FARMINGTON With her high cheekbones and pretty ponytail, Cassie Tippetts looks every bit the Utah college coed. She has bright hazel eyes and a smart personality. She is as cute as they come until she smiles.
"You're not going to like what you see here," dentist Robert Anderson tells visitors as the young woman opens her mouth.
He is right.
Picture an old picket fence run over by a dump truck. Yellow splinters hang from red, swollen gums. The teeth that remain have thick, black cavities.
"I try to hide it as much as I can," Tippetts says.
But she did this to herself, she says, using a drug that eventually stole her job, her money, her freedom and her smile.
The 23-year-old Tippetts is not on a Utah college campus; she is in the Davis County Jail.
Tippetts has advanced evidence of what is known as "meth mouth" a condition rampant among methamphetamine users and particularly evident in jail and prison populations throughout the country.
"It's pretty obvious when an inmate comes in addicted to methamphetamine," said James Ondricek, Davis County Jail nursing supervisor."They smile and you see their teeth all rotted out and fallen out at the gum line."
Mother of four children.
She quit smoking meth at 23 when she noticed her teeth rotting, so she began injecting the drug. A dentist at a county jail has pulled 12 teeth."I used to have a pretty smile," Nicole said.
The unsightly "meth mouth" phenomenon has several implications for a Utah community already burdened by a methamphetamine crisis.
As has occurred as use of the drug has moved east, meth mouth is taxing dental budgets at Utah prisons and jails and in cities across the country like Minneapolis.; Raleigh, N.C.; Grand Rapids, Mich.; Portland, Ore.; and Knoxville, Tenn. In Utah, inmates now have to wait longer and longer for dental services because hours allotted for dental care are clogged by meth addicts with rotting teeth and painful abscesses.
Contract dentists are having to put in more time to keep up with the demand for dental visits. Some jails have a two-month waiting list.
Dentists at jails in Salt Lake, Davis, Weber and Utah counties say the vast majority of their patients are meth addicts. And this condition they call "meth mouth" is wreaking havoc on jail and prison dental budgets.
In Salt Lake County, for example, dental costs for inmates in the Salt Lake County Jail increased 30 percent between 2003 and 2004, according to Jared Davis in the county's finance office.
Dental costs for county inmates: $44,756 in 2003; $58,193 in 2004.
The county does try to charge inmates a co-payment for the teeth dentists yank, the abscesses treated and cavities filled. So, inmates do pay for a portion of their dental care. Inmates contributed nearly $9,000 in 2003 and nearly $12,000 in 2004.
Still, Davis said, "It's a pretty dramatic increase."
Meth mouth also creates a strange phenomenon that will result in a young generation of denture wearers.Maybe more importantly, child advocates say, the pattern of neglect that contributes to "meth mouth" is being passed on to another generation of youngsters.
Colby Anderson, 29.
He had been smoking meth on and off for the past 10 or 12 years when police busted him recently where he was living in a Woods Cross motel.
Today, he is in jail for meth possession and the county is paying the tab for his dental care.
He's been watching his teeth disintegrate.
"You slowly see your teeth just get eaten away."
He once had an abscess the size of a softball. He vowed to quit meth then but couldn't kick the super-addictive drug.
"You go right back to it," Anderson said. "The pain goes away and you go right back to it."
Once he lost a tooth while eating a Wendy's sandwich.
Meth ate away the glue that held his braces on as a teenager.He is now missing 10 or 15 teeth.
Dr. Robert Anderson sees about a dozen inmates at the Davis County Jail each week. "Sometimes every one of them is a meth user," he said. He also sees them in his private practice.
His jail workload has recently increased from five hours per session to eight hours at the jail all because of the number of meth users. Anderson figures meth mouth costs the county as much as $3,000 a year that could have been directed to other services.
"It's going to become an issue here more than it already is," he said. "The problem is growing."
Meth addiction has reached epidemic proportions in Utah. Rampant tooth decay is one of its ugly but little-discussed side effects.
Jerry Cook, Weber County Jail chief deputy, asks facetiously: "Do we have some who don't have rotted teeth?"
Dentists in private practice also see meth mouth.
Jack Ford, spokesman for the Utah Department of Corrections, is reluctant to tie "meth mouth" to any financial burdens. "The medical area is real sensitive," he said. "But it is an ongoing problem."
"I'd say most dentists in the state are familiar with it," said Monte Thompson, director of Utah Dental Association. He plans to include an article about it in the organization's newsletter.Jail dentists are on the front lines of this problem. And they don't do cosmetic or restorative dentistry. They don't cap teeth or do aesthetic work. Dentists behind bars basically do two things: They put temporary fillings in cavities, and they yank teeth.
"About 2,000." Number of teeth pulled each year by dentists at the Salt Lake County Jail, according to Mark Ellsworth, Health Services administrator.
On a recent afternoon, dentist Richard Johnson peered into the mouth of a patient and found an all-too-familiar sight: teeth rotten from methamphetamine abuse.
The man lay handcuffed and chained to the dental chair inside the Utah County Jail as Johnson wrenched a forceps into his lower jaw. With considerable effort, he extracted the remnants of the inmate's badly decayed tooth. Piece by piece, he removed bits of a broken bicuspid.
"There are 28 teeth," said Johnson, a veteran dentist at both the Utah State Prison and the Utah County Jail. "There are 26 of them that need to be extracted sometimes, and sometimes you just have to dig 'em out."
Johnson joins other dentists who say the meth mouth problem is growing.
A few weeks ago, Johnson pulled seven soft, black teeth out of another inmate's mouth. A week later, he pulled out four more from the same inmate's mouth. That patient, too, abused methamphetamine.
Dentists in private practice and public health clinics also see people whose meth addiction has eaten away their choppers. Men and women in their 20s are having to wear dentures.
"They look like someone shot a gun through their mouths," said Dr. Richard G. Ellis, who volunteers at Salt Lake Donated Dental Services. "It just destroys them."
To each of his patients, he asks: "Are you a meth user?"
"The answer is 'yes,' 75 percent to 80 percent of the time," Ellis said. "It's just classic destruction."
Ellis has peered into thousands of mouths in his 45 years as a dentist, including some in Peru and Bolivia. Patients he sees at the Salt Lake Donated Dental Services rival those he saw in South America where good oral hygiene isn't practiced."The meth people that we have coming in compare dentally to what we saw in Third World countries," he said.
One of the many problems this drug produces is rampant tooth decay with the teeth literally falling apart." From "Meth mouth" article, at Web site www.dentistry.about.com.
In a writing titled "A highly addictive substance that rots the teeth," authors at www.dentistry.about.com warn health-care professionals to be on the alert for symptoms of drug use or for patients who are high when they come in for dental work.
There are differing opinions about what causes meth mouth.
Some dentists say the acid in the drug eats away the teeth. Others say it's meth addicts' huge consumption of sugar-laden soda to alleviate dry mouth.
The pseudoephedrine in meth slows saliva production, Anderson says. Saliva naturally neutralizes acids and clears food from the teeth.
Decreased saliva flow allows bacteria to build up 10 times over normal levels. Without it, acids can erode tooth enamel, which in turn causes cavities.
Tooth decay is the No. 1 long-term effect in meth users. They are malnourished as a result of their methamphetamine use. They also have what's called long-term unsustainable metabolism. They are running on such a high they are so stimulated, so hypermetabolic, there is poor circulation to the teeth.
That, coupled with damage to blood vessels, leads to damage and gray and black teeth from lack of circulation and toxic compounds.
The corrosive ingredients in meth such as battery acid and red phosphorus don't seem to eat away enamel as much as the dentin layer beneath it, Anderson says.
"It triples the speed of decay," he said. "It gets very aggressive with gum-line cavities."
So aggressive that pulling the tooth or often teeth is the only option.
Poor oral hygiene and neglect also might be a factor in tooth decay.
Some patients don't care for their teeth at all, while others overzealously and excessively brush, Anderson says. Many also grind their teeth.
"It isn't so much the decay to the enamel but teeth breaking off," he said.
Anderson said he runs into a lot of abscesses and more "stubble" than teeth."You just shuck them out as fast as you can due to the infection in there," he said.
Nick Hohlios, 21.
He started smoking meth at 16 and is serving one year in a county jail for meth possession.
Telltale "meth mouth" cavities start at the gum line of his lower teeth.
"That's why I'm here," Hohlios said from the dentist's chair, "to get them fixed.""I don't want to have bad teeth."
Tippetts, the 23-year-old meth user, doesn't let people see her laugh or grin. She is too self-conscious and embarrassed about what meth has done to her once beautiful smile.
"I cover my mouth up a lot. I try not to smile. I don't talk much anymore," she said.
At 5 feet 2 inches tall, she once weighed 72 pounds because of her meth use.
She says she didn't eat very much, so she didn't think she needed to brush her teeth.
She didn't just wake up one day with the monstrous situation that exists in her mouth now. It sneaked up on her, she says. Plus, she was high a lot of the time and didn't notice.
Certainly, now in jail and sober, she notices.
"It's hard to face people in public," Tippetts said. "People look at you different. They really do."
Potential employers, for example.
Tippetts worked as a live-in nanny in Clearfield for a year before she came to jail.
Even then, she lived like a hermit for that year she didn't want to leave the house because of her rotten teeth. She says she had groceries delivered, had someone bring her cigarettes and only took the children out to play in the back yard. Eventually, she lost her job because of her meth abuse. She had a falling out with the father, who found her asleep on the couch while watching cartoons with the children. The young woman was coming down from a meth run, and her employer called the cops.
Tippetts had her drugs stashed on a high shelf in her bedroom closet. Now she's in jail.
"This is the kind of case that really tugs at me as a health professional," the jailhouse dentist, Anderson, said. "You just look at that and know there's nothing you can do."
She'll need dentures for sure, he says.
Anderson figures it would cost $25,000 to fix her mouth but says it's not worth it unless she gets off meth."We can change the look. The question is, can we change the attitude and the action?"
Nurse to a child at Weber-Morgan Children's Justice Center: "Do you have a toothbrush?"Child: "Grandma reminds me to brush when I'm at her house."
The dramatic aesthetic consequences of meth use are the least of numerous issues, according to Jeanlee Carver, a nurse at the Weber-Morgan Children's Justice Center.
"Not only do these addicts neglect their own health and their own personal hygiene, but they neglect their children," said Carver, a leader in health issues that impact children who live in families where crime and substance abuse are present.
"There is a tremendous trickle-down effect," Carver said.
Babies and toddlers are put to bed with bottles in their mouths. They aren't taught to brush, and their teeth are rotting, too.
Last week, staff at the Children's Justice Center saw two young sisters, ages 3 and 5. Their mom was a meth addict. The children had to be given a general anesthetic for the dentist to do their whole mouths.
The children are on state financial assistance.
State Medicaid officials don't track costs specific to individual drugs of choice. But anecdotally, officials say, there is an associated increase in health-care spending on meth abusers and their families.
"It's such a huge drain on our community economically," Carver said.
The financial costs of methamphetamine abuse in Utah are staggering and cross into every state agency, Carver says.
There are impacts to the welfare system. There are health issues, incarceration issues, court issues."So, teaching children to brush their teeth and making sure they do these are some of those basic things that go by the wayside when you are spending all your money on drugs," Carver said.