Keeping Your Teeth and Your Sanity

Posted on May 11, 2011 in Bipolar Disorder Dentition Psychotropics

Someone raised his hand half way through Dr. Elizabeth Eshenaur Spolarich’s ((Dr. Spolarich specializes in the dental hygiene of people with mental disorders and addiction issues at the University of Southern California.)) talk at the Meeting of the Minds: “Can we take a break to brush our teeth?” Dr. Spolarich laughed. She had just taken us through the horrors that happen when you don’t take proper care of your teeth. Ahead of us still lay the terrors of xerostomia, bruxism, and the hideous “meth mouth”.

You almost don’t want to know what meth can do to your teeth. Keep in mind that the more than 600 sites that tell you how to make [[methamphetamine]] rely on materials you can obtain from any hardware store. That’s right. Hardware store. Among these is lithium which is pulled out of batteries. The manufacturers of the addictant don’t bother to cleanse the lithium, so it goes in along with the acid that coats it. So every time you take a dose of meth, you ingest some of this acid and it melts away your enamel. Meth mouth is not pretty: together with the extreme sugar cravings and lack of motivation for proper dental care, its ingredients turn your oral cavity into a wasteland of blackened gums and teeth that look like they have weathered a thousand years or more of erosion. The bone that holds the teeth in place is gone. The gums flash nearly as red as a traffic signal. Will people hire you with it? Can you chew with the charred crater it leaves you with? Not a chance. Even dentures won’t help you.

Count it as another reason to never start using meth.

When your mother first kissed you, you received your first infectious cultures of the [[streptococcus mutans]] and [[lactobacillus]] species that would, in later life, play havoc with your teeth. Your sterile mouth became a place that required regular care. If you did not get it, these beasties piled upon themselves in layer upon organized layer with the most destructive species — surviving in many cases without oxygen, light, or food — residing at the bottom next to your enamel. These secreted lactic acid which destroyed the hardest part of your body — the enamel of your teeth — and its supporting structures of bone. This is why it is imperative that you brush or floss.

Certain life habits can make things worse. Alcoholics, for example, torture their mouths with their consumable of choice. These are often full of [[caries]]-provoking substances used to give it flavor and color. The alcohol in Listerine, which is denatured, interestingly enough, doesn’t do this because it is a purer form without the extras.

Smoking is the number one risk factor for periodontal disease. Among its effects are increased tartar, increased pocketing of the gums — which lets the bacteria dig deeper around your teeth and bring them down — , loss of gum attachment, increased recession of the gums, and increased bone loss. Plus there is a nasty side effect of nicotine: normal gums look a light pink. When they are diseased, they turn a darker red. But nicotine causes [[vasoconstriction]] of the capillaries. This means that the gums appear lighter. So a smoker can examine his gums in a mirror and think everything was just fine.

Even if you’re not a smoker, mere depression or other mental impairment can lead to bad teeth. I can speak from my own experience here. I needed $40,000 in root canals, deep cleaning, implants, and restorative crowns to fix my mouth after years of impassioned neglect. I despaired that brushing would do any good. I avoided going to the dentist because my life seemed full of bad news anyways, so why gather more? In a blog I wrote some years after the three years of work were done:

…my teeth eroded quite spectacularly so that they resembled the spires at Bryce Canyon. They ached constantly because the bacteria living in them interacted with the sugars I took in and drilled caves for themselves. My incisors looked bad. One was literally split in half. All four of them were rounded off at the inner corner because of my compulsive habit of biting on a pen and rolling it.

A television person once told me that she thought my teeth lent me “character”. I didn’t think so. I was ashamed of my teeth. They looked bad. They hurt. I had trouble chewing. The joint in my jaw ached. And I had done it all to myself.

Today I forgive myself, but the work and the threats are not yet over. Thanks to the medications that I take to control my bipolar disorder and depression, there are two conditions which I now fear. The first is [[bruxism]] or grinding of the teeth which is a byproduct of [[selective serotonin reuptake inhibitors]]. This can be so severe that the hard enamel is sheared off and you are left with flat-topped teeth that expose the inner dentition and the pulp. Think root canal and crown time.

There’s a simple fix for this: a dental night guard. Any dentist can fashion one that fits you perfectly. Though many insurance plans do not cover them, they are relatively cheap compared to other dental appliances.

[[Xerostomia]] or “dry mouth” is a more complicated problem. Normally, you produce about 2 cups of [[saliva]] each day. You can produce half of this and still maintain a healthy mouth. But any less and you run into problems. You will begin to experience difficulty in chewing and swallowing. Your digestion will back up. Speaking may be difficulty as your tongue sticks to your cheeks. Forget about eating dry foods. Or wearing dentures and similar dental appliances.

Saliva protects your mouth from the bump and grind of normal chewing. And it also protects you against oral infections and trauma. Lose it and your mouth grows sticky. Bacterial cultures thrive. Enamel erodes. Your tongue grows smooth and loses feeling.

The scariest fact is that more than 600 drugs cause dry mouth. This includes all antidepressants, anti-psychotics, anti-convulsants, and stimulants.

Do not stop taking your medications. You need them to be able to properly care for yourself. But you must add a few things to your routine: a good soft [[toothbrush]], regular [[flossing]], antiseptic rinses, artificial saliva or a saliva stimulator such as Biotene Oral Balance or Oasis Mouthwash. New technologies are coming out (such as an Air Flosser by the Phillips Company which makes the Sonicare toothbrush line). Do not give up on your mouth because — as I can attest — the cost is high. You may let things get so bad that even dentures cannot help you. Eat right. Visit a hygienist at least every six months and be sure that you tell her about your medications so she can advise an effective course of treatment for keeping your teeth while keeping your sanity, too.