of the California Dental Hygienists` Association

Journal
of the California
Dental Hygienists’
Association
Volume 22, Number 2
Winter 2007
In this issue…
ADHA Continues to Move Our
Profession Forward
RDHAP Journey
Meth Mouth & Dental Considerations
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© 2006 P&G
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“Advancing the art & science of dental hygiene”
In this issue of the…
Editor
Liz Moore, RDH, BS, MSEd
Associate Editor Linda Cryan, RDH
Advisory Board Cathy Draper, RDH, MS
Debbi Frolove, RDH
Holly Knauft, RDH
Gail Starr, RDH
Contributions of scientific and original articles.
The Journal of the California Dental Hygienists’ Association is formatted by and published under the
supervision of the Editor. The opinions expressed or
implied in this publication are strictly those of the
authors and do not necessarily reflect the opinion,
position or official policies of the CDHA nor are
claims or statements by authors verified.
The only permission granted for photocopying or
storage of items is for personal use, or the use by
libraries; all other uses require the written permission
of the Editor or President. CDHA reserves the right
to illustrate, reduce, revise or reject any manuscript
submitted. Articles are considered for publication on
condition they are contributed solely to the Journal.
Contributors are notified within 90 days if a manuscript is accepted for publication.
Correspondence should be addressed directly to:
• E-mail
[email protected]
• Fax
916-797-1852
• Mail
86 Hancock Dr.
Roseville, CA 95678
Display and classified advertising. The California
Dental Hygienists’ Association does not assume
liability for contents of advertisements. Inquires regarding display advertising should be directed to:
Shanda Wallace, RDH
611 Bristol Ave., Stockton, CA 95204
[email protected]
info available @ cdha.org
Copyright 2006 by the California Dental Hygienists’
Association. The Journal is published on a regular
schedule by the California Dental Hygienists’ Association. Subscription rate is $12 for all active members
of the Association, $25 for non- members. All change
of name or address should be sent to:
California Dental Hygienists’ Association
505 N. Brand Blvd., #740
Glendale, CA 91203
818-500-8217
FAX 818-247-2348
E-mail: [email protected]
Internet: http://www.cdha.org
Journal
of the
California Dental Hygienists’ Association
President’s Message:
Professional Evolution
Susan McLearan, RDHAP, MS ......................................... page 3
On the Road with Coast Smiles on Wheels
Maureen Titus, RDHAP .................................................... page 6
SADHA Members Learn from Leadership Visits
Kristy Menage Bernie, RDH, BS ...................................... page 9
ADHA Continues to Move Our Profession Forward
Katie Dawson, RDH, BS.................................................. page 14
Home Study Course:
Meth Mouth & Dental Care Considerations
Noel Kelsch, RDH ............................................................ page 16
Random thoughts...
Liz Moore, RDH, BS, MSEd
A Biz Update
The Three Stages of a Scientific Theory
Stage 1: It is scoffed at and met with disbelief.
Stage 2: It is accepted as true but insignificant and trivial.
Stage 3: It is thought to be correct and even revolutionary. In fact, those
who criticized it most now claim that they invented it and are the
experts.
–Anonymous
I was struck by the quotation above from the
new book by Dr. Robert Marx, Oral & Intravenous Bispohophonate-Induced Osteonecrosis of the
the Jaws. In his excellent new book, he recounts
having experienced just this set of circumstances. He relates, “When I issued a medical
alert that described modern-day intravenous
bisphosphonate-induced exposed bone that
failed to heal and even worsened with surgical debridements, the reality of the condition
was almost universally denied and the report
widely disbelieved.” He states it was not until
his colleague Dr. Salvatore Ruggiero published
a report of cases he had seen, followed by other
smaller reportings by other clincians, the reality could no longer be denied.
Dr. Marx is viewed as a leader of the oral surgery community, and I’ve heard surgeons say,
“If Bob Marx says it’s so, that’s good enough
for me.” So when I researched the article on
Bisphosphonates published in our Fall CDHA
Journal, I was astounded to see that dental
organizations and individuals were saying
we see a correlation but no direct link between
the IV use of this medication and this disease.
Even more interesting was the fact denial
that oral bisphosphonates were even to be
considered as a potential problem. I kept asking myself – what does it take to say there’s a
definite link? Egads!
When I first went online to the OsseoNews
blog last fall, I printed out 3 pages of comments
by dentists and concerned individuals. These
people were saying, regardless of the published studies and the stated positions of the
2
pharmaceutical company panel, they were seeing patients in their offices with symptoms of
ONJ following 4-5 years of oral bisphosphonate
use. Three months later, I returned to that site
and printed out 8 pages of similar comments,
with increasing number of contributors saying
they have patients exhibiting these symptoms.
I found that telling.
In his book Dr. Marx devotes an entire chapter to cases of oral bispohphonate induced
ONJ. He states on page 77 “In general, cases
of osteonecrosis of the jaws induced by oral
bisphosphonates differ dramatically in three
significant ways from those induced by intravenous bisphosphonates. First, a longer period
of exposure to the bisphosphonates is necessary
before exposed bone develops. Second, the
amount of exposed bone is smaller and the
symptoms are less severe. Third, discontinuation of the oral bisphosphonate may lead to
gradual improvement and even spontaneous
healing of the exposed bone, which is also more
responsive to local debridements after about 6
months to 1 year.”
I urge clinicians to get a copy of this book to
learn more about this issue, to be in the best
position to help their patients. In my opinion it
is the best book available with excellent drawings, case photos, and written so the complicated science is understandable. Published by
Quintessence Publishing, it can be found on
their website at www.quintpub.com.

CDHA Journal
Vol. 22, No. 2
Professional Evolution:
Neither unique, radical nor impractical
Susan McLearan, RDHAP, MS
CDHA President
I
n 1914 when the very first class of 27
women graduated from Dr. Fones’ School
things were a bit different in many ways than
they are today.
• The equipment and supplies for their 40 week
course came to a whopping $172.20.
• Only women were allowed to study dental
hygiene (true until 1964)
• Women did not yet have the right to vote
In a report on the Bridgeport clinic
recorded in The History of the
American Dental Hygienists’ Association 1923-1982, Fones said,
“this work in the schools is essentially woman’s work, and
is the great field for the dental
hygienist, to whom it open up
paths of usefulness, activity and
inspiration hitherto undreamed
of, allying her with the workers
of the world who are helping
humanity in masses.”
The hygiene preventive clinics in the Bridgeport schools
compared very favorably with
“relief and repair” clinics. The woman’s work,
as reported by Fones, proved to be statistically
significant in reducing dental disease.
The first DH graduates referred to themselves as
pioneers and in some ways parallels can be drawn to
the suffragettes pioneering efforts to obtain the vote
for the half of the population to which it had been
denied.
In the struggle for the 19th Amendment, a few people,
women and men, passionately pursued rights for all.
We are very fortunate the suffragettes did not abandon their goal – even though they did not have full
support. It was a long effort, some 72 years, but the
endeavor was finally successful.
The lack of full support and the
reality of staunch opposition are
as true for dental hygiene as it
was for the people who fought
for the vote.
Even though women hold a
monopoly in dental hygiene (another situation that must end),
this is not a gender issue. This is
a power issue.
Do we want to be dentists? Not I.
Or, do we want power over our own
scope of practice? And, yes, some of us will
want to develop additional competence and
extend our scope to better serve the public’s
identified needs.
Nurses, Occupational and Respiratory Therapists
have all gained independence before us. Our goal of
con’t on page 4
CDHA Journal
Vol. 22, No. 2
3
self determination (self regulation) is not unique.
These health care providers have served the public
well, providing care that is both more cost effective
and practical than leaving every health care duty
to the medical doctor. All of these professions are
self regulated.
There will be those who choose to take a passive role.
We must wish them luck.
The same will hold true for the dental profession.
Mid level, self-regulating practitioners must be
legalized to serve the need. Ignoring the need and
creating road blocks for proven solutions should
not be acceptable. Why do we allow it?
Abstract thought and dreams are what separates us
from lower animals. Let’s each develop our own mission and goals rather than waiting until our role finds
us or allowing ourselves to be swept up in someone
else’s dream.
In the 21st Century, dental hygienists must take a
more active role on the path to professionalism.
The world is too complicated and in many cases,
too corrupt to leave leadership to the few, or even,
to someone else.
These are extraordinary times and such times demands extra ordinary behaviors from each of us.
The rest of us must overcome our fear of taking a
stand and begin taking a leadership role in the delivery of health care.
Having a mission in life, a vision for ones’ future is
having a dream with teeth.

CDHA “Anything is Possible” Raffle!
2 Prizes to be Awarded
Grand Prize ~ $2,000 Gift Voucher
2nd Prize ~ Dentsply SofTip Implant Insert
$10.00 voluntary donation per ticket
Only 2,000 tickets will be sold!
Drawing at the conclusion of the CDHA House of Delegates ~ June 10, 2007
Winner need not be present to win
Proceeds to benefit CDHA, a non-profit organization,
Advancing the art & science of dental hygiene
Tickets on sale now!
See your Component Trustee Or CDHA Leader
4
CDHA Journal
Vol. 22, No. 2
CDHA Presents...
Spring Scientific Session 2007
“Drugs, Herbals and Nutraceuticals: New Issues for Dentistry”
Featuring
Dick Wynn, Ph.D
Friday, May 4, 2007
Up to 6 CEUs ~ Category I
7:30 a.m. - 4:00 p.m.
Exhibits, Table Clinic Session, C.E. Course
The Sheraton Park Hotel, 1855 S. Harbor Boulevard
Anaheim, CA (714) 750-1811
(Parking ranges from $6 ~ $12)
• This course will present a mix of the most recent reports describing conventional drugs, herbal supplements and nutraceuticals
having impact on dental practice. For conventional drugs, the aspirin and Plavix patient will be discussed, newly approved dental
drugs and products described including those for RAU, herpes labialis, new dentifrices, “remineralization” dentifrices, OTC
whitening/bleaching agents; Halcion and the new Z-drugs for sedation; articaine and paresthesias, the most recent FAQs on
antibiotic prophylaxis presented, the latest on heart attacks, CRP, homocysteine levels and periodontal disease discussed including
antibiotic use and increased risk of breast cancer; and life after the Vioxx fiasco.
By the completion of the course, each participant should be able to:
•
•
•
•
•
•
List the new dental drugs and dental herbal products with their proven effectiveness and ineffectiveness
Describe the concept of free radicals and antioxidants and review their uses in medical and dental conditions
Outline those medical and dental conditions in which nutraceuticals have been show to be effective and those not effective
List the key considerations in treating the patient on antiplatelet therapy
Describe the most recent theory on the relationship between CRP, gingivitis and heart attacks
List the safety concerns by the medical profession about herbal use in patients and effects on surgery and recovery, including herbs
that cause bleeding
Supported Through
Educational Grants From:
Table Clinics Supported Through an Educational Grant From:
Payment Information:
Mail Registration Form and
�Discover Card �Master Card �VISA �Check payable to CDHA
payment information:
Credit Card# _________ -_________ -________ -_________ Expiration:___________
Name on Card:________________________________________ 3 Digit Code___________
Signature:__________________________________________________________
California Dental Hygienists’ Association
505 North Brand Boulevard, Suite 740
Glendale, CA 91203-3948
(818) 500-8217 • (818) 247-2348 FAX
[email protected] www.cdha.org
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Name:
Telephone:
Address:
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City:
State:
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mber S
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pecial!
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217
Fee Schedule (includes course, morning refreshments, Postmarked
After 4/20/07
by 4/20/07
and On-Site
lunch, table clinics, and exhibits)
� ADHA Member ............................................................. $130.00 ............ $150.00
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CDHA Journal
Vol. 22,Refund
No. 2 Policy: A refund will be made if the reservation is canceled by 5 p.m. on April 27, 2007
NO CONFIRMATION WILL BE SENT
5
sss07pm
ON THE ROAD WITH
COAST SMILES ON WHEELS...
A JOURNAL - Chapter Two
by Maureen Titus, RDHAP
Photo courtesy of Char Bruzenak.
T
his is the next chapter on my road trip
or journey which I began to share
with you several months ago. Speed
bumps have been encountered along the way
as well as new directions.
In January of 2006, I applied for the Denti-Cal
provider number with forms I downloaded
from their website, then waited. After a few
weeks, I received a large packet of forms from
Denti-Cal to, again, complete and return to
them for a provider number. I then made a
phone call and asked the representative at
Denti-Cal what had happened to my previously submitted forms and I was informed the
website forms were outdated and no longer
accepted. Of course I inquired as to why they
were still on the website, wasn’t that confusing to future providers? I finally received my
provider number in April, 2006.
While waiting for the Denti-Cal approval, I
began the process of purchasing instruments
and other supplies I would need. I sought the
advice of experienced RDHAP’s for recommendations of portable equipments to use.
It was suggested that I wait to buy the more
advanced units after I started my practice to
learn what I would really need. Many of the
residents in skilled nursing facilities (SNF)
would not like the loud sounds the compressor or vacuum would produce. I decided to
go with the low key approach to begin with,
since I was funding my business without a
loan, only my savings. One of my funding
sources was my little car, which had many
miles on it, and I was concerned it was ready
to leave me stranded. I sold it to a friend for
her daughter, however her husband liked it so
much it’s now his car.
6
The need to create a final brochure to promote my business
was my next project. I had the business class I attended give
me feedback on the draft version. Some graphics I had selected were removed and a more concise brochure evolved.
After printing, I began to distribute my brochures to various individuals and groups involved with SNF’s or home
health care agencies. Because the RDHAP is an unfamiliar
position to many people, I spent additional time explaining and discussing my services at the time I presented my
brochures. A physician who has many patients in one of
the local SNF was thrilled about my business, saying she
would write all the medical orders I needed.
From that encouragement I proceeded to schedule a meeting with the social service director at the SNF to explain the
dental hygiene care I could provide for the residents. She
seemed very interested and said that she would discuss the
idea with the administrator. I had also learned that there
was a dentist who had a mobile practice and was seeing
the residents at this SNF. I finally received a phone message from the director and was told that the administrator
decided that it could be a conflict of interest to promote me,
since the dentist also provides oral health care and they
cannot afford to have him be upset and stop coming to the
SNF. The SNF’s are required to contract with a dentist to
provide dental care and there are very few dentists willing
to treat this population. While I understand the facility’s
concerns, it also is a concern that a dentist can block a
RDHAP from providing preventive oral health care.
In October, 2006 I received my first referral from a dentist
in San Luis Obispo to see a long time patient of his at the
very same SNF I mentioned above. A dental hygienist
friend works for the referring dentist and she suggested
that I could travel to his bedside for dental hygiene care.
What a great way to start!!! I met with the patient and his
family then made plans to provide a prophylaxis for him.
I stopped by the social service director’s office to inform
her I would be seeing a resident the following week. When
the family or a referring dentist requests a RDHAP to
CDHA Journal
Vol. 22, No. 2
treat a specific person, the SNF cannot refuse
the request.
I have met with the nursing director in another
private Alzheimer’s care facility at the request
of a family member who brings her mother
into one of the private offices where I practice.
The nursing director was very enthusiastic and
wanted to print my brochure in their newsletter that is sent out to families of the residents.
The same dentist I spoke of earlier also sees this
facility’s residents and his fee for a prophylaxis
is less than what I would charge. That could be
a concern; however, I will continue to promote
my services for the skills I possess.
After awhile I decided to write this particular
dentist a very nice letter introducing my self
and suggested we could collaborate our efforts
to provide access to dental care for these underserved SNF residents. I did copy the president
of the local corporation who owns several of
the SNF’s that the dentist contracts with, as
well as Ron Mead, a respected oral surgeon
from San Luis Obispo and the current president of California Dental Association (CDA).
To date the only person who has contacted me
regarding this letter is Ron Mead. I have left
several messages with the dentist but have
had no response. Although the president of
the corporation has not spoken with me yet, I
do plan on connecting with him.
I was recently told by several attending San
Luis Obispo dentists and our CDHA officers
that during the 2006 CDA House of Delegates,
newly installed President Ron Mead spoke in
support of RDHAP’s within California. At a
recent lunch meeting with him, we discussed
my local concerns as well as the problems
many RDHAP’s in California are facing. He
has given me permission to quote him on
thoughts contained in his installation speech
regarding RDHAP’s . He is aware of our efforts
to be accepted as providers in SNF’s and how
many of us have met resistance from the staff
dentists. He stated in his speech at CDA, “ it
would be ideal if the residents were receiving
regular care from a dentist but I don’t believe
this is the case”.
On the RDHAP/DDS collaboration issue,
Dr. Mead’s comments included, “If a patient
chooses to see a RDHAP, the dentist should
communicate the patient’s need to the RDHAP.
The patient may not be one of the most consistent patients. Ask the RDHAP to stress the
need for a complete exam and treatment plan.
If there is a good working relationship it will be
CDHA Journal
Vol. 22, No. 2
mutually beneficial. Keep them as part of your dental team. Don’t force
them to be independent by your unwillingness to work with them. We
must make the relationship as smooth as possible. Remember, we are
moving forward, together.”
I do not believe CDA can “force” change upon any dentist who is unwilling to accept change, even with encouragement from their President.
I do believe his comments to the House of Delegates are sincere and a
step in the right direction. Access to oral health care, which can benefit
many people in our communities, is a long term goal for me. RDHAP’s
and DDS’s must work together for access to become reality. There can
be a new approach with AB 1334, allowing RDHAP’s to provide care
for 18 months before a formal prescription is required.
Since the SNF’s have presented me with a “speed bump,” I have a
meeting in one week with a local care facility where developmentally
disabled individuals live. I know there are many facilities and individuals that can benefit from preventive oral health care which I can provide.
These challenges will not stop me from continuing to pursue my goal.
Dental hygienists are more than willing to collaborate with all health
care professionals, however, there still seems to be fear or unwillingness
with too many dentists to achieve this collaborative state.
The future is unknown, however, I will share my journey or road trip
with anyone who wants to listen.

A Tribute
At this time I would like to honor a special man who encouraged
me to pursue a goal. To hold my license as a RDHAP I am required
to have a relationship with a dentist, who could be called upon
for consultation, emergencies and referral. During the fall of 2005
I asked Robert Campbell, DDS, to be my dentist of record and he
was more than willing to be that person.
“Dr. Bob,” as he was referred to by patients, practiced with Ron
Barbieri, DDS, in San Luis Obispo. He appreciated and supported
the idea of thinking “outside of the box” to provide dental hygiene
care to people in a non- traditional setting.
Unfortunately, Bob had been fighting colon cancer for almost 3
years, yet he was still treating his patients between chemotherapy
treatments. What an amazing strength of character and commitment to his profession. There were days you could tell he wasn’t
feeling well, but when asked,; he would only say he was “feeling
pretty good today.” I work at Ron Barbieri’s office on Mondays,
and knowing that it wasn’t my favorite day of the week, Bob
would always say, “Happy Monday!” to me. Sadly, he lost his
battle with colon cancer on December 5, 2005, and the loss for his
wife and their three children was devastating. His patients, and
those of us who were fortunate enough to have known him, will
always be grateful for his kindness, compassion, sense of humor
and love of people and God.
7
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8
CDHA Journal
Vol. 22, No. 2
SADHA
Members
Learn from
Leadership
Visits
by
Kristy Menage Bernie, RDH, BS, RYT,
SADHA Council Chair
Cerritos SADHA members show
their enthusiasm and camaraderie.
Programs Take Advantage of
CDHA Leadership Visits
CDHA Announces the Annual
SADHA Regional Conferences
CDHA has always appreciated our future colleagues and supports dental hygiene students
through a variety of programs. One program
that has received rave reviews is the CDHA
Leadership Program Visits. This program
provides students one-on-one access to CDHA
leaders. Topics are tailored to each program as
requested. Schools have gone as far as creating
a full SADHA event with updates, fund raising
review and establishing the year’s goals.
Put these on your calendar:
CDHA has enjoyed this outreach program, and
been able to access nearly all students and faculty at these schools. We look forward to these
future colleagues becoming active members of
ADHA/CDHA!
February 3, 2007
Concord Hilton, Concord, CA
February 4, 2007
Radisson Hotel, Culver City, CA
These events will feature a presentation regarding employment options within the profession.
Co-sponsored by Philips/ Sonicare, this popular annual event will include the opportunity
for students, faculty and CDHA leaders to network and visit with exhibitors and each other.
Registration information can be found online
at: http://cdha.org/sadha/index.html
con’t on page 10
CDHA Journal
Vol. 22, No. 2
9
CDHA Announces the 2007
Cora Ueland Scholarship Essay
Competition
The California Dental Hygienists’ Association
is pleased to announce the 6th annual Cora
Ueland Scholarship for dental hygiene students. This scholarship was first established
as a fund in the 1950’s in the memory of Cora
Ueland, founder and director of the dental
hygiene program at the University of Southern
California. Supported by individual and component donations, the fund was distributed
in recent years as a loan to eligible students.
In 1998, the CDHA Board of Trustees voted to
convert the loan into a scholarship. Two $1,000
awards will be awarded to one (1) first year
and one (1) second year student. Applications
must be postmarked by Feb. 15, 2007. Application and information are located online at:
http://cdha.org/sadha/2007_cu.htm
Students from District XI
(California & Arizona) are invited
to apply for the District Student
delegate position!
STUDENT DELEGATE & ALTERNATE
DELEGATE
Students have a unique opportunity to apply
for a position as Student Delegate or Alternate Student Delegate. As a Student Delegate,
you not only represent all student members
of ADHA, but
you also sit on
the House of
Delegates floor
during all three
meetings. In
addition, during the Student
House of Representatives,
student delegates elect one
Voting Student
Delegate who
votes on behalf
of all SADHA
members.
Amber McCoog, Alternate Student Delegate(L),
Shanda Wallace, Student Mentor and Allie Witt,
Student Delegate (R) at the ADHA Annual Session
where students participated and learned.
10
Student delegates and alternates are funded
to attend their district workshop and ADHA’s
Annual Session. Funding consists of airfare,
lodging (two students per room), ground
transportation and per diem. Because funds
may vary annually, please contact your District
Trustee for the exact dollar amounts.
In August each year, ADHA mails the criteria
and applications for student delegate positions to SADHA Advisors. The advisors are
asked to distribute the information to SADHA
members.
Qualifications:
• Must be a SADHA member.
• Must be a matriculating dental hygiene
student with a minimum of one semester/trimester remaining after annual
session.
• Must be in good standing in a dental hygiene
program and have written approval of
the program director for candidacy.
• Must be available to fulfill all obligations of
a district workshop and full attendance
at the ADHA Annual Session.
Completed applications are due to your
ADHA District Trustee ([email protected]) by
February 15. Applications can be accessed at:
http://cdha.org/sadha/index.html
2006 Student Delegate and
Alternate Student Delegate
Reports
Allie Witt, the student delegate, was elected
the voting student delegate to the ADHA
House of Delegates and did an outstanding
job representing student opinions and opportunities!
This past year District XI was also represented
by Arizona alternate student delegate Amber McCoog, who submitted the following
report:
Amber McCoog, District XI Alternate
Student Delegate, Phoenix College:
As an alternate student delegate, I was able
to experience many opportunities. The first
of which was traveling to Burbank, California
for District XI’s caucus. After Burbank, it was
off to San Francisco for California’s House of
CDHA Journal
Vol. 22, No. 2
Delegates, and then Orlando for the ADHA
annual session. I learned a lot between these
trips and am proud to be apart of the organization.
Once I found out I was chosen, I left for Burbank, California. I was lost at first, but after
the initial meeting I was able to settle in. I got
a chance to meet with our district members
and discuss different issues. I was happy to
find the women in our district are very strong
individuals. It’s nice to be apart of an organization that will fight for what they believe in
(whether they all agree or not). I am so proud
of our district. These women do so much for
our profession.
After the first caucus, I was able to attend California’s House. This really helped prepare me
for the annual session in Orlando. California
has so much involvement and I can only hope
that some day Arizona will be as involved. All
the ladies from District XI helped me with any
questions I had and helped prepare me for the
SHOR meeting at the annual session.
district members that I was able to answer a
lot of the questions that other students didn’t
know.
On the last trip, I headed to Orlando for our
annual session. I didn’t realize how busy our
schedule was going to be but I have learned
so much about what the association has done
for our career. All of us have a voice and can
speak about issues that concern us. Without
our association, hygienists would not have a
strong voice. This is how we are able to give
anesthesia, have affiliated practice, and hopefully soon open the doors for an Advanced
Dental Hygiene Practitioner.
This is such a great learning experience for
individuals. It helps us understand that we
need a voice to fight for what others are trying to take away from us. We are professionals
and no one should be able to take that from
us. Every hygienist should help contribute to
our association. This is what keeps our career
going, and it keeps our jobs safe and secure.
I was able to meet several awesome students
from California that are very passionate about
our profession. I even saw some of the girls
in Orlando. I was so well prepared from the
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13
ADHA Continues to
Move Our Profession
Forward
by Katie L. Dawson, RDH, BS
Government Relations Committee Co-Chair
T
he ADHA “Clinical Practice Guideline”
(CPG) continues through development by the CPG Task Force. This document will serve to provide guidelines for the
clinical practice of dental hygiene. One of the
common requests coming from the branding
campaign input was the desire for tools that
will improve the clinicians’ quality of care provided to patients and clients. The Task Force
projects completion of the draft by early spring
in time for review during the March 2007 meeting of the Board of Trustees; the guideline will
also be presented to the general membership
during the June 2007 annual session in New
Orleans.
The ADHA 2007-2010 Strategic Plan was developed by the Board of Trustees, councils
and staff; also included in this process was the
input provided by the general membership
during the strategic planning forum at the 2006
annual session in Orlando.
The five new goals of the ADHA strategic plan
are as follows:
• The dental hygiene community will understand the value of ADHA membership
and choose to belong.
• ADHA will be the recognized community
and resource for dental hygiene.
• ADHA will be a data driven, fiscally sound,
effectively governed organization.
• The dental hygiene profession will advance
through effective advocacy by ADHA.
• ADHA and its members will work in partnership with dentists to advance the oral
health of patients.
14
One of the major considerations in developing
the strategic plan was utilizing the feedback
provided by the branding campaign data. It
became evident that ADHA can no longer do
the same things the same ways we’ve always
done – change is inevitable. One of the first
changes will be the identification of the strategic plan’s primary objectives.
The three primary objectives adopted by the
board were as follows:
• Expand collaborative opportunities for the
professional associations to work synergistically
• Establish our brand identity
• Increase tangible membership benefits
The six secondary objectives adopted by the
board were as follows:
• Increase visibility and communications
• Understand the values of dental hygiene
students and other potential members
• Expand opportunities to promote quality
patient care delivered by the dentist and
dental hygienist in partnership
• Increase our ability to collect and use data
• Expand partnerships with stakeholders
• Increase the public’s direct access to dental
hygienists (CPG)
The Advanced Dental Hygiene Practitioner
(ADHP) Task Force continues with the development of the draft curriculum framework.
Future meetings are scheduled for the spring
of 2007; an update will be presented during the
March 2007 BOT and June 2007 annual session
CDHA Journal
Vol. 22, No. 2
meetings. The ADHP Advisory Group is not
funded for formal meetings during the current
fiscal year, however dialogue continues with
the group.
ADA Meeting Proposals Would
Affect Dental Hygiene
The October 2006 American Dental Association
annual session was attended by ADHA officers
and senior staff. The annual session provided
an opportunity for the ADA to introduce its
proposal for addressing allied personnel workforce issues. Of interest to the ADHA were the
resolutions calling for the development of two
allied dental personnel – the Oral Preventive
Assistant (OPA) and the Community Dental
Health Coordinator (CDHC). These proposals
expand the scope of practice of the dental assistant and broaden the description of current
dental hygiene practice.
The OPA resolution called for the appointment
of a work group to design and develop pilot
projects that can be carried out to test the OPA
model in selected states or locales. The OPA
is envisioned to provide scaling of perio Type
I (gingivitis) patients. The primary concern
is that the educational component would be
for 12 months with no requirement for the
program’s accreditation.
The CDHC resolution calls for the development of three pilot training programs in 20072008 envisioned to work in community-based
settings such as state/local health clinics or
with private practitioners serving underserved
communities. For the most part, the CDHC
proposal, in nearly all cases from a scope of
practice perspective, outlines duties that can be
performed today by dental assistants and dental hygienists. The ADA Foundation provided
over $300,000 for the immediate development
of the pilot training programs.
Another issue of interest to ADHA is the
ADA’s membership study proposal. This
proposal will develop an allied dental health
personnel category of membership within
the ADA. The debate created a great deal of
interest and was referred to the Council on
CDHA Journal
Vol. 22, No. 2
Membership for further study and a report to
the 2007 House of Delegates. If adopted, the
dental professional associations would offer
membership to dental hygienists and dental
assistants. Local constituents and components
would be encouraged to offer the same membership to their allied personnel.
The Calfiornia Government
Relations Council (GRC)
Legislative Update
GRC members, Katie Dawson, RDH, BS,
JoAnn Galliano, RDH, M Ed., and Lori
Gagliardi, RDH. M Ed., attended the November 14-16 meetings of the Dental Board
of California and the Committee on Dental
Auxiliaries’ meetings in Sacramento. The
GRC reminded DBC members of Governor
Schwartzennegger’s message included in the
veto of SB 1472 (Figueroa). His veto message
included the following statement: “I believe
the concerns of dentists and dental hygienists
can be addressed within the existing regulatory structure through the cooperation of all
interested parties. I strongly encourage the
Dental Board to work with the dental hygienists to provide the existing Committee on
Dental Auxiliaries with a stronger voice on the
Dental Board.” One of the recommendations
suggested by COMDA was a reconfiguration
of the current DBC. The current membership
of the DBC includes eight dentists, four public
members, one dental assistant and one dental
hygienist. Please visit the CDHA website at
http://www.cdha.org for the complete legislative
update/report.
GRC is drafting new legislation to create a
dental hygiene board or bureau that will allow
self-regulation of dental hygiene by dental
hygienists.

15
Meth Mouth & Dental
Care Considerations
By Noel Kelsch, RDH
A
s dental healthcare professionals, it is
vital to be aware of the illegal use of
Methamphetamines (MA). MA has
a direct effect on a person’s health, lifestyle,
ability to function and mental status. Unlike
many other street drugs, the use of MA is
increasing. Dental professionals must have
knowledge of the symptoms of use, possible
side effects, drug interactions with medications
and dental treatment considerations. This will
aid in delivering appropriate dental treatment
and patient education.
MA is a popular illegal drug choice because:
1. It is cheap to produce ($600 of material =
$2,000 MA)
2. The high it induces lasts on average twelve
hours (cocaine averaging one hour in
comparison)
3. It’s easy to make
4. Materials used to manufacture MA are readily available
5. It can be smoked, snorted, melted and
injected, taken orally, placed rectally, or
vaginally1
6. It’s a very effective central nervous system
(CNS) stimulant and gives the user a
feeling of euphoria, strength and endurance
16
These MA facts have lead to a five-fold increase in usage in the past decade.1 Side effects of MA on the oral cavity and the CNS
are severe and can include permanent brain
damage.2 Results of MA use are devastating,
and can have fatal consequences. MA users
experience acute and chronic mental, physical,
and behavioral changes.
History
As early as 3000 B.C. Chinese writings mentioned the ephedra plant, the source of the
alkaloids ephedrine and pseudoephedrine.3
First synthesized in 1887 as a medication for
dealing with everything from “tired blood to
breathing difficulties,” MA was patented in
the 1930’s for use in individuals with asthma,
rhinitis and for its anorectic effects. MA’s euphoric and anorectic effects were quickly recognized and led to severe abuse of the drug.
During the Second World War, MA was used
by soldiers to increase wakefulness and attention, resulting in many soldiers coming
home addicted to the substance. The 1940’s
followed as a pandemic of abuse, with this
pattern spreading to countries such as Japan
CDHA Journal
Vol. 22, No. 2
Methamphetamine user, 21 year
old Chris, displaying classic oral
symptoms from his drug use. As a
result of his MA use, Chris suffered
a series of strokes and memory loss
so severe he doesn’t really remember
those strokes. Photos courtesy of
Dr. Mitchell Goodis.
These photos demonstrate the tremendous
toll methamphetamine use takes on the
overall health and physical appearance
of the user. Photos courtesy of Sheriff’s
Department, Multnomah County, Oregon
United States Department of Justice Meth
Awareness Program.
Methamphetamine
Cocaine
Man-made
Plant-derived
Smoking produces a high
that lasts 8-24 hours
Smoking produces a high
that lasts 20-30 minutes
50% of the drug is removed
from the body in 12 hours
50% of the drug is removed
from the body in 1 hour
Limited medical use
Used as a local anesthetic in
some surgical procedures
CDHA Journal
Vol. 22, No. 2
Methamphetamines and Cocaine
are often confused in the eyes
of the public but affect the user
differently.
17
Table 2: Common ingredients in
Methamphetamine production
Product
Available From
Side effects
Pool supply
A corrosive acid with vapors that
are irritating to the respiratory
system, eyes, and skin. If
ingested, causes severe internal
irritation and damage that may
cause death.
Tincture of iodin
Feed store
Give off vapor that is irritating
to respiratory system and eyes.
Solid form irritates the eyes and
may burn skin. If ingested, cause
severe internal damage.
Acetone/Ethyl
alcohol
Paint store
Extremely flammable, posing
a fire risk in and around the
laboratory. Inhalation or
ingestion of these solvents causes
severe gastric irritation, narcosis,
or coma.
Hydrioic acid
Red phosphorus
Strike pad on
match book
May explode as a result of contact
or friction. Vapor from ignited
phosphorus severely irritates the
nose, throat, lungs, and eyes.
Pseudonepherine
Pharmacy
Ingestion of doses greater than
240 mg causes hypertension,
arrhythmia, anxiety, dizziness,
and vomiting. Ingestion of doses
greater than 600 mg can lead to
renal failure and seizures
Phenylpropanoamine
Pharmacy
Ingestion of doses greater than
75 mg causes hypertension,
arrhythmia, anxiety, and
dizziness. Quantities greater than
300 mg can lead to renal failure,
seizures, stroke, respiratory
failure and death.
Lithium
Anhydrous
ammonia
Freon
18
Batteries
Fertilizer
Automotive
Extremely caustic to all body
tissues. Reacts violently with
water and poses a fire or
explosion hazard.
A colorless gas with a pungent,
suffocating odor. Inhalation
causes edema of the intestinal
tract and asphyxia. Contact with
vapors damages eyes and mucous
membranes
Inhalation can cause sudden
cardiac arrest or severe lung
damage. It is corrosive if
ingested.
and Sweden. There were very few regulations on the use of MA which lead to
the over-use. In the 1950’s, substance
regulation became more stringent and
yet the drug continued to be abused by
students, athletes, truck drivers and others. The Controlled Substance Act of the
1970’s strictly regulated the manufacturing of this particular amphetamine. Even
though there was a severe decline in the
manufacturing of the drug, the use of
street meth has increased notably.4
Composition
MA is a synthetic psychomotor stimulant
and is closely related to decongestants,
ephedrine and phenylpropanolamine.1 It
is synthesized by converting ephedrine
or psuedoephedrine into methamphetamine through a process of distillation.
This process can be achieved by simply
following “cookbook” directions found
on the Internet which include preparation hints as well as the essential ingredients.3 The ingredients necessary are
available at any hardware store, feed
store or local pharmacy. Substances such
as tincture of iodine, denatured alcohol,
red phosphorus, psuedonepherine, lye,
lithium, and anhydrous ammonia, are
all readily available and relatively cheap
(Table 2). Illicitly synthesized MA may be
contaminated by inorganic compounds.
Table 3: Street Names for
Methamphetamines
Bikers Coffee
Chalk
Chicken Feed
Crank
Crystal Meth
Glass
Go-Fast
Tweek
Methlies Quick
Poor Man’s Cocaine
Shabu
Speed
Stove Top
Trash
Yellow Bam
Yaba
Meth
Black Beauties
Fire
Uppers
Psycho dope
CDHA Journal
Vol. 22, No. 2
Table 4
Short term physical
and mental effects of
methamphetamines
Long term physical
and mental effects of
methamphetamines
There have been cases of exposure to everything from lead to carcinogenic materials.4
Euphoria, surge of energy
High blood pressure
Seizures, tremors
Increased risk behavior
Though many states have limited the distribution of some of the materials necessary to
manufacture MA, many materials are available
by simply crossing a state line.
Sweating, clammy feeling
skin
Stroke, heart infections,
cardiac arrest
Nausea, vomiting, diarrhea,
loss of appetite
Liver disease, lung disease,
kidney disease
Breathing rate and blood
pressure increase
Cracked teeth, destruction of
oral cavity
Headaches, dilated pupils
Sores, skin infections, acne
Interaction
Surge of energy, euphoric
feeling
Hallucinations, delusions,
psychotic events
At the cellular level, methamphetamines
stimulate the release and blocks the reuptake of
neurotransmitters called monoamines (dopamine, norepinephrine and serotonin). Several
areas of the brain are affected by this cellular
process and the result is a feeling of euphoria.
The “rush” that many MA users report is a
result of the high release of monoamines into
the CNS.5
Elevated body temperature,
increased wounds that do
not heal
Violence
Dry mouth, bad breath,
uncontrollable clenching
Anxiety, paranoia, insomnia
Compulsive behavior
Weakened immune system
Grinding and clenching of
teeth
Brain damage
Table 3 shows the street name for methamphetamine varies from region to region (Table 3)
Brain imaging studies show that amphetamines
increase a person’s dopamine level, especially
within the nucleus acumen, the major reward
center in the brain that is thought to be central
to mediating addictive behavior. Supporting
this hypothesis is the notion that stimulantinduced euphoria is related to the dopamine
levels and occupancy of the dopamine receptor. While the acute use of MA results in an increased dopamine level, prolonged use results
in a chronically depressed dopamine level.
The chronically depressed dopamine level can
result in symptoms like those of Parkinson’s
disease, a severe movement disorder.3
The prolonged use of MA also results in chronically depressed dopaminergic activity. The
changes in dopamine level and activity are
thought to be due to the neurotoxic effects of
chronic methamphetamine use, which leads to
the reduction of axonal dopamine transports,
and synthesis pathways in dopaminergic neurons. Animal studies show repeated exposure
to MA results in degeneration and destruction
of dopamine axon terminals within the CNS.
The CNS actions that result from taking even
small amounts of MA include increased wake-
fulness, increased physical activity, decreased
appetite, increased respiration, hyperthermia
and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia and aggressiveness. It
is important to note that hyperthermia (with
temperatures as high as 108 degrees) and convulsions can result in death.1
Physical/Mental
Signs and Symptoms
Although we may have been unaware of it,
most of us have treated a MA user. The signs
and symptoms of MA use are sometimes
subtle and other times clearly evident. Recognizing the signs and symptoms of MA use
is vital in keeping patients safe from harming
themselves, as well as others and the create a
treatment program that meets each patient’s
needs.
People react to the presence of MA in the body
just as they would with the fight or flight syncon’t on page 20
CDHA Journal
Vol. 22, No. 2
19
drome because MA floods the body with adrenaline, the
hormone that aids in quick response during an emergency.
This reaction gives the user great strength and endurance.1
One person interviewed reported staying awake for over
72 hours in order to complete the painting of his two-story
home. Users often report needing less sleep and being able
to withstand great amounts of work and strenuous tasks.
This unreasonable sense of strength and ability can create
an atmosphere for damage to the body and the brain.3
Photos courtesy of Sheriff’s Department, Multnomah County,
Oregon United states department of Justice Meth Awareness
Program Before and After One year
Short term effects of MA use include vomiting, tremors,
hyperactivity, and decreased appetite. Long term effects
are much more devastating, ranging from allergic reactions
to strokes (Table 4). MA use causes increased heart rate and
blood pressure and can cause irreversible damage to blood
vessels in the brain, producing a stroke. Other effects of
methamphetamine include respiratory problems, irregular
heartbeat, lowered immune response and extreme anorexia.
Its use can result in cardiovascular collapse and death.8
Quality of life is often altered due to the higher incidence of
conditions such as Parkinson’s
disease(3,6 and Human Immuno-supressed Virus.7 Psychiatric symptoms include anxiety,
psychosis, difficulty controlling
anger, violent behavior, depression and attempted suicide.9
Case study
Skin lesions resulting from the use
of MA. Photo courtesy of Prairie
View Prevention Services.
A 27 year old male presented
in the clinic with a draining
apical abscess on #9. His chief
complaint was pain with #9.
Further investigation revealed
that all his anterior teeth had
rampant caries and most of his
molars had been worn down
to the gingival margin. His
plaque level was extremely
Photo courtesy of: Sharlee Shirley,
RDH, MPH; Jim Cecil, DMD, MPH,
University of Kentucky, School of
Dentistry United states Department of
Justice Meth Awareness Program
20
CDHA Journal
Vol. 22, No. 2
high and he reported he did not know when
he had brushed last. His eyes were dilated, his
blood pressure was elevated to 165/89 and his
temperature was 104.5 degrees. While waiting
for his appointment he was observed pacing
back and forth while picking at his skin. He
explained he was trying to remove the bugs
he was sure were embedded beneath his skin.
(Author’s note: this feeling is a result of MA
constricting capillaries near the surface of the
skin, which causes intense itching.6)
Review of his health history revealed he had
been using MA in the oral form for eight
months. His diet consisted of high carbohydrate intake in the form of soda to moisturize
his dry mouth. His increased bacteria from the
lack of care, dry mouth and lowered immune
response resulted in rampant caries.
His clothing was stained and the remnants of
his last meal remained on his chin. He continued to pace for a short period of time and
finally sat down and heaved a sigh of relief.
Sweat was rolling down his face and he started
to scratch his skin while he lifted his shirt. His
skin was raw from constant scratching and
his ribs protruded. His face was gaunt and
deep lines chased his sagging skin. After the
needs of the patient were assessed, he was referred to a General Practitioner for evaluation
and drug intervention
before starting dental
treatment.
Oral Signs and
symptoms
The use of MA has
a pattern of damage in the mouth.
There are several
factors which, when
combined, create an
environment that destroys the teeth, the
blood supply and supporting tissues.
In the past the rampant caries associated with
MA use were attributed to the acidic nature
of MA in the oral cavity when it was smoked.
Studies involving the oral intake of the drug
for narcolepsy and attention deficient hyperactivity disorder revealed the same characteristic
carious lesions seen in MA users. The current
hypothesis involves a group of conditions that
when combined create the perfect environment for dental disease to occur.12
Photo courtesy of:
Sharlee Shirley, RDH,
MPH; Jim Cecil, DMD,
MPH, Univer-sity
of Kentucky, School
of Dentistry United
states Depart-ment of
Justice Meth awareness
program
MA users are unable to take care of daily tasks,
such as brushing and flossing, due to the
crash affect of this drug which can last many
days. When they are awake for long periods
of time the energy
bursts they experience do not allow
them to concentrate
on simple tasks.9
Physical and social signs of
MA causes blood
MA use:
vessels to constrict,
including those in the
Malnourished appearance
mouth. This in turn
Abnormal vital signs
causes a lack of the
blood that nourishes
Pale complexion, red eyes
the periodontium and
teeth properly. With
Disheveled appearance
repeated shrinking,
the vessels will not
Irritability or euphoria
recover, thus causing
dental tissue to starve
Nervousness, compulsive
and break down. The
behavior, picking of skin
end result is tooth
decay, gum disease,
Fast aging of patient and
and bone loss .12
sagging of skin
Table 5
Oral signs of MA use:
Angular Cheilitis
Glossitis
Candidia
Mucosal ulceration
Xerostomia
Facial pain, Trismus, and
myofacial pain resulting in
sever occlusal wear
Rapidly progressive
periodontitis
Rampant caries often starting
on the buccal smooth surfaces
of posterior and the interproximal surfaces of anterior teeth
CDHA Journal
Vol. 22, No. 2
Sweaty, clammy, skin
The caries rate in MA
abusers is four times
higher than control
con’t on page 22
21
Table 6:
Resources for Treatment of Addiction
samhsa.gov
Substance Abuse & Mental Health Services Administration
dasis3.samhsa.gov Rehab locations.
MethResources.gov
The federal government’s comprehensive directory of information and
programs related to methamphetamine.
Justthinktwice.com
Just think twice is a youth oriented site created by the Drug Enforcement Agency’s Demand Reduction Program.
Whitehousedrugpolicy.gov
Office of National Drug Control Policy- Detailed description of
methamphetamine and other resources.
www.usdoj.gov/dea/concern/meth
The Drug Enforcement Administration – MA Information, statistics
and resources.
nationaldec.org
The National Alliance for Drug Endangered Children . Resources for
safety of children in MA environment.
naco.org
National Association of Counties - MA Action Clearinghouse is
committed to raising public awareness about and helping counties
respond to drug problems.
drugabuse.gov/MethAlert/MethAlert.html
National institute on drug abuse has resources and information on
tends in use, prevention, identifying users and treatment options.
asam.org
American society of Addictive Medicine Studies, facts and resources.
SayNOtoMeth.com
Say no to meth is devoted to the education of children and youth to
the devastating results of MA use.
crystalrecovery.com
This website seeks to support and promote the recovery of MA addicts;
and to provide information to teens, adults, parents, teachers,
professionals, or anyone who may be affected by their own or someone
else’s MA use.
22
groups.13 The dry mouth accompanying
the use of this drug leads to many problems. Without saliva, acids accumulate,
lowering the pH of the mouth and causing
the breakdown of the surface of the teeth.
Xerostomia is caused by the vasoconstriction and reduction of salivary gland function. The tongue and lining of the mouth
can become raw and irritated without the
surfactant action of saliva. This can lead
to secondary infections, limited ability to
speak and eat.10
Many patients try to reduce the xerostomia by consuming sugary sodas. The
soda, coupled with decreased home care,
vomiting side effects of the drug and
decreased immune response, creates the
perfect environment for the disease of
caries to occur.
Some chemicals used to manufacture MA
are caustic, causing chemical burns on the
skin. These harmful chemicals will also
come into contact with the soft tissue or
mucosal lining of the oral cavity. Without
the buffering effects of saliva present to
protect the oral tissues, severe inflammation, painful mouth sores, and ulcers can
develop.3,4,8
The pattern of decay is distinctive in that,
initially, it involves the smooth buccal
surface of posterior teeth and the interproximal of the anterior teeth. It eventually
leads to the complete destruction of the
coronal portion of the tooth. 1,3,13
MA users are chronic grinders and clenchers due to the muscle constriction accompanying MA use. Grinding quickly wears
down the teeth to small nubs. Grinding
and clenching were once attributed to the
impurities of the processing in homemade
laboratories, however there is no current
clinical evidence to support this.12
The other result of the constriction of blood
vessels is the gaunt look and quick aging
of the patients. Tissues of the face quickly
die and sag from the lack of nutrients and
blood supply. 2, 3, 9 This aging effect can
be seen in “before and after” photos and
is irreparable. The intense itching that
many MA user experience is also from
CDHA Journal
Vol. 22, No. 2
the constricting capillaries near the surface of
the skin. Compulsive scratching often leads to
infection and bacterial cellulitis.6
Treatment considerations and
planning
Being aware of the signs and symptoms of MA
abuse is the first step of treatment (see Tables
4 and 5). Updating the health history, communicating concerns, assessing the current use of
MA and referring for rehabilitation must occur
before treatment begins.
MA users have a higher tolerance to anesthetics, a reduced ability to metabolize
medications, and a greater chance of a drug
interaction.14 Dentists and hygienists must
communicate with the patient and discover
when the last dose of MA occurred. No vasoconstrictors should be used within 24 hours of
MA use. An increase in blood pressure from
vasoconstrictors can lead to a stroke or cardiac
arrest.15 Sharing these facts with the patient
may help them to feel comfortable sharing
their MA habits.
Using frank, direct questions that are nonjudgmental will aid in a quick diagnosis.
The health history can help in the screening
process. Include questions such as “Do you
have a history of drug dependency?” on the
health history. Document all conversations
on drug use and history in the patient’s chart.
It’s important to include the patient’s report of
the last date of use and the names of the any
medications prescribed for the patient or drugs
taken by the patient.
After initial examination, ask open ended
questions such as “How did your teeth get to
be this way? Normally, we don’t see this kind
of decay and/or tooth damage very often. It
usually happens if someone drinks excessive
amounts of sugary soda or takes drugs. Have
you used Methamphetamines or are you using
now?” Point out the signs of damage that can
be seen clinically. Express concern and use the
opportunity to educate patients while discussing their dental findings. Present the facts
(non-jundgementally), explaining how important it is to stop now. Once the patient’s needs
have been assessed there are many things the
clinician can do to prevent further damage.
Resources for Rehabilitation
It’s important for the dental healthcare provider to be equipped with resources to refer
the patient to the proper healthcare professional for treating drug addiction. Having a
list of area resources will help in delivering
care. Health departments and social service
agencies can aid in gathering this information
(Table 6).
Pain control
No patient should have to live with pain. The
typical MA patient may not experience the pain
you would expect from such extensive decay
because MA can block or lessen pain receptors. Other patients will have such severe pain
that it is difficult for them to eat. James Hill,
DDS, with the California Correction system
has developed a special understanding of the
pain needs of MA patients through his work
in the prison system. Dr. Hill stated, “The most
important thing that I can do is help to restore
people’s self image and self esteem. It is so
important that I treat them as I would want to
be treated. I would not want to be in pain and
I should do everything that I can to help my
patients get out of pain.” Dr. Hill explained he
is seeing an increasing number of patients with
the severe effects of MA use. He stated “it is
very frustrating to watch someone go through
the process of extensive pain and losing all
their teeth but, having a patient turn their life
around after receiving treatment makes it all
worth while.”
Unless there are contraindications, anti-inflammatory medications should be the first drug of
choice for pain control. Prescribing narcotics
should be avoided. Cardiac reactions have
been reported when mixing narcotics with
MA. Patients addicted to MA will use narcotics
to increase the high. Pain control in the office
should include use of a long lasting anesthetic,
such as Marcaine, if the patient has not had
MA in the last 24 hours.14 Local anesthetics
should not be administered if there is doubt
con’t on page 24
CDHA Journal
Vol. 22, No. 2
23
whether the patient has used MA in the past 24
hours. When using anesthetic, vasoconstrictors
should be avoided as they can lead to increased
blood pressure, stroke or cardiac arrest. Caution should be used when using general anesthesia and nitrous oxide as adverse reactions
may occur when mixing drugs.
If it becomes necessary to prescribe narcotics,
consider asking permission to discuss any
prescription with the patient’s drug counselor,
sponsor, or medical doctor. It’s important to
include in this discussion the proper use of
the medication, limits of use, and side effects.
Some patients will use the excuse of pain
related to the extensive decay to get prescriptions for painkillers, so caution should be used
when prescribing drugs, especially if they are
not patients of record.
Patients may go “doctor shopping” from one
dental office to another to obtain drugs. The
Substance Abuse and Mental Health Services
Administration (SAMHSA) reported that prescription drugs are the second most popular
category of recreational drugs (just behind
marijuana). Surveys of recovery groups in
2002 revealed that fifty-four percent of addicts
reported obtaining narcotics by manipulating their dentist. Keep prescription pads in
a locked place to limit access by patients. Do
not print Drug Enforcement Agency (DEA)
number on the prescription pad.17
Xerostomia
The vasoconstriction of the salivary glands,
along with the drying effects of the agents
from which MA is made, leaves the oral mucosa severely dry. Upon examination, patients
with xerostomia may complain of generalized
mouth soreness, dry mouth, painful or burning
tongue, taste changes, difficulty in chewing,
and problems with talking and swallowing.
Clinical presentation of xerostomia includes
oral fissuring, ulceration, and epithelial atrophy. Saliva substitutes and moisturizers can
reduce some symptoms. Encourage patients
to drink water rather than trying to quench
their thirst with sodas, sports drinks, or fruit
juices that contain sugar. Preventive fluoride
treatments, both in-office and at home, are
strongly recommended to strengthen and
remineralize the damaged enamel rods. Rec-
24
ommend the use of xylitol products to reduce
the development of caries, resist the fermentation of bacteria, reduce plaque formation and
increase salivary flow.18
Decay
Patients may report that their teeth decayed
“from the inside out.” A possible explanation
may be from reduced blood supply to the tooth.
With repeated shrinking, the vessels won’t recover and, without nutrients to the tooth, it will
die. Treating carious lesions with conventional
means is of little value with a patient who is
using MA. The disease will reoccur under the
filling material. Sealing the area with fluoride
and a xylitol releasing fluoride varnish and/or
Glass Ionomer Sealant & Surface Protectant are
treatment modalities that may be of benefit until the patient stops drug use. Dr. Hill reported
using both acrylic and composite temporary
crowns with great success. Intermediate restorative material (IRM) aids in relieving pain
and serves as a temporary solution. IRM is easy
to use and its strength properties are close to
those of zinc phosphate cement, with good
sealing properties, low solubility and excellent
abrasion resistance with grinding.
Mitchell Goodis, DDS, of El Dorado County,
California, treats hundreds of MA patients a
year. He has made it his mission to educate
dental professionals, youth and “anyone who
will listen”. His experience has shown that
most MA users end up losing their teeth. He
suggests “comfort care” until it is time for
extractions and dentures.
Periodontal Disease
MA users do not generally seek regular dental
treatment so will often present with gingivitis
or periodontitis from lack of professional oral
care and inadequate home care. Patient education on plaque control, nutrition and the etiology of disease can help the patient maintain
the area until they are ready for treatment.
Nutrition issues need to be addressed to aid
in tissue healing after treatment. Dr. Hill sug-
CDHA Journal
Vol. 22, No. 2
Table 7: Working with Tweakers
1. Keep your distance - coming too close can be perceived as
threatening.
2. No bright lights - the tweaker is paranoid and bright lights
may cause them to react violently.
3. Slow your speech, lower your voice.
4. Slow your movements - the tweaker is paranoid and may
misunderstand your movements.
5. Keep your hands visible, or they may feel threatened and
become violent.
6. Keep the tweaker talking - a tweaker who falls silent can be
extremely dangerous. Silence often means that his paranoid
thoughts have taken over reality, and anyone present can
become part of the tweaker’s paranoid delusions. If you are
threatened, call the police and tell them that this person may
be under the influence of Meth or other drugs.(16)
gested the use of alcohol-free Chlorhexidine
until treatment can take place.
tweaker is also using alcohol or other drugs,
the danger may be intensified.
Oral mucosa
The tweaker craves more MA, but no dosage
will help recreate the first rush. This may cause
frustration and lead to unpredictable behavior
and violence. To support their habits, tweakers often participate in spur-of-the-moment
crimes, such as purse snatching or burglaries. Tweakers are often involved in domestic
disputes and automobile accidents. They may
also be present at raves or parties. They may
at first appear to be normal but a closer look
will reveal eye movement ten times faster than
normal, a voice with a slight quiver and jerky
movements (Table 7).16
Oral mucosa wounds, angular cheilitis, mucositis, or Candida albicans (oral thrush) are the
results of a compromised immune response
coupled with exposure to a dry, acidic environment. Having the patient swish with a
mixture of liquid Kaopeptate and Benedryl
mixed fifty-fifty will aid in healing and give
relief from pain. Evaluate the patient for the
presence of candida albicans. If present, treat
oral candidiasis by prescribing either Nystatin
suspensions or clotrimazole troches, both of
which are extremely effective treatments.19
Tweakers
If abuse or neglect is occurring as a result of
meth use, dental professionals are mandated
to report to the proper authorities.
People who abuse MA regularly are known as
‘tweakers’. All offices need to have a protocol
for the Tweaker patient as they often behave or
react violently (see Table 7). Keep in mind, the
tweaker may not have slept in three to fifteen
days and may be irritable and paranoid. If the
con’t on page 26
CDHA Journal
Vol. 22, No. 2
25
Conclusion
Methamphetamine abuse is increasing and it affects all
aspect of a patient’s life and health. Oral diseases including rampant caries, periodontal disease, severe xerostomia
are key signs of chronic MA abuse and frequently lead
to edentulousness. Understanding the disease process,
treatment strategies and drug abuse referral system can
assure appropriate intervention. Knowing the patient’s
drug habits, health status and the recommended treatment
strategies will ensure proper intervention, patient education
and prevention of disease progression.
MA use is also increasingly affecting our communities
and society. The loss of these individuals as contributing
members to society, and the need for social agencies to cope
with their actions or rehabilitation cost taxpayers untold
millions yearly.
A website worth viewing
http://www.mitchtv.net/index.html
Why would one man make it his life mission to get the
word out on the effects of one drug? Why would one
man spend his time, money and every resource available to try to change the lives of drug abusers?
Mitchell Goodin, DDS is doing just that. He has used
his own money to create a website aimed at ending the
cycle of METH MOUTH. It was not enough for him to
devote his practice to helping the oral devastation of
the oral effects of MA; he has gone much further by
developing a video, power points, lesson plans, and
slide shows of before and after.
“I have to educate the public on the devastating results of the use MA, how can I not after
I have seen what it does to peoples oral health,
self esteem and lives?”
He volunteers at high schools, for dental professional
organizations, at churches and conferences to teach
the public and professionals just what MA does to
health, mouths, family and life. When Dr. Goodin was
asked why he does this he humbly replied “There is
no greater satisfaction than preventing the spread of
this horrendous drug.” This man has served the underserved of El Dorado County for years and has been
spreading the message “to anyone who will listen! If I
can help prevent just one person having to experience
the devastation of this disease my life will be worth
while.”
26
The affect on the MA users families is devastating. If the
dental healthcare provider can play a role in helping these
patients or their families through alleviating their dental
pain or disease, or by contributing to their drug use cessation, everyone in our society wins.
The dental hygienist plays a vital role in identifying or
aiding these individuals when they present in our clinical
setting. As stated previously, we’ve probably all treated
an MA user in our office unknowingly at one time. It’s the
author’s hope the dental hygienist reading this will now be
more knowledgeable and in a better position to properly
treat and/or refer these patients.

About the Author
Noel Brandon Kelsch is a
freelance cartoonist, writer, speaker and Registered
Dental Hygienist. Noel’s
cartoons can be seen in RDH
magazine and many other
publications. Her articles
have been published in dental and nursing trade magazines, well as in books from
Love is the Best Medicine to
Especially for Women.
Noel has received many
national awards including
Colgate Bright Smiles Bright Futures, RDH Magazine Sun
Star Butler Award of Distinction, USA Magazine Make a
Difference Day award, President’s Service Award, Foster
Parent of the Year, and is a five time winner of the Castroville Artichoke cook-Off!
Noel is the current Vice President of California Dental
Hygienists Association, a member of Organization for
Safety and Asepsis Procedures and board member of Simi
Valley Free Clinic.
Her hobbies include under water basket weaving, naval
contemplation and water colors. Noel received her dental
hygiene degree from Cabrillo College and is currently attending Northern Arizona University.
CDHA Journal
Vol. 22, No. 2
References
1.
Colfax, Grant N. MD. Methamphetamine-The Scope
of the Problem, Medscape HIV/AIDS, 2005;11(2)
11. Diago, Steven. When your patient is an addict. AGD
Impact, Dec, 2003, vol. 33, no. 9
2.
Timothy E Albertson, MD, PHD, et al. Methamphetamine and the Expanding Complications of Amphetamines, WJM, April, 1999-Vol. 170, no. 4, p. 214-219
12. J.W. Shaner DMD. Meth Mouth and Rampant Caries
in Meth Abusers, APC, Vol. 20, No.3 p.146-150
3.
Curtis, Eric K DDS, MAGD. Meth Mouth; Review of
methamphetamine abuse and its oral manifestations,
Oral Medicine, Oral Diagnosis, 2006, March-April, p.
125-129
4.
5.
Derlet, Robert W., Heischober, Bruce, MD. Methamphetamine Stimulant of the 1990s?, WJM 1990,
December, Vol. 153, no.6, p. 625-627
Daberkow, DP, Kesner RP, Keefe KA. Relationship
between Methamphetamine-induced monoamine depletions in the striatum and sequential motor learning, Pharmacol Bio Chem Behavior, 2005, May;81:1,
p.198-204
6.
Prah, OPH. Methamphtamines: Are Tougher antimeth Laws needed? CQ Researcher, 2005: july, Vol 15,
p.589-612
7.
Boddiger, D. Methamphetamine linked to rising HIV
transmission. Lancet 2005: Vol.365, p. 1217-1218
8.
National Institute on Drug Abuse, InfoFacts: Methamphetamine (Rockville, MD: US Department of
Health and Human Services), from the web at http://
www.nida.nih.gov/infofacts/methamphetamine.html last
accessed Nov, 9, 2006
9.
Zweben, J., et al. Methamphetamine Treatment Project, Psychiatric symptoms Methamphetamine users.
AM J Addict, 2005, vol. 13, p. 181-190
13. De Cugno, F., et. al. Salivary secretion and dental
caries experience in drug addicts. Arch Oral Bio.1981,
vol.26, p. 363-367
14. Murphy D. Wilmer, S. Patients who are substance
abusers. NYDentJ, 2002, vol. 68, p 24-27
15. Eyalka, T. Rural America’s Epidemic Destroying
patients teeth, Ill Dental News, 2005, Vol. 74, p.4-5
16. http://www.mappsd.org/Treatment.htm, Accessed
10/11/2006
17. http://www.samhsa.gov/ accessed 10/11/2006
18. Creanor SL, Strang R, Gilmour W, et al. The effect of
chewing gum use on in-situ enamel lesion remineralization. J Dent Res 1992;71:1895-1900
19. Jose A. Vazquez, M.D. Options for the Management
of Mucosal Candidiasis in Patients With AIDS and
HIV Infection Pharmacotherapy 19(1):76-87, 1999.
© 1999 Pharmacotherapy Publications
Personal interview with Dr. James Hill DDS 11/03/2006
conducted by Noel Kelsch RDH
Personal interview with Dr. Mitchell Goodis 11/6/2006
conducted by Noel Kelsch RDH
10. National Institute on Drug Abuse, InfoFacts: Methamphetamine (Rockville, MD: US Department of
Health and Human Services), http://www.nida.nih.
gov/infofacts/methamphetamine.html last accessed Nov,
9, 2006
Need a treatment referral?
Call 1-800-662-HELP or Visit findtreatment.samhsa.gov
CDHA Journal
Vol. 22, No. 2
27
Home Study Course:
Meth Mouth &
Dental Care Considerations
2 Continuing Education Units
Please Print
Name _____________________________________________________________ License # ___________________________
Address ______________________________________________ City ___________________________ State ____ Zip_____
ADHA Membership ID# _________________________ Expiration _____________________________
Home Phone Number ___________________________________ Email ____________________________
Signature _______________________________________________________________________________
CE Credit available: Members - $20
Non-members - $35
Forward the answer sheet below (photo copies accepted), and completed information with your check made payable
to CDHA:
Mail to CDHA Home Study Course, 505 N. Brand Blvd., #740, Glendale, CA 91203 • 818-500-8217
A confirmation and CE certificate will be mailed within 4–6 weeks.
-----------------------ANSWER SHEET: Circle the correct answer for questions 1– 10
1.
Methamphetamines are synthesized by converting
ephedrine or psuedoephedrine through the process of:
A. Carbonization
B. Distillation
C. Oxygenation
D. Anabolism
6.
The pattern of tooth destruction in the mouth of
methamphetamine users includes:
A. Smooth buccal surfaces of posterior teeth
B. The interproximal of anterior teeth
C. The grinding down of occussal surfaces
D. All of the above
2.
The chronically depressed _____________ level seen in
patients who chronically use Methamphetamines can
lead to symptoms like those of Parkinsons disease:
A. Glucose
C. Dopamine
B. Thyroid
D. Histamine
7.
3.
Short term affects of methamphetamines do not include:
A. Vomiting
B. Hyperactivity
C. Narcolepsy
D. Decreased appetite
The first step in providing dental treatment for a
methamphetamine user is:
A. Ask if they used MA today.
B. Use more anesthesia because they will have a
high tolerance to it.
C. Be aware of the signs and symptoms of use.
D. Refer the patient, as the clinician can do nothing
for them.
8.
The signs of a patient actively using methamphetamine
are so obvious you will always be able to tell.
A. True
B. False
9.
Patients should not receive any vasoconstrictors within
__________ of methamphetamine use:
A. 10 days
C. 72 hours
B. 24 hours
D. All of the above
4.
Methamphetamines cause blood vessels to:
A. Expand
C. Constrict
B. Exfoliate
D. Capsulate
5.
The first drug of choice for dental pain control with
metamphetamine users is:
A. Nonsteroidal Anti-inflammatories
B. Narcotics/Opiods
C. Cannabis
D. Nothing, they do not experience pain
28
10. The clinician should do the following when treating
“tweakers:”
A. Keep your hands out of sight.
B. Make sure you have bright lighting.
C. Get close to them so you can see if they are listening.
D. Slow your speech and keep the tweaker talking.
CDHA Journal
Vol. 22, No. 2
Dentsply Professional
CDHA Journal
Vol. 22, No. 2
29
California Dental Hygienists’ Association
2005 – 2006 Executive Officers
MASTER CALENDAR
President
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President Elect
Jean Honny, RDH, BS
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& Membership
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Vice President Administration
& Public Relations
Noel Kelsch, RDH
Secretary-Treasurer
Diana Thomson, RDH
Immediate Past President
Lin Sarfaraz, RDH, AS
Speaker of the House
Colleen Beasley, RDH
ADHA District XI Trustee
Sharon Zastrow, RDH
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May 4
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