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2 CE credits
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Methamphetamine Abuse –
Oral Implications and Care
A Peer-Reviewed Publication
Written by Noel Brandon Kelsch, RDHAP

PennWell designates this activity for 2 Continuing Educational Credits

Publication date: February 2009 Go Green, Go Online to take your course
Review date: April 2011
Expiry date: March 2014
This course has been made possible through an unrestricted educational grant. The cost of this CE course is $49.00 for 2 CE credits.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.
Educational Objectives over a century ago. Meth was first manufactured as a medica-
Upon completion of this course, the clinician will be able to tion in 1887.4 Compared to amphetamine, meth is a greater
do the following: stimulant, lasts longer and is more harmful. Meth also differs
1. Describe and recognize the short-term effects of from cocaine in its effects – it is quicker acting than cocaine,
methamphetamine use longer lasting and has a higher stimulant effect. These effects
2. Describe the psychological, medical and oral conse- contribute to its greater appeal over cocaine.
quences of long-term methamphetamine use
3. Describe the role of the dental professional in the early
identification and care of methamphetamine abusers and Meth is a greater stimulant than cocaine and has
a more prolonged effect
addicts
4. Describe the care that can be provided for oral conditions
associated with methamphetamine use. Due to the potential for abuse and addiction, meth is classified
as a Schedule II stimulant. Its legal indications by prescrip-
Abstract tion include for the treatment of attention deficit hyperactiv-
Methamphetamines were originally derived from amphetamine. ity disorder and narcolepsy.5 However, meth can be illegally
Meth can be illegally and easily synthesized, and is known by many and easily synthesized from ephedrine or pseudoephedrine,
names, including speed, crystal meth and ice. In the United States, both readily available drugs, through distillation. Ingredients
more than 10 million people report having tried meth. Its use results used for the distillation process are available over the counter
in immediate effects that can be pleasurable but medically danger- and can include tincture of iodine,6 acetone/ethyl alcohol,
ous. Longer-term use results in serious and devastating medical, anhydrous ammonia, lithium and Freon.7
psychological and oral conditions, and in extreme cases can result
in death. Dental professionals are in a position to help with the early Figure 1. Manufactured meth
identification of meth abuse and to refer patients to medical profes-
sionals for counseling and treatment. Palliative and preventive oral
care and treatment, as well as counseling, should be provided, along
with monitoring of the patient, and definitive care should be pro-
vided when appropriate for the individual patient.

Introduction
Methamphetamine (meth) abuse has medical, dental, psy-
chological and social consequences for the individual using
the drug, and for his or her family and the community.
Meth use is a serious and growing problem in the United
States. While it was previously found mainly in Hawaii Thus, it is possible to manufacture meth in small homemade
and Western states, it has spread across the country. It is labs and to illegally source meth manufactured in larger
estimated that 10.4 million people, aged 12 and over, have “commercial” labs. It is known on the street by many names,
used meth at least once in their lifetime; just over 500,000 including speed, bikers coffee, uppers, crystal meth and ice.
people reported current use, according to the 2005 National
Figure 2. Meth in liquid form in syringe
Survey on Drug Use and Health (NSDUH).1 In a separate
study, 3.1% of eighth graders reported using meth, and
4.5% of high school seniors said they had used meth at least
once. Emergency-room visits and admissions for primar-
ily meth abuse are increasing – 73,000 visits and 150,000
admissions in 2004, compared to less than half that number
of visits and 21,000 admissions (8% of all admissions) in
1992.2 Meth use also places a significant financial burden
on emergency clinics.3

More than 10 million people 12 years of age and

older in the United States are estimated to have Route of Administration and Immediate
tried meth at least once Effects of Meth Abuse
Meth can be taken orally, smoked, snorted, injected, or placed
Methamphetamines were originally derived from amphet- rectally, ophthalmically or vaginally.8,9,10 Meth provides a
amine, which was used as a nasal decongestant and inhaler, prolonged high stimulus as compared to cocaine, a factor in

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its greater appeal along with its easy synthesis, availability excess of 90/160 are common. The heart rate increases and ir-
and relative inexpensiveness. The effects of meth abuse can regular heartbeats also occur. Blood vessels and capillaries de-
be split into the immediate effects for the user who is seeking teriorate in these patients, becoming constricted and resulting
pleasure in the form of a high, and the longer-term effects in an inadequate blood supply to the skin and internal organs.
of continued use and addiction. Immediate effects are influ- Blood vessel damage increases the risk of stroke and memory
enced by the route of administration, and may include a flash loss. In the extreme, cardiovascular events lead to death.16
or euphoria, and a high-energy surge that lasts up to 12 hours
(users feel they are strong, with incredible energy, while on a Meth abusers can experience dangerously high
high). Smoking or injecting meth results in a rapid-onset in- blood pressure and blood vessel damage. In the
tense flash. Oral administration takes 15–20 minutes to have extreme, cardiovascular events lead to death
an effect, while snorting takes around 5 minutes.11 Other im-
mediate effects include dilated pupils, hyperthermia (poten- As a result of capillary constriction, a lack of blood supply re-
tially life-threatening) and cardiovascular effects (Table 1).12 sults in formication - an abnormal sensation with chronically
and severely itchy skin that patients compulsively scratch,
Table 1. Immediate effects leading to open sores and infections. Gaunt and sagging skin
Flash of intense pleasure – smoking, injecting also ensues; and users often have sweaty skin. Capillary con-
Euphoria and energy surge – oral, snorting striction also reduces blood flow to the oral mucosa.
Increased wakefulness
Figure 3. Facial skin lesions in a meth user over a 10 month period
Increased physical activity
High energy level
Increased respiration
Dilated pupils
Hyperthermia
Rapid heartbeat
Irregular heartbeat
High blood pressure
Increased libido

Longer-Term Effects of Meth Abuse

Longer-term effects are evident in psychological, medical Figure 4. Formication in a meth user, images 3 months apart
and oral conditions. They are wide-ranging, starting with
addiction. These effects are severe and in some cases life-
threatening - including cardiovascular events, susceptibility
to infection and a lack of immune response to infection.

Psychological conditions
Psychological effects include nervousness, compulsive
behavior, violent and aggressive behavior, paranoia, hal-
lucinations and delusions, as well as depression and suicidal
behavior.13,14 Meth abusers are unable to care for themselves
adequately, contributing further to meth-related medical and
dental conditions.
Figure 5. Disheveled, gaunt appearance after habitual meth use
Medical conditions
Meth abuse affects the cardiovascular system, respiration, liver,
skin, central nervous system (CNS), dietary habits and associ-
ated diseases, and can result in a lowered immune response.
Meth users are also susceptible to metabolic syndrome with
hyperinsulinemia, dyslipidemia and abdominal obesity.15

Cardiovascular effects
Meth abusers can experience dangerously high blood pressure
that can be life threatening. Diastolic and systolic pressures in

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CNS effects the interproximal region of the anteriors, before rampant
Psychological and medical conditions related to central caries compeltely destroys the crowns of the teeth. In the
nervous system (CNS) activity have similar origins. Contin- absence of another identifiable cause, such as previous head
ued use of meth results in chronically depressed dopamine and neck radiation or autoimmune disease, rampant caries
levels. Based on animal studies, it is believed that meth – particularly with this pattern – may be the first clue that a
destroys dopamine axion terminals. Meth users are subject patient is a meth abuser.
to motorneurone problems, resulting in neuromuscular
dysfunction17 that mimics Parkinson’s disease – a currently In the absence of another identifiable cause, rampant
incurable condition. Permanent brain damage can result caries with complete destruction of the clinical crowns
from meth use.18 may be the first clue that a patient is a meth user
Table 2. Longer-term medical, psychological and oral conditions One hypothesis to explain the increased caries rate seen in
Medical and Pyschological Conditions Oral Conditions the meth user considers three factors – xerostomia, poor
oral hygiene due to lack of attention and inability to care for
Motorneurone problems Xerostomia
oneself, and a poor diet that often includes large quantities
Parkinson’s-like disease Rampant caries of soda drinks.19 These soda drinks typically have a high
Constriction of blood vessels, capillaries Attrition sugar content, and are highly acidic whether they contain
sugar or a sugar substitute; they are imbibed frequently by
Stroke Erosion
meth users to counteract dry mouth, leading to repeated
Sagging, gaunt skin with open sores Poor oral hygiene and frequent insults to the dentition, and contribute to ero-
Permanent brain damage Periodontal disease sion and increased caries.
Lowered immune status Oral ulcerations Figure 6a. Caries-free dentition in a 20-year-old
Malnutrition and anorexia Oral irritations
Liver damage Epithelial atrophy
Risk behavior Angular cheilitis
Paranoia and delusions Candidal infections
Violent behavior Dysgeusia
Mood swings and depression
Decreased sexual function (men)

Immunocompromised status Figure 6b. Rampant caries in same patient, associated with meth use
Long-term abusers have a lowered immune status and are
less able to fight off infections. In addition, these patients
are more likely than the general population to engage in
high-risk behaviors that could lead to infection with HIV.

Dietary conditions
Patients abusing meth are unable to take care of themselves.
Lack of appetite, vomiting and an inability to function nor-
mally can result in severe anorexia and malnutrition. Xerosto-
mia also causes compromised mastication and swallowing. Figure 6a and 6b courtesy of Dr. Mitchell Goodis

Oral conditions Figure 7. Cervical caries in meth user

Xerostomia, rampant caries, periodontal disease and in-
traoral infections are all commonplace and severe in the
meth user. Methamphetamine use causes damage to the
blood vessels supplying the salivary gland, leading to dam-
aged glands and reduced salivary flow. The results are ram-
pant caries, as with other severely xerostomic patients. The
pattern of caries in meth abusers is distinctive, frequently
presenting initially in the posterior buccal area followed by

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Figure 8. Periodontal disease in meth user a person of meth abuse. Early identification of meth abuse
results in earlier counseling and treatment and a better chance
of recovery. If a patient presents with rampant caries with no
other identifiable cause, such as another xerostomia-related
condition or habitual soda pop drinking in the absence of
xerostomia, or presents with sudden onset of periodontal
disease or a change in periodontal status and oral hygiene
habits, meth abuse should be considered and the patient care-
fully questioned. The presence of multiple oral ulcerations
and irritations in all patients, and epithelial atrophy in young
patients, is also suspect. The dental professional may also be
the first person to identify the skin lesions associated with
compulsive scratching, when a meth abuser arrives for an
Figure 9. Candida infection in a meth user emergency dental visit due to abscesses or pain (while users
might avoid visiting a medical professional, they might be
compelled to visit a dental professional for pain relief). Behav-
iors such as rapid pacing, restlessness and twitching, as well
as rapid eye movements, also suggest a possible meth abuse
problem. Meth abusers can feel threatened due to paranoia
and may become violent. It is therefore important to be cau-
tious when treating a patient you suspect or know is a meth
abuser and to avoid sudden actions or actions that the patient
may perceive as threatening.

Table 3. Signs and symptoms aiding early identification

Rampant caries that is otherwise unexplained
Periodontal disease of increasing severity occurs due to the Periodontal disease or periodontal status that has changed rapidly
patient’s inability to perform – or unwillingness to perform Oral ulcerations, irritations and infections
– regular oral hygiene. The same capillary constriction re- Epithelial atrophy in young patients
sponsible for cardiovascular effects and CNS events also re-
sults in poor blood supply to the periodontium and increased Beyond identifying abuse and referring the patient for coun-
periodontal disease and bone loss. This is compounded by the seling and medical treatment, the dental professional must
decreased resistance to infection experienced by these patients provide palliative care and, where possible, preventive and
and by HIV-positive patients. definitive care for the patient. It is important that this occur
only after consulting with the patient’s physician or medi-
Figure 10. Periodontal disease and caries in a meth user cal provider and, if possible, after initial medical treatment.
The meth user is an at-risk patient for medical emergencies
due to meth’s deleterious effects on the cardiovascular sys-
tem and other body systems. Long-term meth users have a
compromised cardiovascular system and cannot tolerate the
vasoconstrictors in local anesthetics – using these could result
in increased blood pressure, collapse or death.

Palliative and Preventive Care

Palliative care can be provided for pain, oral irritations and
ulcerations, periodontal conditions, and cavities. Patients
with abscesses should be treated only following medical con-
sultation; the usual result is extraction of the tooth or teeth.
Implications for the Dental Professional Antibiotics may be required to combat infection, particularly
Early identification of meth abuse given the lowered immune response of these patients. Unfor-
Given the highly visible and, in some cases, unique presen- tunately, meth users are resistant to local anesthetics, have an
tation of oral conditions in the meth abuser, the dental pro- increased risk of adverse events related to drug interaction and
fessional may be the first healthcare professional to suspect are less able to metabolize local anesthetics than the general

www.ineedce.com 5
population.21 These patients will require a larger than normal rinse should be prescribed or recommended (this avoids
dose of local anesthetic, without vasoconstrictors. If you are the drying effect of alcohol); available options include cetyl
unsure whether a patient has taken meth within the last 24 pyridinium mouth rinse and chlorhexidine mouth rinse.
hours, do not give local anesthetic as this could cause a severe Once the meth user has kicked the meth habit or addiction,
reaction. If general pain control is required, nonsteroidal anti- definitive oral care and treatment can be provided.
inflammatory drugs (NSAIDs) should be provided – avoid, if
at all possible, prescribing narcotics, as many of these patients Oral Care Counseling and Monitoring
will deceptively seek narcotics from dentists for their addic- Oral care counseling should include instructing patients in
tion.22 If narcotics are necessary to relieve pain, this must first oral hygiene and advising them to avoid soda pop and other
be discussed with the patient’s physician/medical team. high-sugar/low-pH drinks as well as sugary and complex
carbohydrate snacks. Patients should be encouraged to
Many meth users deceptively seek narcotics from drink water and other healthy alternatives, such as milk.
dentists to feed addictions Reinforcement of oral hygiene and motivational support
and counseling must be provided at regular intervals to the
Palliative care of oral ulcerations and irritations can include recovering or current meth user. These patients must be
the use of gels, pastes and rinses. Topical gels and pastes closely monitored and counseled by both dental and medi-
provide pain relief and, depending on what is used, can cal healthcare professionals to help prevent disease progres-
provide a bioadhesive coating locally over each ulcer or irri- sion and further damage, and to detect any signs of relapse.
tation. These are useful if irritations and ulcerations are not It is important to note that the medical and psycho-
extensive and if the patient has the ability and coordination logical effects of meth abuse may still be evident years after
to target the site of irritation. If irritations and ulcerations a patient has abstained from meth use, while some degree of
are more widespread, or if the patient lacks coordination, impairment may be permanent (in the case of cardiovascular
a rinse that provides a bioadhesive coating and pain relief accidents, severe and permanent). Recovering addicts also
can be used. Using a mix of Kaopectin and Benadryl in a 1:1 experience withdrawal symptoms that include depression and
ratio is also effective in providing pain relief and reducing mood swings, both of which further complicate the treatment
oral irritation. In severe cases, liquid corticosteroid rinses protocol, present difficulties for oral and medical self-care,
may be required; however, care should be taken to limit and can result in relapse and resumption of meth use. There
their length of use. Candida infections can be treated using are many sources of assistance for referrals (Table 4).
nystatin or clotrimazole.
Treatment of carious lesions can include the use of fluo- Table 4. Treatment and education resources
ride varnish to help prevent further demineralization and to
Treatment Resources
try to remineralize early lesions. Given the rampant nature
of caries in the meth user, the use of fluoride varnish as a www.CrystalRecovery.com
base, along with a temporary or intermediate restorative ma- Federal Government Directory of Information and Programs:
terial and self-adjusting glass ionomer that releases fluoride www.MethResources.gov
into the area may be required while the patient undergoes Substance Abuse & Mental Health Services Administration:
treatment for the addiction; this will provide pain relief (if www.samhsa.gov
present) and may help to restore some degree of function. Substance Abuse & Mental Health Services Administration
Rehab locations: http://dasis3.sarnhsa.gov/
Products that contain casein and calcium for remineraliza-
tion therapy can be helpful. The use of xylitol-containing Awareness and Education Resources
chewing gum is also helpful. Daily use of a fluoride mouth-
American Society of Addictive Medicine: www.asam.org
rinse or a prescription 5000 ppm fluoride dentifrice can help
prevent further lesion development. Frequently, preventive Just Think Twice
care is a staging process only – many patients with a meth KCI: The Anti-Meth Site
abuse problem ultimately lose their full dentition due to National Association of Counties - Meth Action Clearinghouse
destruction from rampant decay and periodontal disease at National Institute on Drug Abuse: www.drugabuse.gov/
the time of diagnosis, as well as due to ongoing neglect in MethAlertlMethAlert.html
patients in whom the condition was found at an early stage. Office of National Drug Control Policy - Methamphetamine Fact
Oral moisturizers and bioadherent coatings will help relieve Sheet:
the symptoms of xerostomia. www.whitehousedrugpolicy.gov/drugfact/methamphetamine/
Periodontal care should be provided – this could involve www.SayNOtoMeth.com
only oral hygiene instruction, gross debridement and the use
The Drug Enforcement Administration - Meth Information
of a chemotherapeutic mouthrinse to help prevent infection
and reduce microbial loads. Ideally, an alcohol-free mouth The National Alliance for Drug Endangered Children

6 www.ineedce.com
Summary 14 Zweben J, Cohen JB, Christian D, et al. Psychiatric symptoms
Meth use is a serious and growing problem in the United Methamphetamine users. Am J Addict. 2004;13(2):181-90.
States that results in psychological, medical and oral condi- 15 Virmani A, et al. Metabolic syndrome in drug abuse. Ann N
tions. The dental professional is in a position to aid in the Y Acad Sci. 2007 Dec;1122:50-68.
early identification and referral of meth abusers to medical 16 National Institute on Drug Abuse, InfoFacts: Meth­
professionals and counselors. The oral care of meth users amphetamine (Rockville, MD: US Department of Health and
requires consideration of the medical implications of their Human Services). Available at www.nida.nih.gov/infofacts/
habit, including possible drug reactions and adverse reac- methamphetamine.html. Accessed Nov. 9, 2006.
tions to anesthetics. Users experience xerostomia, rampant 17 Volkow ND, et al. Association of dopamine transporter
reduction with psychomotor impairment in methamphetamine
caries and periodontal disease, as well as oral ulcerations,
abusers. Am J Psychiat. 2001; 158(3):377–82.
infections and epithelial atrophy. Prior to treatment, con-
18 Timothy E Albertson, MD, PHD, et al. Methamphet­amine
sultation with the patient’s medical care provider or team is
and the Expanding Complications of Amphet­amines. WJM.
essential, and during treatment, dental professionals must
April 1999;170(4):214-9.
consider the psychological reactions and potentially violent
19 Shaner JW. Caries associated with methamphetamine abuse.
and aggressive behavior exhibited by meth abusers when
J Mich Dent Assoc. 2002 Sep;84(9):42-7.
they feel threatened. Dental professionals must alleviate
20 Rhodus NL, Little JW. Methamphetamine abuse and “meth
pain for the meth abuser and provide palliative and preven-
mouth.” Pa Dent J (Harrisb). 2008 Jan-Feb;75(1):19-29.
tive care until definitive oral care can be provided.
21 Murphy D. Wilmer S. Patients who are substance abusers.
NY Dent J. 2002; 68:24-7.
References 22 www.samhsa.gov. Accessed: Oct. 11, 2006.
1 Methamphetamine Abuse and Addiction. Research
Report. Available at: www.nida.nih.gov/ResearchReports/
Methamph/Methamph.html. Accessed April 26, 2008. Author Profile
2 Ibid. Noel Brandon Kelsch, RDHAP
3 Swanson SM, Sise CB, Sise MJ, et al. The scourge of Noel Brandon Kelsch is a freelance cartoonist, writer, interna-
methamphetamine: impact on a level I trauma center. J tional speaker and Registered Dental Hygienist in Alternative
Trauma. 2007 Sep;63(3):531-7. Practice. Her articles have been published in dental journals
4 Kelsch N. Meth Mouth and Dental Considerations. Calif and nursing trade magazines. Her passion
Dent Hyg Assoc J. 2007;22(2):16-27. for disseminating information on the oral
5 Methamphetamine Abuse and Addiction. Research effects of this devastating drug has taken her
Report. Available at: www.nida.nih.gov/ResearchReports/ from NBC news to ESPN. Her 15 years of
Methamph/Methamph.html. Accessed April 26, 2008. serving the needs of meth users has helped
6 Curtis, Eric K DDS, MAGD. Meth Mouth: Review of her to develop a comprehensive treatment
methamphetamine abuse and its oral manifestations. Oral plan and resources for health care provid-
Medicine, Oral Diagnosis, 2006, March-April, p. 125-129. ers. Noel has received many national awards including Colgate
7 Kelsch N. Meth Mouth and Dental Considerations. Calif Bright Smiles Bright Futures, RDH Magazine Sun Star Butler
Dent Hyg Assoc J. 2007;22(2):16-27. Award of Distinction, USA magazine Make a Difference Day
8 Colfax, Grant N. MD. Methamphetamine-The Scope of the award, and Presidents Service award. Noel is the current Presi-
Problem, Medscape HIV/AIDS, 2005;11(2) dent of California Dental Hygienists Association, a member of
9 Kashani J, Ruha AM. Methamphetamine toxicity secondary OSAP and board member of Simi Valley Free Clinic.
to intravaginal body stuffing. J Clin Toxicol. 2004;42:987-9.
10 Schifano F, Corkery JM, Cuffolo G. Smokable (“ice,” “crystal Acknowledgment
meth”) and nonsmokable amphetamine-type stimulants: The author would like to thank Multnomah County Sheriff’s Of-
clinical pharmacological and epidemiological issues, fice for Figures 3-5, and the DEA, CDC, Mayo Clinic and ADA
with special reference to the UK. Ann Ist Super Sanita. for Figures 7-10 respectively.
2007;43(1):110-5.
11 National Institutes of Health. Methamphetamine Abuse Disclaimer
and Addiction. National Institute on Drug Abuse Research The author of this course has/have no commercial ties with the
Report Series. NIH Publication Number 06-4210. providers of the unrestricted educational grant for this course.
12 Kiyatkin EA. Physiological and pathological brain
hyperthermia. Prog Brain Res. 2007;162:219-43. Reader Feedback
13 Methamphetamine Abuse and Addiction. Research We encourage your comments on this or any PennWell course.
Report. Available at: www.nida.nih.gov/ResearchReports/ For your convenience, an online feedback form is available at
Methamph/Methamph.html. Accessed April 26, 2008. www.ineedce.com.

www.ineedce.com 7
 Questions
1. An estimated _________ people, aged 12 c. posterior lingual area 25. Given the rampant nature of caries in
and over, have used meth at least once in d. none of the above the meth user, the use of __________may
their lifetime. 14. In the absence of another identifiable be required while the patient undergoes
a. 8.4 million cause, rampant _________ may be the first
b. 9.4 million treatment for the addiction.
clue that a patient is a meth abuser. a. a fluoride varnish base
c. 10.4 million a. erosion
d. 11.4 million b. a temporary or intermediate restorative material
b. caries c. a self-adjusting glass ionomer that release fluoride
2. Methamphetamines were originally c. oral lesions into the area
derived from _________. d. none of the above d. all of the above
a. diamphetamine
b. tri amphetamine 15. The poor diet of a meth user often 26. Many patients with a meth abuse problem
c. amphetaminase includes large quantities of _________. eventually _________ their full dentition.
d. amphetamine a. water a. keep
b. milk b. lose
3. Compared to cocaine, meth is _________ c. soda drinks c. value
and _________, and _________. d. all of the above d. none of the above
a. quicker acting; longer lasting; has a higher stimulant
effect 16. _________ results in poor blood supply 27. Definitive oral care and treatment can be
b. slower acting; longer lasting; has a higher stimulant to the periodontium and increased provided __________.
effect periodontal disease and bone loss. a. before the patient seeks counseling
c. quicker acting; longer lasting; has a lower and safer a. Capillary dilation b. at any time during the patient’s treatment for
stimulant effect b. Capillary constriction addiction
d. none of the above c. Capillary innervation c. once the meth user has kicked the meth habit or
4. Meth is classified as a _________ stimulant. d. none of the above addiction
a. Schedule I d. none of the above
b. Schedule II 17. The dental professional may be the 28. Oral care counseling should include
c. Schedule III _________ healthcare professional to
suspect a person of meth abuse. __________.
d. Schedule IV a. instructing patients in oral hygiene
a. last
5. Meth can be illegally and easily synthe- b. first b. advising patients to avoid soda pop and other
sized from ephedrine or pseudoephedrine c. intermediate high-sugar/low-pH drinks
through _________. d. none of the above c. encouraging patients to drink water and other
a. cortication healthy alternatives
b. distillation 18. Early identification of meth abuse results d. all of the above
c. fermentation in _________.
a. earlier counseling 29. Both dental and medical healthcare profes-
d. b and c
b. earlier treatment sionals must closely monitor and counsel
6. The immediate effect of meth use can c. a better chance of recovery
include _________. meth patients in order to __________.
d. all of the above a. help prevent disease progression
a. a flash or euphoria b. help prevent further damage
b. dilated pupils 19. Epithelial atrophy in young patients is c. detect signs of relapse
c. cardiovascular effects suggestive of _________. d. all of the above
d. all of the above a. heavy coffee drinking
7. Longer-term effects include _________ b. late menopause 30. The dental professional is in a position
conditions. c. meth abuse to aid in the _________ of meth abusers to
a. medical
d. none of the above medical professionals and counselors.
b. oral 20. It is important to _________when treating a. early identification
c. psychological a patient whom you suspect or know is a b. early referral
d. all of the above c. late identification
meth abuser. d. a and b
8. Meth abuse can result in _________. a. be cautious
a. a lowered immune response b. avoid sudden actions 31. Methamphetamine abusers experience
b. changes in dietary habits c. avoid actions that may be perceived as threatening _________ resistance to infection.
c. increased longevity d. all of the above a. increased
d. a and b 21. The dental professional should provide b. maintained
c. decreased
9. _________ events associated with meth use palliative care for the meth user _________ d. none of the above
can lead to death. consulting with the patient’s physician or
a. Diabetic medical provider. 32. The capillary constriction experienced by
b. Cardiovascular a. before patients with a meth abuse problem results
c. Ocular b. at the same time as in _________.
d. none of the above c. after a. cardiovascular effects
d. none of the above b. CNS events
10. Meth use results in _________. c. increased periodontal disease
a. a lack of blood supply to the skin 22. Meth users are _________. d. all of the above
b. chronically and severely itchy skin a. resistant to local anesthetics
c. gaunt and sagging skin b. less able to metabolize local anesthetics than is the 33. Palliative care of oral ulcerations and ir-
d. all of the above general population ritations can include the use of _________.
c. more likely to have an adverse event related to drug a. gels
11. Lack of appetite, vomiting and an interaction b. pastes
inability to function normally can result in d. all of the above c. rinses
_________ in meth users. d. all of the above
a. severe anorexia 23. Meth use patients will require ________.
b. a nervous tic a. a smaller than normal dose of local anesthetic, 34. Patients should be encouraged to drink
c. malnutrition without vasoconstrictors _________.
d. a and c b. a larger than normal dose of local anesthetic, without a. water
vasoconstrictors b. milk
12. ______ is commonplace in the meth user. c. a larger than normal dose of local anesthetic, with c. healthy alternatives
a. Rampant caries vasoconstrictors d. all of the above
b. Xerostomia d. none of the above
c. Periodontal disease 35. The medical and psychological effects of
d. all of the above 24. If possible, the dentist should avoid meth abuse may still be evident _________
prescribing _________ to patients with a after a patient has abstained from meth use
13. The pattern of caries in meth abusers is meth habit. their full dentition.
distinctive, frequently presenting initially a. aspirin a. weeks
in the _________. b. narcotics b. months
a. posterior buccal area c. treatment c. years
b. anterior cervical area d. all of the above d. none of the above

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 ANSWER SHEET

Methamphetamine Abuse – Oral Implications and Care

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Educational Objectives Academy of Dental Therapeutics and Stomatology,
1. Describe and recognize the short-term effects of methamphetamine use. A Division of PennWell Corp.

2. Describe the psychological, medical and oral consequences of long-term methamphetamine use.
P.O. Box 116, Chesterland, OH 44026
or fax to: (440) 845-3447
3. Describe the role of the dental professional in the early identification and care of methamphetamine abusers and addicts.
4. Describe the care that can be provided for oral conditions associated with methamphetamine use. For immediate results,
go to www.ineedce.com to take tests online.
Answer sheets can be faxed with credit card payment to
(440) 845-3447, (216) 398-7922, or (216) 255-6619.
P ayment of $49.00 is enclosed.
Course Evaluation (Checks and credit cards are accepted.)
Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0. If paying by credit card, please complete the
following: MC Visa AmEx Discover
1. Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No
Acct. Number: _____________________________
Objective #2: Yes No Objective #4: Yes No
Exp. Date: _____________________
2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0 Charges on your statement will show up as PennWell
3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Do you feel that the references were adequate? Yes No

9. Would you participate in a similar program on a different topic? Yes No

10. If any of the continuing education questions were unclear or ambiguous, please list them.
___________________________________________________________________

11. Was there any subject matter you found confusing? Please describe. 31.
___________________________________________________________________ 32.
___________________________________________________________________ 33.
34.
12. What additional continuing dental education topics would you like to see?
35.
___________________________________________________________________
___________________________________________________________________ AGD Code 157

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

AUTHOR DISCLAIMER INSTRUCTIONS COURSE CREDITS/COST RECORD KEEPING

The author(s) of this course has/have no commercial ties with the sponsors or the providers of All questions should have only one answer. Grading of this examination is done All participants scoring at least 70% on the examination will receive a verification PennWell maintains records of your successful completion of any exam. Please contact our
the unrestricted educational grant for this course. manually. Participants will receive confirmation of passing by receipt of a verification form verifying 2 CE credits. The formal continuing education program of this sponsor offices for a copy of your continuing education credits report. This report, which will list
form. Verification forms will be mailed within two weeks after taking an examination. is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for all credits earned to date, will be generated and mailed to you within five business days
SPONSOR/PROVIDER current term of acceptance. Participants are urged to contact their state dental boards of receipt.
This course was made possible through an unrestricted educational grant. No EDUCATIONAL DISCLAIMER for continuing education requirements. PennWell is a California Provider. The California
manufacturer or third party has had any input into the development of course content. The opinions of efficacy or perceived value of any products or companies mentioned Provider number is 4527. The cost for courses ranges from $49.00 to $110.00. CANCELLATION/REFUND POLICY
All content has been derived from references listed, and or the opinions of clinicians. in this course and expressed herein are those of the author(s) of the course and do not Any participant who is not 100% satisfied with this course can request a full refund by
Please direct all questions pertaining to PennWell or the administration of this course to necessarily reflect those of PennWell. Many PennWell self-study courses have been approved by the Dental Assisting National contacting PennWell in writing.
Machele Galloway, 1421 S. Sheridan Rd., Tulsa, OK 74112 or [email protected]. Board, Inc. (DANB) and can be used by dental assistants who are DANB Certified to meet
Completing a single continuing education course does not provide enough information DANB’s annual continuing education requirements. To find out if this course or any other © 2008 by the Academy of Dental Therapeutics and Stomatology, a division
COURSE EVALUATION and PARTICIPANT FEEDBACK to give the participant the feeling that s/he is an expert in the field related to the course PennWell course has been approved by DANB, please contact DANB’s Recertification of PennWell
We encourage participant feedback pertaining to all courses. Please be sure to complete the topic. It is a combination of many educational courses and clinical experience that Department at 1-800-FOR-DANB, ext. 445.
survey included with the course. Please e-mail all questions to: [email protected]. allows the participant to develop skills and expertise.

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