To the Editor: Single case reports of “meth mouth”, similar to that recently published in the Journal,1 exaggerate the dental problems surrounding the use of methamphetamines. Evidence that methamphetamines cause grinding and wear of teeth,2 xerostomia,3 and cravings for sweet drinks is weak. The drug use reported by Shetty was intravenous or intranasal, not oral. While systemic effects may contribute to dental problems, local oral effects associated with acidity of methamphetamines would be minimal with intravenous or intranasal drug use.

A more plausible explanation for dental disease may be the years of neglect, trauma and poor diet experienced by many people who use drugs.4 Many drug users begin using as early as 14 years of age and consume multiple illegal psychoactive and legal antipsychotic and antidepressant medications associated with xerostomia. A comprehensive drug-use history is required before dental problems are attributed to one drug.

Advising treating dentists to avoid the use of analgesics is misinformed and potentially leaves patients in severe pain unnecessarily. People affected by methamphetamines are unlikely to seek dental or medical treatment. A more likely scenario is presentation because of pain between methamphetamine binges, or presentation when they are taking stock of their health problems. At such times, they are unlikely to be affected by methamphetamines, which generally have short half-lives. At these times, non-steroidal anti-inflammatory drugs, nitrous oxides, narcotics (including codeine) or increases in methadone dose may be needed to manage pain. Analgesic depressants are not contraindicated unless other illicit or licit depressants are being used concurrently, as depressants work on different receptors and areas of the brain than amphetamine-type stimulants. Careful discussion with the patient and the patient’s general practitioner or alcohol and drug specialist is critical in balancing the need for pain relief with the potential for drug interactions and even overdose, if the patient is taking other depressants (legal or otherwise).

Practitioners can contact a 24-hour drug information line for health professionals for information of this kind in most Australian states and territories (Box).