When children drop in for a dental checkup or cleaning, Dr. Gail Redman usually ends the appointment with her familiar reminder to brush...

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SIKESTON, Mo. — When children drop in for a dental checkup or cleaning, Dr. Gail Redman usually ends the appointment with her familiar reminder to brush and floss regularly. But she recently added something new: “Whatever you do, don’t do meth.”

The unusual advice, rarely heard in a dentist’s office, is the result of Redman’s seeing more and more cases of a disturbing dental decay considered a telltale sign of methamphetamine abuse. The condition, commonly known as “meth mouth,” leaves users’ teeth black-stained, rotted and often unsalvageable. It can advance so rapidly that patients even in their late teens and early 20s have required full-mouth extractions.

Almost unheard of in urban areas, meth mouth is a growing problem for dentists working in the nation’s rural stretches, where meth has hit the hardest. Already rural social services and law enforcement are dealing with the drug’s fallout, from families torn apart by addiction to the toxic home labs where meth is made.

Now, rural dentists say meth is changing their jobs, too.

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“There’s never been a drug that’s had such an extreme dental impact as crystal meth,” said Dr. Nancy Williams, a dental hygiene professor at the University of Tennessee Health Science Center in Memphis, who lectures around the country on drug abuse.

The decay is striking, dentists say. The cavities appear black, much darker than the discoloration found on the teeth of smokers or other drug abusers. The damage is focused along the gum lines. Extracting the brittle, broken teeth is often the only option.

Little is known about what causes meth mouth. Few academic studies have been done. Many dentists, especially those in cities where other drugs dominate, are not even aware of the problem. “There may be a lot more of it seen than recognized,” said Dr. William Goebel, head of diagnostic specialties at Southern Illinois University Edwardsville’s School of Dental Medicine.

Several factors are believed to contribute to the condition. Meth users tend to suffer from poor oral hygiene and seem to prefer drinking sugary sodas while high. The drug also dries up saliva, leaving the mouth without a natural defense against cavities. Some dentists also blame the drug’s corrosive ingredients.

The results are difficult to miss.

“You can look at their teeth and tell, no doubt about it,” said Matt Fowler, an agent with a local drug task force.

“They smile and it’s like, oh, my God,” said Dr. James Russell, a dentist in Ellington, Mo.

Russell said he tries to bring up the subject indirectly, gauging a patient’s reaction when he says that meth use might cause a bad interaction with the numbing agent. “If you question them enough about it, they’ll usually fess up to it,” Russell said.

Redman said she started seeing the condition about five years ago, but at the time had no idea that it was related to an illicit drug.

Then her assistants began pointing out which patients were using meth, she said. Today, she easily recognizes the decay pattern. And her hygienists will note in a patient’s file, “Meth?”

While many dentists run into meth mouth on a regular basis, it is the youngest patients who stand out.

Dr. John Sauer, a dentist in Cape Girardeau, Mo., said he once diagnosed a teenager’s drug problem through her teeth. A 16-year-old went from just one cavity to 18 cavities bunched along the gum line a year and a half later, Sauer said. “I went to the mom and I asked her if she’d noticed anything unusual about her daughter,” Sauer recalled. The mother admitted to having trouble controlling her daughter and later, in private, the teen admitted to using meth, he said.

Carrie Gregory, a hygienist at Redman’s clinic, saw a 14-year-old patient last fall who she suspected of using meth after seeing his teeth marred by multiple black cavities. Gregory said she decided to talk to the boy’s mother.

“I felt bad after that,” Gregory said. “But I wouldn’t be doing my job if I hadn’t.”

The rise in meth-induced cavities also has resulted in dentists tipping off their local police narcotics unit, despite federal privacy laws that might prohibit such disclosures.

Even decades in practice don’t dull the shock of seeing meth mouth. Redman said she’s constantly amazed that people would use a drug that is so toxic. Russell said 26 years of working on teeth didn’t prepare him for this.

“To see the things we see,” he said, “I would not have thought it possible.”

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