Cliff Gill hardly finds it unusual to see dental problems among new inmates at his jail. After all, life behind bars is often the first time they use two things they ignored on the outside -- "a toothbrush and a Bible."
But the explosion of methamphetamine use has taken it to a scary new level, with inmates coming in every week with black-orange smiles, enamel completely rotted, gums bleeding and receding, and no choice but to have every tooth pulled.
"It's almost unbelievable," said Gill, who sees four or five inmates a month at his lockup in western Kentucky's McCracken County who must be sent to an oral surgeon for a complete tooth extraction -- at a cost to the taxpayer of $500 per inmate.
Jails and prisons across the South and Midwest have become besieged with an increasingly expensive problem called "meth mouth," the catchall for the methamphetamine side effects that combine to lay waste to a mouthful of teeth in a matter of months.
"Meth mouth" is caused in part by the harsh chemicals used to make methamphetamine -- such as brake cleaner and lithium from batteries -- which slow the blood flow to teeth, speeding decay. The drug also dries up saliva as well as gives users a sweet tooth often fed by copious amounts of junk food and soft drinks with high caffeine content, such as Mountain Dew.
Tom Shields, director of Dental Services for the Florida Department of Corrections, said inmates with "meth mouth" stand out from other inmates who just have not taken care of their teeth.
"Meth mouth" inmates look similar to patients treated for head and neck cancer, Shields said. "It just looks like the enamel is eaten off the teeth."
Statistics on "meth mouth" are hard to come by. Many prison systems do not ask dental patients what their crimes are and are not equipped to track the cases anyway. Anecdotal evidence from jailers and corrections departments everywhere from Florida to Wyoming show the problem growing.
"It's in every state I can think of," said Ken Fields, a spokesman for Correctional Medical Services in St. Louis, which provides dental and medical care in prisons in 27 states.
Darcy Jensen, a drug prevention and treatment counselor who runs Methamphetamine Awareness and Prevention Project of South Dakota, said meth's toll on the mouth, teeth and rest of the body is quick and obvious.
Cocaine and heroin have a physical impact, as do alcohol and marijuana, on the user but over a longer period. With meth, teeth quickly change color and fall out, gums recede, cheeks collapse and the person loses weight.
"It happens rapidly and in so many ways," Jensen said. "It just kind of multiplies."
That was the case with Steve Collett of Manchester, Ky., who had his teeth pulled and repaired after getting out of prison last year.
Collett said meth was "his drug of choice," and the realization of its effects hit him one morning when he had sobered up.
"I looked in the mirror and it was, 'God, what did I do to me?' " he said. "I couldn't look people in the face. I hated the way I looked."
A donor from his church gave Collett the $1,900 to have his teeth repaired.
Of the few states that have tracked the disorder behind bars, the jump in dental visits and costs has been noticeable.
The number of days a dentist served inmates in North Dakota shot from 50 in 2000 to 78 in 2004. Minnesota's bill for inmate dental care went from $1.2 million in 2000 to $2 million in 2004.
Most states, including Kentucky, can offer only anecdotal evidence that "meth mouth" is growing into an expensive problem.
James Cecil, administrator of oral health for the Kentucky Cabinet of Health and Family Services, has heard about the disorder from oral surgeons and dental students who call looking for help in diagnosing and treating the disorder.
"It's coming up the expressways, I-64, I-75 and the Western Kentucky Parkway," he said. "Those are the drug delivery routes."
Collett said, based on his experience, he expects more cases to pop up before things get better.
"It's just amazing what drugs will do," Collett said. "Drugs became my god. I didn't care about my teeth. I didn't care about nothing."