How does methamphetamine use cause painful mouth sores to form?

Dear Alice,

First things first, I love your website. I really like the format and especially love getting Alice in my e-mail box! My question is regarding smoking ice (methamphetamine). Sometimes, but not always, after I've smoked a lot, I get white sores on my tongue, especially, but all over in my mouth. I have a theory about this, and I'd appreciate any info you could supply. I think it is a sort of chemical burn from the iodine in the ice. I know it makes you get dehydrated, and I think this is part of why it burns (if it is a burn). You don't have normal amounts of saliva to naturally flush things out of your mouth. I also think that's a contributing factor in why it is so damaging to the teeth. I'm sorry, I'm babbling. My mouth is in so much pain! It looks like little patches of something growing and is especially bad where my tongue rubs against the back of my molars. Thanks in advance for the help!

Dear Reader,

Ouch! As you’ve had the displeasure of discovering firsthand, methamphetamine (meth) use may result in some unwanted and uncomfortable oral side effects. These mouth issues may be caused by the drug itself, a person’s behavior while high, and opportunistic infections by other pathogens. Given the level of pain you report, you may wish to seek care from a dentist or other health care provider sooner rather than later to identify the underlying issue and start treatment. Read on for more information!

Meth can damage or cause issues in the mouth through a variety of mechanisms, including:

  • Cottonmouth: Stimulants, including methamphetamine, deplete salivary secretions and raise body temperature to a higher level than normal. As such, long-term use of stimulants leads to dehydration, which worsens dry mouth. Without saliva to protect the mouth, teeth, and gums by acting as a neutralizing agent against acidic substances (e.g., some of the ingredients found in meth, as well as a variety of commonplace foods and beverages), an extended state of dry mouth can cause sores or ulcers to form in the mouth. 
  • Chemical burn: Some of the chemicals used to manufacture methamphetamine are caustic, meaning they burn skin. Similarly, when meth is vaporized and inhaled, the hot vapor may irritate and burn soft tissue in the mouth, exacerbating dry mouth.
  • Tissue damage: Meth use can constrict the blood vessels in the mouth, resulting in tissue damage. Long-term usage and accumulated damage may result in tissue death.
  • Tongue and teeth friction: Continuous friction between the tongue and teeth with the inside of the mouth while on meth can cause skin to become raw and irritated, which may lead to infection.

The chemistry of the drug itself, the act of doing meth (especially if smoked), and a person’s behaviors while high on meth can all physically impact different parts of the mouth, including the teeth, gums, and tongue, which may lead to something colloquially called “meth mouth.” This term refers to the damage caused by meth use to a user’s mouth as a result of tooth decay and gum disease, which in turn are caused by cottonmouth, chemical burn from the acidity of the drug, and long periods of oral hygiene neglect. The teeth often become blackened and stained, and they may even begin to rot, crumble, and fall apart.

However, meth use also weakens the immune system of the user, which makes the body more vulnerable to infection and disease. One particularly common condition among adults with weakened immune systems is oral thrush, which is an overgrowth of a fungus called Candida albicans. In a body with a healthy microbiome (a term to describe the many types of bacteria, viruses, and fungi that colonize the human body and contribute to its functioning), Candida albicans is naturally occurring; however, a weakened immune system or a disruption to the microbiome’s balance may allow an overgrowth of this fungus to occur. Oral thrush causes symptoms such as creamy white lesions on the tongue and inner cheeks, which sounds similar to what you’re describing. Oral thrush can also spread to the gums, tonsils, the roof of the mouth, and the back of the throat. Other symptoms include redness, burning, soreness, difficulty eating or swallowing, and loss of taste.

If you haven’t already, you may wish to consider making an appointment with a health care provider or dentist to have your mouth sores examined and evaluated. While oral thrush caused by meth use may be a potential explanation for your mouth sores, only a medical professional will be able to make an official diagnosis. It may feel uncomfortable or embarrassing to disclose your drug usage, but it's critically relevant context for your current health issues. Choosing not to disclose may result in an incorrect diagnosis or a delay in identifying appropriate treatment, potentially increasing the amount of time you spend in pain before finding a treatment that will bring you relief. 

If it is determined that your mouth sores were caused by or related to smoking meth, you may be advised to quit, either permanently or temporarily, in order to allow time for your mouth to heal completely and the treatment to take effect. You might also give some thought to the benefits and drawbacks of continued meth usage, what it offers you, and what your life might be like with and without it. If your mouth woes are indeed caused by smoking meth, you may find that the only long-lasting treatment is to quit meth altogether. If you decide that this is something you might like to pursue or learn more about, your health care provider may be able to direct you to relevant support groups or addiction treatment. Whatever you decide, here’s to you for taking the first step in reclaiming your oral health.

Last updated Aug 12, 2022
Originally published Oct 31, 2003

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