Case Report: Unusual oral cavity changes associated with methamphetamine abuse

Abstract

Methamphetamine abuse is a growing global health concern, recognized for its highly addictive properties and severe effects on the human body. Commonly referred to as crystal, chalk, or ice, methamphetamine is a synthetic stimulant that can be administered in various ways. Methamphetamine abuse is associated with a spectrum of oral health issues known as "meth mouth," including rampant teeth caries, extensive occlusal tooth wear, periodontal diseases, xerostomia, bruxism, and poor oral hygiene. Despite the significant oral health impact, the exact pathogenesis remains unclear due to the limited number of reported cases and comprehensive studies performed. This case series details changes in oral and general health of different severity associated with methamphetamine abuse, highlighting unusual presentations such as the generalized decrease in teeth sensitivity, which can be associated with aseptic tooth pulp necrosis, hairy black tongue, rampant arrested caries, decreased periodontal inflammation, specific sunflower seed abrasions on antagonistic central incisors, pityriasis rosea skin lesion and palmar erythema. The clinical management was presented in detail and justified, which entails conservative dental, periodontal and oral mucosae treatments and highlighted the need for a comprehensive complex examination of these patients and financial consideration in treatment planning. This case series underscores the need to recognize the diverse oral and general health effects of methamphetamine abuse, which vary with duration and individual symptoms. Patients often withhold substance use, leading to delayed diagnosis until severe manifestations arise. Enhanced awareness among healthcare providers can improve diagnosis and management, offering valuable insights into underlying mechanisms and enabling better care for this high-risk population.

Keywords: black hairy tongue; case report; drug abuse; meth mouth; methamphetamine; palmar erythema; pityriasis rosea; pulp necrosis.

Figure 1

Clinical presentation of the first patient before treatment. Extensive and widespread caries affect multiple teeth, severely destroyed teeth, and poor oral hygiene. (A) Two separate images of the 1st and 4th sextants, and the 2nd and 3rd sextants, combined to illustrate the relationship of the teeth in central occlusion, (B) combined photo of the occlusal view of the first, second, third and fifth sextant, (C) vertical craze lines on right canines and premolars, denoted by black arrowheads and (D) the left side.

Figure 2

Patient 1. CT scan examination of the upper and lower jaw. A CT scan image of the (A) first sextant, (B) second, (C) third, (D) sixth, and (E) fourth and fifth sextants.

Figure 3

Treatment stages of the first patient. (A) Fourth and (B) sixth sextants (on left side teeth after selective carious tissues removal and on the right side teeth after direct restoration), (C) the combined image which illustrates stages of the third sextant restorative treatment: initial condition, teeth after selective carious tissues removal, occlusal and vestibular view of teeth after restoration (images presented from left to right), (D) the combined image which illustrates stages of the tooth 44 restorative treatment: initial condition, teeth after selective carious tissues removal, vestibular view of tooth 44 after restoration (images presented from left to right), (E) teeth 21 and 22 after selective carious tissues removal (left image) and after their direct restoration (right image).

Figure 4

Clinical presentation of the second patient’s oral cavity before treatment. Notice, teeth are densely covered with dental plaque and the marginal gingiva is inflamed. (A) Two separate images of the 1st and 4th sextants, and the 2nd and 3rd sextants, combined to illustrate the relationship of the teeth in central occlusion. (B) Combined image that illustrates the view of the right lateral, dorsal (with black hairy tongue lesion), and left lateral surfaces of the tongue before treatment (from left to right), (C) clinical presentation of the dorsal surface of the tongue after treatment on a 10th day, (D) presentation of pityriasis rosea lesions on the skin of abdomen area, (E) higher magnification of teeth 11 and 41 teeth with a notch-shape abrasion defect on the incisal edge, caused by the shelling of sunflower seeds, (F) clinical presentation of the palmar erythema on a patient’s palms.