Pubdate: Fri, 17 Jun 2005 Source: Washington Blade (DC) Copyright: 2005 The Washington Blade Inc. Contact: http://www.washblade.com/ Details: http://www.mapinc.org/media/1754 Author: Elizabeth Weill-Greenberg Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) THIS COULD BE YOUR MOUTH ON METH 'Tina' Causes Some Users' Teeth To Loosen, Fall Out, Dentists Say Michael's story is, tragically, almost a cliche now in gay circles. Michael said his boyfriend became addicted to crystal meth last year. The drug led to a predictable list of consequences: his boyfriend disappeared for days at a time, lost his job, suffered extreme mood swings and stopped eating and sleeping. Finally, he said, the drug led to their breakup. It is no surprise that crystal meth ravages lives. But there is another consequence of meth use that some users may not know about - the drug's impact on teeth, a condition known as "meth mouth." Last week, a front-page report in the New York Times detailed how the drug eats away at users' teeth and mouths. Much of what is known about "meth mouth" is anecdotal, said Donald McVinney of the Harm Reduction Coalition. All stimulants will impede saliva production, he explained. But the difference between crystal and cocaine or crack is that because the high is longer and more intense, the saliva shutdown in crystal users is more pronounced. This may mean that a user's mouth can't break down bacteria, he said. Long-term users may experience receding gums, loosened teeth and gum disease. Users' teeth can become gray, and their breath atrocious. But the symptoms are not always this extreme. It is difficult for dentists to know when a patient is using crystal meth, he said, especially since most are reticent to admit it and a long-term user is unlikely to even go to the dentist. "It's not easy to identify a meth user in dental practice," said D.C.-based dentist, Dr. John Hunter. About 85 percent of his clients are gay or lesbian. He said only one or two patients admitted they were using. "I talk to them about their symptoms," he said. "Very rarely a light bulb goes off. The symptoms are common to other patients." Dr. Gary Seiden, a dentist in Dupont Circle, said he's "savvy to crystal behavior." About 20 percent of his patients are gay and about five percent of those might be using crystal, he said. He sees crystal use among his patients "pretty infrequently." Teeth grinding and dry mouth are common symptoms of crystal use, he said. When he does suspect drug use, he stays quiet. They're there for dental help, not to be accused, he said. "It's hairy bringing that up," Seiden said. Even though long-term crystal use may damage users' teeth, dental care is just about the last thing on a user's mind. "If they forget to eat, why make an appointment to go to the dentist?" said Sessa. Rare In Private Practice Dr. Sally Cram, a D.C. dentist and consumer adviser for the American Dental Association, said she has not seen any crystal meth users in her practice. Most likely, they would go for treatment at community clinics or hospitals. "It's not real prevalent in private practice," she said. Some users avoid dentists and other health care providers because they fear being judged, said McVinney. He advises providers "not to shame, not to lecture." It's more productive if dentists can provide tips on oral hygiene and educate themselves on drug use, he said. For example, because many users get dehydrated and chew a lot of gum, McVinney suggests drinking Gatorade and chewing sugarless gum. Dentists can ask their patients if they've thought about ways to stop and try to develop a rapport with the patient, he said. "Once [someone] feels stigmatized, they're less likely to go for help," he said. "The goal is to interrupt the downward spiral." Jonathan, a recovering crystal user and D.C.-based artist who spoke on condition that his real name be withheld, said he rarely visited the dentist or doctor when he was using. Jonathan began doing crystal about eight years ago; he's been sober for more than three. For three years, he used everyday. "I didn't have a lot of those severe symptoms," he said. However, he said matter-of-factly, "I did become HIV positive." Once, he visited the dentist after breaking a tooth. He didn't think he could stay sober for the procedure so he left and didn't return. He fixed his tooth six months ago. Jonathan said he hasn't had any major trouble with his teeth, although while he was using he only brushed his teeth when forced to. Edward Liu, a health educator at the Whitman-Walker Clinic, pointed out that not every user's teeth erode and fall out, although it does occur. "We don't want to scare people," he said. "[But] we want people to realize this could happen."