Meth Mouth in Montana: How Dental Hygienists Can Help Meth Users

© Laurin Rinder / Adobe Stock

What will you see when driving down any country highway in Montana? Our country’s flag is flapping in the cool Chinook winds, sun-faded John Deere green tractors, a rancher, riding horseback with his sly heeler dog, fields of golden Montana wheat rippling upward to the Snowy Mountains ‒ iconic western imagery and home to the state’s residents.

You will also see stacked hay bales with the rattle-can-painted warning, “Meth, Not Even Once,” a phrase coined by the Montana Meth Project. Grain bins feature painted zombies lurching around the steel curves. Abandoned brick buildings that were once creameries, soda fountains, and local hardware stores all display haunting verses meant to help keep our small communities safe from methamphetamine. This is also home.

In Montana’s cities, you can witness residents doing “the meth dance,” which is a move you might imagine if you crossed a hippie from the 1960s with Frankenstein’s monster. Addicts sleep under bridges, in bushes, and on park benches. They linger within the shadows, waiting to reveal themselves and ask for spare change, like electric eels stretching from coral coves.

Meth has permeated our state. Montana is vast and provides a lot of rural space to hide meth labs, and our extensive interstates make it easy to traffic the drug. Montana’s healthcare providers experience meth abuse secondhand through their patients, and dental hygienists are certainly no exception.

So Many Tragic Stories

This is the drug my generation of Montanans has been raised to fear. It will steal your dignity and turn you shameless. Meth doesn’t discriminate. It doesn’t care what color your skin is, how much money you have in your pocket, the brand of clothing on your back, or the quality of your heart. Meth will take what you love about a person and strip it clean from them.

I remember being eight years old and hearing a story about a Montana teen whose life was cut short by meth. Her name was Cassie Haydal, and she was 18 years old and a senior at Custer County High School when she overdosed. She lost her life in Billings in the intensive care unit.1

Years after Cassie’s death, her mother bravely traveled to the schools in our high and wide state and spoke publicly about the dangers of meth. She shared her heartbreak with us, and we cried together in the auditoriums. (Cassie’s mother, Mary, wrote about her experience, and her story can still be found online. It is worth reading and sharing).

Current Meth Usage in Montana

Today, thanks to increased public awareness and organizations such as the Montana Meth Project, methamphetamine use in teenagers has decreased significantly in Montana. The Montana Meth Project released the results from their 2021 Montana Risk Behavior Survey, reporting that since 1999 methamphetamine use in students grades 7-12 has dropped from 13.5% to 1.9% in 2021.2

I was unable to find any statistics indicating the rate of use in adult residents in Montana, presumably because this is a more challenging group to survey than classrooms full of students. The Montana Meth Project, however, reports that use among adults has increased since 2015. The Montana Meth Project also reports that 53% of the children in our state foster care system are there due to methamphetamine-related incidences, 20% of the adults in our state treatment centers are there as a result of methamphetamine abuse, and half of the inmates in Montana’s prison system are locked up on methamphetamine-related charges.3

Personal Encounters with Meth Mouth

I had the privilege of providing dental hygiene treatment in our state prison in Deer Lodge while in dental hygiene school. One inmate who was my patient shared his story of methamphetamine abuse and how it destroyed his family. He shared his fear that he might not be able to keep from falling back into the same lifestyle once released from prison. He had meth mouth, and it was one of the first mouths I had ever seen that had been ravaged by the chemical drug.

Since my experience in the prison, I have seen plenty of patients with the telltale “meth mouth.” The teeth are dehydrated, fragile, and literally crumble under dental instruments. They are characteristically dark with areas of dark brown enamel, and the exposed cementum and dentin often turn black.

Due to the fragility of the dentition, it is also common to see only root tips remaining, appearing as black, blunted nubs sunk within walls of neglected connective tissues. The sight makes me feel panic-stricken and with the urge to frantically dig them out of their rotting pits.

In my experience, patients who have meth mouth are either recovering patients just out of prerelease or rehab, or they are early users, not yet deep enough into their addiction to lose their routines. As the addiction progresses, active users tend to only come in for emergency procedures and become more and more vacant from the hygiene op.

Meth Factors in Oral Health

The American Dental Association completed oral examinations of 571 methamphetamine users and found that 96% had decay and 31% had six or more missing teeth.4 This extent of decay is due to a multitude of factors.

The first consideration is the recipe used to cook meth. Highly acidic household products are often used, and common ingredients include (but are not limited to) pseudoephedrine, acetone, lithium, hydrochloric acid, and freon ‒ in other words, cold medicines, paint thinners or fingernail polish removers, battery acid, drain cleaners, and refrigerator coolants.5

Another consideration is the user’s habits. Users often will not prioritize oral hygiene. They may make poor nutritional choices when they are high, often consuming high caloric, high carbohydrate, and sugary diets.

Once the user comes down and crashes from their high, they may sleep for days, leaving their teeth vulnerable to biofilm and acid attacks. When they wake up from their crash, their first priority is not brushing and cleaning interdentally. They obsessively prioritize their next fix.4

The last factor worth noting is that the associated psychosis from meth use often encourages grinding and clenching of the user’s teeth. Significant occlusal and incisal wear, as well as abfraction, may be other indicators of meth abuse observed during clinical dental care.

Office Safety

As dental hygienists, it is important to be aware of methamphetamine use and how it affects the user. It is also important for us to be able to identify meth abuse if a user is in our dental practice. We need to be aware for our own safety but also so we might aid our patients who are struggling with addiction.

Identification is also important in avoiding a medical emergency. Don’t forget that mixing meth with a local anesthetic containing epinephrine can cause cardiac distress. Patients won’t always be honest and transparent, so look for telltale signs, such as track marks (scars on the inner forearms from intravenous injection), paranoia and other strange behaviors, pock-marked skin (in any visible areas – up and down the arms, on the face, along the clavicle or across the patient’s chest, etc.), and meth mouth.

The advice I would give is to prioritize the safety of yourself and your patient. If you are unsure whether or not you can proceed with the appointment safely, don’t.

Remember that addicts need love and compassion and are often grateful for a little understanding. We might be the only friendly faces they know, and we should give them props for visiting the dental office. Perhaps they are trying to better themselves? We might feel good knowing that we helped.

Now Check Out the Peer-Reviewed, Self-Study CE Courses from Today’s RDH!

Listen to the Today’s RDH Dental Hygiene Podcast Below:


  1. Haydal, M. (n.d.). Cassie Haydal, 18. U.S. DEA: Just Think Twice.
  2. Meth Report: Health Risk Behaviors of Students Who Ever Used Methamphetamines. (2021). Montana Office of Public Instruction.
  3. Montana Meth Project: Has It Curbed Teen Meth Use? (2021, November 11). The Recovery Village.
  4. Meth Mouth: How Methamphetamine Use Affects Dental Health. (n.d.). American Dental Association.
  5. How Is Meth Made? Ingredients and Cutting Process. (n.d.). Windward Way.