I remember the first time I saw a "meth mouth" billboard on the highway. I was in the backseat of a car driving up into the North Carolina mountains. The landscape was blurring by outside my window in a static mix of rock, snow, and sky. Then, as the car went around a bend in the road, a terrifying face broke through the monotonous scenery, looming down at me like a miserable giant. The words at the bottom of the billboard read: "Need Help?" followed by a phone number.
Usually, these kinds of billboards employ a "before and after" format. On the left side we have a pretty woman, and on the right we have the haggard zombie that meth has turned her into. The juxtaposition of these images is powerful, a warning that if you even think about touching meth, you too could suddenly have a body littered with sores, wrinkles lining your face like a topographic map, and teeth that look as if you've tried to chew on a stick of dynamite.
Despite these kinds of graphic warnings, meth continues to be a growing concern in North Carolina. According to a 2013 report by the NC Department of Justice, the number of meth labs shut down by authorities had increased from 460 in the previous year to 561. These production sites were located predominantly in the eastern and western parts of the state, and 81% of these labs were designated as "shake and bake" operations, small-scale productions that require little more than a few key ingredients, temporary seclusion, and an empty soda bottle in which to produce the meth. While local authorities are busy trying to stop the production of homegrown meth, dental professionals are equally as busy trying to clean up the wreckage that meth leaves behind in the mouths of its users.
A few months ago, East Carolina University's School of Dental Medicine hosted an academic presentation entitled "Meth Mouth: An Interdisciplinary Team-Based Approach," that brought dental and healthcare professionals together to discuss "meth mouth" and meth addiction. I spoke with Dr. Robert Carter, the director of the General Practice Residency Program at ECU and one of the conference's presenters, about his own experiences working with these kinds of patients, and the new developments his program is undertaking in order to change the way "meth mouth" treatment is approached.
VICE: Can you describe the first time you saw a case of meth mouth in person?
Dr. Carter: The first time I remember seeing someone with Meth Mouth was at one of these Missions of Mercy clinics in Dare County, Kill Devil Hills. My first patient was someone who admitted to me that he was a meth abuser and said, "my teeth are all messed up." And they were! They were all broke down and carious. I basically had to take out all of his teeth. He was a young guy, in his 20s.I think it was a good 25... 26 teeth I took out of him.
From there I assume you have to start wearing dentures, but how do addicts and recovering addicts pay for that?
That's a big issue. Dental costs range... Let me give you some rough estimates, since everyone is different. The first level of care is you take out all their teeth and give them dentures. Dentures cost anywhere from $1,000 to $1,500, and the extraction cost can be anywhere from $100 to $200 a tooth. So if you're taking out 20 teeth and getting new dentures... You're looking at spending about $5,000 dollars for the most basic level of care.
There are other levels, though, where you take out only the really bad teeth, and then you try to fix the other ones with root canals and fillings. Then you give them partial dentures to replace the ones they've lost. That can range from $6,000 to $12,000.
But if you're talking about completely rehabilitating the mouth where you go ahead and fix everything—you change the "bite" on the patients so their teeth aren't closing down so much, you do implants where they're needed to be done—you could come out at around $50,000 to repair the ravages of meth mouth.
If you're going to get that much work done, you've already beaten the addiction, right?
Let's face it, if someone is abusing drugs they really need to be led by the hand from one place to another to get the help they need. It's treating the abuse that's the key. Usually the folks who are able to quit using meth have already been in the system and know what they need to do to get themselves back to normal in terms of "dental."
At what point do you remember the issue of meth mouth becoming part of the conversation within dental schools?
It's been something in the works for a while. In the old days a patient would come in with this kind of rapid decay and you would turn them over to social services or try to get them to some place that could help them. Now, we kind of have a new method where you have social workers, nurses, physicians, allied health personnel such as counselors and nurse practitioners, physicians' assistants, all working together to help identify meth abusers and get them the help they need.
Do you think the way ECU's School of Dentistry has been focusing on meth mouth education stems from North Carolina having its own unique issues with the disease?
Well, yes. Especially in this part of North Carolina [Eastern North Carolina], it's a big issue. I think thatNorth Carolina has one of the highest concentrations of meth labs in the United States. Hang on...
[Dr. Carter pulls out some statistic sheets]
OK. These are numbers from the calendar year 2012. There's a total of 11,210 meth labs. North Carolina had 457. That's probably the highest on the East Coast. Twenty-five percent of meth labs are located in homes with children. It's not confined to young, single people. There are families that make this stuff. Financially it's very rewarding for some of these folks. They just go down to the lab and say, "I have to go to the lab, Johnny." It's pretty pervasive. It becomes the new normal.
Why do you think meth has such a hold on the eastern part of North Carolina?
The I-95 corridor. You have transportation up and down the east coast, and also North Carolina, even though it's a pretty populous state, is still pretty rural, so these labs can hide out in the rural areas and there's less likelihood of detection. You can go back and forth. It's easier to move chemicals. Meth labs involve a lot of hardware, so they need that infrastructure to get these things built. I understand that there's a new brand of Mexican meth that's making inroads into the area now.
When you're looking into someone's mouth, what's the first sign that let's you know your patient is a meth abuser.
It all relates to one thing: dry mouth. What happens is meth dries your mouth out, and without the saliva to cleanse your teeth, the bacteria collects on your teeth and goes crazy. It causes massive decay.
So it's a misconception that meth mouth is simply caused by smoking meth?
Meth just causes the "dry mouth," and the dry mouth causes the problem. The way meth users try to take care of that is they'll drink a lot of sugary drinks and eat sweet things because sweets cause salivation. But it doesn't make that much saliva, just a little bit. It gives them the sensation. Of course, that feeds the bacteria on their teeth and it eats them away. Another aspect of meth is it causes you to have high anxiety, and one symptom of high anxiety is tooth grinding. So you can imagine your teeth are already weakened by the acidic bacteria, and then you're grinding on them. It's a very nasty result.
Does dealing with patients like this take a personal toll on you?
What helps me and some of our residents get through it is that we realize these patients have a problem, and part of that attitude is the problem. It's a disease. They're not bad people. They just happened to make some bad decisions that resulted in this terrible situation they're in. So you're treating the whole person, not just the mouth. You're dealing with their terrible social situation and the medical situation. You have to look at the whole being. So when you're looking at it from that standpoint, you don't take their outbursts or lack of cooperation so personally. If you don't do that, it can take its toll. You can let the patient start making you feel guilty and responsible for their problems.
It can be very exhausting to work on a patient with meth abuse, but when they turn around and improve, it's worth it.
So there's a psychological aspect to having your teeth fixed?
Absolutely. That's an outward sign of them fixing themselves. When you take out the bad teeth and put in the dentures they can smile again and chew again and they look good and people start responding to them positively because they're looking better. It gives them more confidence to keep on going to the next steps to break the addiction. Dentistry is a big part of the rehabilitation of a meth abuser.