Dental Team Considerations

1. The dental team is urged to become educated on the signs and symptoms of meth use as well as the precautions required when treating a meth abuser.

2. When methamphetamine use is suspected, the dental professional needs to thoroughly document a comprehensive medical history and dental history.

• Determine the personal and family history of drug use

• Current medications

• Smoking status

• Alcohol use

• Illicit drug use (frequency and administration of substance)

3. Complete and thoroughly document a comprehensive intra and extra oral exam.

• Physical results of drug use.

• Express concern regarding the dental findings.

4. Review the Prescription Monitoring Program for your state (PMP) registry before issuing any controlled substance prescription, including for stimulants. Consider the patient’s controlled substance histories in determining whether and what to prescribe. The dental practitioner should avoid narcotic analgesics and recommend instead non-steroidal anti-inflammatory drugs to treat dental pain.

• For pain control in dentistry the first drug of choice is an anti-inflammatory such as ibuprofen.

• Use acetaminophen with caution as the user may have compromised liver function due to detoxification of meth and high body temperatures resulting from meth use.

5. Because this drug affects every organ in the body it is important to refer the patient for a complete physical including a blood panel before the treatment begins.

6. Caution should be used when administering local anesthetics, sedatives, general anesthesia or nitrous oxide. These treatments could cause severe or fatal hypertensive episodes or cardiac arrhythmias. Methamphetamine abusers typically are resistant to local anesthetics, have an increased risk of adverse events related to drug interaction and are less able to metabolize local anesthetics than the general population. These patients will require a larger than normal dose of local anesthetic, without vasoconstrictors. If you are unsure whether a patient has taken meth within the last 24 hours, do not give local anesthetic as this could cause a severe reaction.

• Do not administer nitrous oxide until appropriate lung function has been determined by a primary health care provider.

• Do not prescribe medication or use anesthetic until appropriate kidney and liver function has been determined by a primary health care provider.

• Do not administer epinephrine or prescribe narcotics until cardiovascular status has been determined.

7. Provide appropriate and safe treatment. The dental practitioner should deliver stigma-free care by withholding judgment about patients’ substance use.

8. Suggest relief options for the discomforts associated with xerostomia. These could include salivary stimulants (sugar free gum, adhesive discs, gels), or pharmaceutical salivary stimulators.

9. Encourage consumption of water, rather than sugar containing carbonated beverages.

10. Educate the patient about the various risks associated with meth or other illicit drug use.

11. Demonstrate and encourage proper oral hygiene instruction including brushing and flossing. Provide nutritional counseling and information regarding dietary restrictions. Encourage the use of xylitol containing products.

12. Consider employing preventive measures such as topical fluorides, silver diamine, glass ionomers, and/or daily prescription fluorides. Materials containing fluoride may offer some protection until the patient is in recovery and enough time has passed to determine the outcome of use.

13. Temporary crowns, bridges, and veneers can be utilized to give the patient a temporary “smile” until definitive treatment can be delivered.

14. The American College of Prosthodontics recommends postponing prosthodontic treatment until the patient is no longer dependent on stimulants, is emotionally stable, and is motivated.

15. Involve the patient’s physician, drug counselor, pastor or probation officer in treatment decisions including pain management, appointment considerations, etc.

16. Have contact information for a local physician, clinic, or substance abuse rehabilitation facility available and be familiar with their protocol.

17. Make sure that the office/clinic is prepared for a medical emergency. Update medical emergency kit, and review and practice emergency procedures in the office.

18. If it is suspected that a child is living in the environment of a meth lab, reporting of this suspected child endangerment is mandatory.