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MARK DONALDSON, PHARM.D., is Director of Pharmacy Services, Kalispell Regional Medical Center, Whitefish, MT, and Clinical Assistant Professor, School of Dentistry, Oregon Health and Sciences University, Portland. JASON H. GOODCHILD, D.MD., is Assistant Professor and Director, Division of Oral Diagnosis, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, and Clinical Assistant Professor, Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia.

Address correspondence to Dr. Donaldson at Pharmacy Services, Kalispell Regional Medical Center, 310 Sunnyview Lane, Kalispell, MT 59901 (mdonaldson{at}krmc.org).

Purpose. The pharmacology of methamphetamine is reviewed, and the effects of methamphetamine use on oral health are described. Summary. Methamphetamine is a highly addictive amphetamine analogue, initially synthesized in 1919. Illicit methamphetamine use leads to devastating effects on health, particularly the dentition. Illegal production of methamphetamine has skyrocketed in recent years, as have the number of users. The chief complaint of methamphetamine users is xerostomia. Without the protective effects of saliva, caries development in these patients is rampant. The typical pattern of decay involves the facial and cervical areas of both the maxillary and mandibular teeth, with eventual progression to frank coronal involvement. The acidic substances used to manufacture this drug have also been implicated as a cause of tooth decay and wear in users, as has bruxism as a result of drug-induced hyperactivity. When possible, these patients should be referred to a dentist to improve their oral health status and minimize the potential for adverse cardiovascular sequelae. Other preventive measures for methamphetamine users include stimulating saliva flow and increasing fluoride supplementation. Pharmacists should also counsel users to avoid carbohydrate-rich soft drinks in favor of water. Oral moisturizers may also be effective. Conclusion. Methamphetamine use causes xerostomia secondary to sympathetic central nervous system activation, rampant caries caused by high-sugar intake in the absence of protective saliva, and bruxism as a result of hyperactivity. Practitioners should know how to recognize the signs of and manage the oral health of patients with a history of methamphetamine use. Index terms: Drug abuse; Fluorides; Mechanism of action; Methamphetamine; Mouth diseases; Oral health; Patient information; Pharmacists; Toxicity