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The impact of the new scene drug “crystal meth” on oral health: a case–control study



The use of methamphetamine (MA), a highly addictive stimulant, is rapidly increasing, with MA being widely abused as the scene drug “Crystal Meth” (CM). CM has been associated with severe oral health effects, resulting in so-called “Meth mouth”. This term appeared for the first time in 2005 in the literature and describes the final complex of symptoms including rampant caries, periodontal diseases and excessive tooth wear. The aim of this study was to investigate the effects of chronic CM abuse on teeth and intraoral tissue with respect to potential symptoms of Meth mouth.

Materials and methods

In cooperation with two centres for addiction medicine, we performed clinical intraoral investigations in 100 chronic CM users and 100 matched-pair controls. We undertook a caries and periodontal examination by using the clinical parameters DMF-T/DMF-S, bleeding on probing index (BOP) and periodontal screening index (PSI) and tested individual oral hygiene by using approximal space plaque index (API). All clinical data were analysed by the t test for independent samples.


We found significantly larger numbers of caries (p < 0.001) and higher levels of gingival bleeding (p < 0.001) and periodontal disease (p < 0.001) among CM users. Oral hygiene was significantly lower in CM users (p < 0.024).


Chronic CM use can lead to extensive potential damage within the intraoral cavity. When CM is used over a long period of time and in the absence of treatment, clinical symptoms in terms of Meth mouth syndrome cannot be excluded.

Clinical relevance

Based on our results, we recommend a specific prevention and therapeutic concept including educational campaigns for MA users and specialized dental care for CM patients.

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  1. 1

    Nagai, Nagayoshi (1893) Kanyaku maou seibun kenkyuu seiseki (zoku). Yakugaku Zasshi 13:901

    Google Scholar 

  2. 2

    Ogata A (1919) Constitution of ephedrine—desoxyephedrine. J Pharm Soc Jpn 451:751–754

    Google Scholar 

  3. 3

    Hamamoto DT, Rhodus NL (2009) Methamphetamine abuse and dentistry. Oral Dis 15:27–37. doi:10.1111/j.1601-0825.2008.01459

    Article  PubMed  Google Scholar 

  4. 4

    Turkyilmaz I (2010) Oral manifestations of “meth mouth”: a case report. J Contemp Dent Pract 11:E073–E080

    PubMed  Google Scholar 

  5. 5

    De-Carolis C, Boyd GA, Mancinelli L, Pagano S, Eramo S (2015) Methamphetamine abuse and “meth mouth” in Europe. Med Oral Patol Oral Cir Bucal 20:e205–e210

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6

    Bavarian Police (2013) Police Crime Statistics for Upper Franconia. Accessed 21 Aug 2013

  7. 7

    Schifano F, Corkery JM, Cuffolo G (2007) Smokable (“ice”, “crystal meth”) and non smokable amphetamine-type stimulants: clinical pharmacological and epidemiological issues, with special reference to the UK. Ann Ist Super Sanita 43:110–115

  8. 8

    Donaldson M, Goodchild JH (2006) Oral health of the methamphetamine abuser. Am J Health Syst Pharm 63:2078–2082. doi:10.2146/ajhp060198

    Article  PubMed  Google Scholar 

  9. 9

    Curtis EK (2006) Meth mouth: a review of methamphetamine abuse and its oral manifestations. Gen Dent 54:125–129 quiz 130

    PubMed  Google Scholar 

  10. 10

    Rhodus NL and Little JW (2005) Methamphetamine abuse and “meth mouth”. Northwest Dent 84:29, 31, 33–7.

  11. 11

    Shaner JW, Kimmes N, Saini T, Edwards P (2006) “Meth mouth”: rampant caries in methamphetamine abusers. AIDS Patient Care STDS 20:146–150. doi:10.1089/apc.2006.20.146

    Article  PubMed  Google Scholar 

  12. 12

    Ravenel MC, Salinas CF, Marlow NM, Slate EH, Evans ZP, Miller PM (2012) Methamphetamine abuse and oral health: a pilot study of “meth mouth”. Quintessence Int 43:229–237

    PubMed  Google Scholar 

  13. 13

    Wang P, Chen X, Zheng L, Guo L, Li X, Shen S (2014) Comprehensive dental treatment for “meth mouth”: a case report and literature review. J Formos Med Assoc 113:867–871. doi:10.1016/j.jfma.2012.01.016

    Article  PubMed  Google Scholar 

  14. 14

    Naidoo S, Smit D (2011) Methamphetamine abuse: a review of the literature and case report in a young male. SADJ 66:124–127

    PubMed  Google Scholar 

  15. 15

    Lange DE, Plagmann HC, Eenboom A, Promesberger A (1977) Clinical methods for the objective evaluation of oral hygiene. Dtsch Zahnarztl Z 32:44–47

    PubMed  Google Scholar 

  16. 16

    Lange DE (1986) Periodontology in daily practice. Quintessenz, Berlin

    Google Scholar 

  17. 17

    Rhodus NL, Little JW (2008) Methamphetamine abuse and “meth mouth”. Pa Dent J (Harrisb) 75:19–29

    Google Scholar 

  18. 18

    Walter AW, Bachman SS, Reznik DA, Cabral H, Umez-Eronini A, Nath A, Flournoy MW, Young NS (2012) Methamphetamine use and dental problems among adults enrolled in a program to increase access to oral health services for people living with HIV/AIDS. Public Health Rep 127(Suppl 2):25–35

    PubMed  PubMed Central  Google Scholar 

  19. 19

    Shetty V, Mooney LJ, Zigler CM, Belin TR, Murphy D, Rawson R (2010) The relationship between methamphetamine use and increased dental disease. J Am Dent Assoc 141:307–318

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20

    Goodchild JH, Donaldson M (2007) Methamphetamine abuse and dentistry: a review of the literature and presentation of a clinical case. Quintessence Int 38:583–590

    PubMed  Google Scholar 

  21. 21

    Heng CK, Badner VM, Schiop LA (2008) Meth mouth. N Y State Dent J 74:50–51

    PubMed  Google Scholar 

  22. 22

    Shaner JW (2002) Caries associated with methamphetamine abuse. J Mich Dent Assoc 84:42–47

    PubMed  Google Scholar 

  23. 23

    Backman TK, Larmas MA, Kaar ML, Paavilainen T (1990) Caries incidence in children with acyanotic congenital heart diseases before and after the heart operation. J Clin Pediatr Dent 15:51–54

    PubMed  Google Scholar 

  24. 24

    Eslamipour F, Borzabadi-Farahani A, Asgari I (2010) The relationship between aging and oral health inequalities assessed by the DMFT index. Eur J Paediatr Dent 11:193–199

    PubMed  Google Scholar 

  25. 25

    Feldmann D, Hefti AF, de Crousaz P, Marthaler TM, Hotz P, Menghini GD, Vock P (1993) Dental caries (DMFT) in adults in Switzerland 1988. Schweiz Monatsschr Zahnmed 103:835–843

    PubMed  Google Scholar 

  26. 26

    Mandal KP, Tewari AB, Chawla HS, Gauba KD (2001) Prevalence and severity of dental caries and treatment needs among population in the Eastern states of India. J Indian Soc Pedod Prev Dent 19:85–91

    PubMed  Google Scholar 

  27. 27

    Micheelis W, Bauch J (1996) Oral health of representative samples of Germans examined in 1989 and 1992. Community Dent Oral Epidemiol 24:62–67

    Article  PubMed  Google Scholar 

  28. 28

    Ramezani GH, Valaei N, Eikani H (2004) Prevalence of DMFT and fluorosis in the students of Dayer city (Iran). J Indian Soc Pedod Prev Dent 22:49–53

    PubMed  Google Scholar 

  29. 29

    Tipton DA, Legan ZT, Dabbous M (2010) Methamphetamine cytotoxicity and effect on LPS-stimulated IL-1beta production by human monocytes. Toxicol in Vitro 24:921–927. doi:10.1016/j.tiv.2009.11.015

    Article  PubMed  Google Scholar 

  30. 30

    In SW, Son EW, Rhee DK, Pyo S (2005) Methamphetamine administration produces immunomodulation in mice. J Toxic Environ Health A 68:2133–2145. doi:10.1080/15287390500177156

    Article  Google Scholar 

  31. 31

    Talloczy Z, Martinez J, Joset D, Ray Y, Gacser A, Toussi S, Mizushima N, Nosanchuk JD, Goldstein H, Loike J, Sulzer D, Santambrogio L (2008) Methamphetamine inhibits antigen processing, presentation, and phagocytosis. PLoS Pathog 4:e28. doi:10.1371/journal.ppat.0040028

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32

    Hellwig E, Klimek J, Attin T (2003) Introduction to restorative dentistry. Urban & Fischer, München

    Google Scholar 

  33. 33

    Laslett AM, Crofts JN (2007) Meth mouth. Med J Aust 186:661

    PubMed  Google Scholar 

  34. 34

    Morio KA, Marshall TA, Qian F, Morgan TA (2008) Comparing diet, oral hygiene and caries status of adult methamphetamine users and nonusers: a pilot study. J Am Dent Assoc 139:171–176

    Article  PubMed  Google Scholar 

  35. 35

    Padilla R, Ritter AV (2008) Meth mouth: methamphetamine and oral health. J Esthet Restor Dent 20:148–149. doi:10.1111/j.1708-8240.2008.00167.x

    Article  PubMed  Google Scholar 

  36. 36

    Fox PC (2008) Xerostomia: recognition and management. Dent Assist 77:18, 20, 44–8; quiz 50–1.

  37. 37

    Okubo M, Yoshikawa M, Shinomiya T, Kawaguchi M (2013) Methamphetamine-withdrawal stress activates PACAP-DBI pathway in rat salivary gland, resulting in inhibition of salivary secretion. Tokai J Exp Clin Med 38:55–61

    PubMed  Google Scholar 

  38. 38

    Navarro M, Pichini S, Farre M, Ortuno J, Roset PN, Segura J, de la Torre R (2001) Usefulness of saliva for measurement of 3,4-methylenedioxymethamphetamine and its metabolites: correlation with plasma drug concentrations and effect of salivary pH. Clin Chem 47:1788–1795

    PubMed  Google Scholar 

  39. 39

    Buzalaf MA, Hannas AR, Kato MT (2012) Saliva and dental erosion. J Appl Oral Sci 20:493–502

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40

    Darling MR (2003) Cannabis abuse and oral health care: review and suggestions for management. SADJ 58:189–190

    PubMed  Google Scholar 

  41. 41

    Chapman CR, Lipschitz DL, Angst MS, Chou R, Denisco RC, Donaldson GW, Fine PG, Foley KM, Gallagher RM, Gilson AM, Haddox JD, Horn SD, Inturrisi CE, Jick SS, Lipman AG, Loeser JD, Noble M, Porter L, Rowbotham MC, Schoelles KM, Turk DC, Volinn E, Von Korff MR, Webster LR, Weisner CM (2010) Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base. J Pain 11:807–829. doi:10.1016/j.jpain.2010.02.019

    Article  PubMed  Google Scholar 

  42. 42

    Zaclikevis MV, D’Agulham AC, Bertassoni LE, Machado MA, de Lima AA, Gregio AM, Azevedo-Alanis LR (2009) Effects of benzodiazepine and pilocarpine on rat parotid glands: histomorphometric and sialometric study. Med Chem 5:74–78

    Article  PubMed  Google Scholar 

  43. 43

    Brand HS, Gonggrijp S, Blanksma CJ (2008) Cocaine and oral health. Br Dent J 204:365–369. doi:10.1038/sj.bdj.2008.244

    Article  PubMed  Google Scholar 

  44. 44

    Cretzmeyer M, Walker J, Hall JA, Arndt S (2007) Methamphetamine use and dental disease: results of a pilot study. J Dent Child (Chic) 74:85–92

    Google Scholar 

  45. 45

    Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, Eke PI, Beltran-Aguilar ED, Horowitz AM, Li CH (2007) Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat 11:1–92

    Google Scholar 

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This study was funded by internal funding sources of the Department of Oral and Maxillofacial Surgery, Munich University of Technology. It was also supported by the funding provided by the Koinor Horst Mueller Foundation.

Conflict of interests

The authors declare that they have no competing interests.

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Correspondence to Niklas Rommel.

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Rommel, N., Rohleder, N.H., Wagenpfeil, S. et al. The impact of the new scene drug “crystal meth” on oral health: a case–control study. Clin Oral Invest 20, 469–475 (2016).

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  • Crystal methamphetamine
  • Meth mouth
  • Caries
  • Periodontal diseases
  • Oral hygiene
  • Prevalence study