Stimulant use disorder (methamphetamine, cocaine)

Oral health effects

• Severe caries and erosive tooth wear ("meth mouth")

  Chronic methamphetamine use is associated with rampant, rapidly progressing caries, often on smooth/interproximal and vestibular surfaces of anterior teeth, plus severe occlusal wear.

  Mechanism: Combines methamphetamine-induced xerostomia, vasoconstriction of oral mucosal/salivary blood flow, bruxism/clenching, craving for high-sugar/carbonated drinks, and poor oral hygiene during binge use.

  Clinical management: Aggressive caries risk reduction (fluoride, saliva substitutes), staged restorative treatment once the patient is medically stable, and referral for substance use treatment as part of an interdisciplinary plan.

• Xerostomia (reduced salivary flow)

  Stimulants reduce salivary output, producing dry mouth that accelerates caries and mucosal irritation.

  Mechanism: Sympathomimetic vasoconstriction of salivary gland blood supply and sympathetic suppression of serous secretion.

  Clinical management: Saliva substitutes, sugar-free xylitol gum, frequent water intake, and high-fluoride toothpaste.

• Teeth grinding, clenching, and jaw joint pain (bruxism, TMD)

  Stimulant use drives intense clenching and grinding, causing attrition, fractured teeth/restorations, and masticatory muscle pain.

  Clinical management: Occlusal guard once use is controlled, protect restorations, and manage TMD symptoms conservatively.

• Cocaine-specific lesions: palatal/septal perforation, gingival lesions, erosion

  Intranasal cocaine can perforate the nasal septum and palate (cocaine-induced midline destructive lesions); rubbing cocaine on the gums causes localized gingival ulceration and recession; acidic cocaine preparations erode tooth surfaces.

  Mechanism: Intense local vasoconstriction causes ischemic necrosis of mucosa and underlying bone/cartilage.

  Clinical management: Examine the palate in known or suspected cocaine users, refer oroantral/oronasal communications to oral surgery or ENT, and defer prosthetic obturation until use has stopped.