Severe Dental Issues
About a year ago, I had the pleasure of seeing a patient who presented me with severe dental issues like gross decay in almost all his teeth with advanced periodontal disease. He came to my office asking me to remove all his teeth and replace them with dentures. He was also interested in getting a few implants for anchoring the dentures for more stability. He was looking for a quotation on the fees for the above treatments. He has suffered from severe depression since his injury a few years ago, which renders him having difficulty walking and with constant pain in his left side down to his left leg. He had neglected his teeth because he thought they could not be saved and needed to be extracted for dentures. He had some missing teeth and molars; the remaining teeth are stained black and have severe decay. The patient appeared to have past drug-induced dental problems that caused teeth damage and gum disease. In dental terminology, we like to coin the word meth mouth, which describes the general dental conditions of patients who use methamphetamine. It is also called ice, crystal meth, glass, shards, or puff. Patients who use methamphetamine have severely eroded stained black teeth because the drug is very acidic. In addition, It causes dry mouth and teeth grinding. The situation is also compounded by poor diets (high sugar intake) and poor oral hygiene practices by the patients on the drug. With all the conditions caused by the drug, all the patients on it have severe tooth decay in a very short amount of time.
Some other medications and substances that can cause similar drug-induced dental problems are listed here:
- Cocaine is also called coke or blow. If the users rub cocaine over their gums, it can cause ulceration of the gums and the underlying bone because of its high acidity, especially after mixing with saliva. The acid from the melted cocaine erodes tooth enamel and exposes the underlying dentine to decay-causing bacteria. They also cause dry mouth and teeth grinding (bruxism), increasing tooth decay risk and wear.
- Ecstasy is also called the love drug, E, eckies, pingers, or caps. It is a derivative of methamphetamine, and the side effects on the teeth are similar.
- Heroin is also called smack, horse, or hammer. It can cause dry mouth and teeth grinding. People who use heroin tend to crave sweet foods, increasing the risk of tooth decay.
Upon examination and objective observations, I established that he had no past drug-induced dental problems. He likely had an acidic diet from excessive coffee drinking, compounded by acid reflux. He also smoked cigarettes and vaped. Smoking joints and tobacco do have adverse effects on oral health. Marijuana can cause dry mouth craving for carbohydrates, while smoking cigarettes and joints can cause gum inflammation and delay tissue healing, not to mention teeth staining.
Paradoxically, coffee, although slightly acidic, has an antibacterial effect and hence can prevent dental cavities because it inhibits the growth of Streptococcus mutants, the bacteria responsible for dental decay.
After reviewing his medical history, knowing he does not do drugs, and realizing he was motivated, I felt he was a good candidate for an oral health makeover. He was motivated, but he did not have a lot of disposable income. He is living on his own and is on Disability Support Program. He could choose a few options to restore his oral health.
- The first option was to remove all the hopeless teeth, perform endodontic treatments on the teeth with a bacterial infection in the pulps, place crowns and veneers on the endodontically-treated and severely decayed teeth, and place fillings in the teeth with lesser cavities.
- The second option was to do all the procedures outlined in the first option and to place implants with crowns on them to replace the missing teeth.
- The third option was to do all the procedures outlined in the first option but to have removable partial dentures to replace the missing teeth.
- The fourth option was to remove most or all the teeth and replace them with dentures.
- The fifth option was to remove most or all the teeth and replace them with implant-supported dentures for additional stability and retention.
- The last option was to do all the procedures outlined in the first option except the crowns and veneers. All the teeth were strictly restored with composite resin fillings only.
After going through all the pros and cons of the six options, the patient decided to have the last treatment option. He could not afford to pay for the implants, crowns and bridges. Paying for the costs would create an extra financial burden on him, potentially creating mental stress that could further deteriorate his health. He could use the money on healthy foods and other medical necessities for his wellness, like a wheelchair.
Knowing that having his functional teeth would be a far better option than any dental prostheses, I checked his teeth carefully to make sure the teeth to be extracted were truly hopeless in prognoses. Fortunately, only one tooth was deemed unsavable by me using the most stringent criteria.
I restored the rest of his teeth, even the most challenging ones that generally would be considered hopeless, with endodontic treatments and composite resin restorations. Besides, all of the dental treatments were covered by his Disability Support Program dental benefits. The patient could spend his scarce money on other necessities.
The results of the restorations using fillings and bondings only are not perfect, but they are very close to the much more expensive alternatives. The patient could retain almost all of these teeth when he arrived at my office a year ago without spending his savings. He could smile and feel confident about himself.
He has been working toward improving his mental health and social life. He is actively seeking treatment for his chronic pain due to job-related injuries ten years ago. I am also trying to find out if there is a sleep-related breathing disorder that could exacerbate his other comorbidities. He was also advised not to drink too much coffee, which could cause sleep disturbances and teeth erosion. A smoke cessation program has been initiated with him. Whether it’s a history of neglecting dental hygiene or past drug-Induced dental problems, I provide a holistic approach to treating my patients and try to help them regain their beautiful smiles.
Before the treatments
After the treatments with white fillings only. No expensive crowns, bridges, implants, and veneers.