And now on to the popular press dishonor roll:

Chronic meth smokers have teeth rotted to the gum line from the continuous effect of the vapors on tooth enamel. The condition is referred to as "meth mouth."
Even snorting meth causes chemical damage to teeth. Toxic substances drain through the nasal passages and into the mouth, "bathing" the teeth.
—Craig (Colo.) Daily Press, Dec. 7, 2005
"I know that meth and crack eat away calcium and make (the teeth) weaker," [Frank, a pseudonym] said. "Sometimes I brushed, but it don't help. The more drugs you do, the worse it gets."
—Dubuque, Iowa, Telegraph Herald, Feb. 20, 2006
It also causes "meth mouth," where the user's teeth rot out because chemicals in meth eat tooth enamel.
—Fort Wayne Journal-Gazette, March 30, 2006
Meth addicts develop rotten teeth in a condition known as "meth mouth" because meth robs the body of calcium, decreases saliva production and changes the pH of the mouth.
—Holmen (Wis.) Courier, April 14, 2006
Methamphetamine is concocted in home laboratories and can contain lye, battery acid, ether or other corrosive agents. These destroy tooth enamel and burn the gum tissue, which becomes infected.
—Arizona Republic, April 22, 2006
"Meth mouth" is a condition common in habitual meth users that results in rotting and deteriorating teeth and gums due to chemical ingredients in meth.
—Maryville, Tenn. Daily Times, April 25, 2006
In this KHQA Safe Family Health report, KHQA tells you how dentists are dealing with the "Meth Mouth" epidemic.
Bleach, cold tablets, Drano, anhydrous ammonia. It's no wonder someone ingesting these materials would end up with their teeth rotting away.
"Most everything in meth is a corrosive material and they consume enormous amounts of carbonated beverages and they're on highs for so long, they don't brush their teeth or take care of them so the combination is there just to eat up everything," Dr. Bill Esicar said.
—KHQA-7 Online (The tri-cities of Keokuk, Iowa; Hannibal, Mo.; and Quincy, Ill.), May 8, 2006

My advice: Don't do meth. Don't believe everything you read about illicit drugs in newspapers or hear over the airwaves. And if your dentist or local police officer likes to talk to the press about meth mouth, tell them to keep up on the medical literature.

******

Dan Wilson of the Appleton (Wis.) Post-Crescent deserves honor-roll treatment for this well-reported, skeptical April 30 story about the "methidemic." I read my e-mail at . (E-mail may be quoted by name unless the writer stipulates otherwise.)