Maryville, Mo. Jeffery Lotshaw flossed regularly. He brushed faithfully, sometimes four or five times in a day.
All that care makes his condition seem incomprehensible -- at the age of just 33, Lotshaw's grin is toothless. His teeth all broke apart, tarnished with yellow and black.
"Before I started doing meth, I didn't have a cavity in my head," said Lotshaw, imprisoned on drug charges at Missouri's Maryville Treatment Center.
The growing use of highly addictive methamphetamine throughout the country is creating a prominent scar on an increasing number of users -- rotting, brittle teeth that seem to crumble from their mouths.
Methamphetamine can be made with a horrid mix of substances, including over-the-counter cold medicine, fertilizer, battery acid and hydrogen peroxide.
Together, the chemicals reduce a user's saliva, which neutralizes acids and physically clears food from the teeth, said Dr. Eric Curtis, an Arizona-based spokesman for the Academy of General Dentistry.
"When the saliva isn't flowing, the bacteria build up a lot faster," said Dr. Darrell Morton, an Atlanta dentist.
Meth users also may neglect their teeth, or moisten their dry mouths with high-sugar drinks, and anxiety caused by the drug prompts them to grind their teeth, which speeds decay.
The problem is particularly noticeable among inmates, whose oral problems have some prison systems struggling to provide dental care.
"They're rotting teeth, missing teeth, rotting way into the gums," said Kathy Bachmeier, the head of medical services for North Dakota's prisons. "It's ugly."
There are no statistics on "meth mouth" -- as the condition has come to be known -- because addicts are sometimes reluctant to admit their drug use and because it is difficult to distinguish between damage done by bad dental hygiene and that caused by narcotics. But there are signs it is on the rise across the country.
The head of the company in charge of dental care for Missouri inmates says he is seeing teeth rotted by meth use nearly every day. In North Dakota, the number of days a dentist was serving inmates jumped from 50 in 2000 to 78 in 2004. And the tab for inmates' dental care in Minnesota rose from $1.2 million five years ago to about $2 million last year.
"There are more and more urgent care needs, which pushes back routine care like cleanings," said Nanette Schroeder, director of health services for Minnesota's Corrections Department. "They're seeing just worse mouths, generally. This is really an emerging problem."
Missouri pays a company $7.50 per day per prisoner for health care, regardless of what's needed, so no major cost increase has been incurred.
"My dentists always opt for the best treatment we could offer our patients, as we would in private practice," said Dr. Ernest Jackson, whose Jefferson City-based company is in charge of dental care for Missouri prisons.
But that philosophy isn't necessarily at play everywhere.
Schroeder said there was a constant juggling act among constitutional obligations to inmates, costs and the risk of lawsuits.
"Do we always think that it's fair to provide some services to our offender population that people on the outside might not get? Of course not," Schroeder said. "On the other hand, we have to balance that with the risk."
Bryan Rogers, another inmate at the Maryville facility, which is exclusively for convicts with drug problems, said he noticed other users' teeth were rotting but made sure he brushed regularly.
"I was always thinking that's not going to happen to me because I keep brushing," he said.
Rogers, 30, has had three teeth pulled since arriving at the prison in August, and he's awaiting a dental plate.