In just a couple of school presentations so far this year, speakers from the Hawaii Meth Project have discovered that gruesome photos of an extremely painful condition called "meth mouth" send a more vivid anti-crystal methamphetamine message to Hawai'i teenagers than any statistics or warnings from adults.

"Those pictures are certainly the attention-grabber," said Cindy Adams, executive director of the Hawaii Meth Project, which is planning to visit dozens of middle and high schools around the Islands this school year.

"The students all go, 'Ooh, oh, that's so gross,' "Adams said. "Some kids close their eyes and turn away. Physical appearances are so, so important to teenagers, so it really freaks them out."

After years of warnings to Island students about the dangers of smoking crystal methamphetamine — "ice" — new attention has been focused on a little-known side effect in which gums recede and teeth break apart and begin to rot as soon as six months after ice use.

From the halls of Congress to the offices of a kind-hearted dentist in Kalihi, more information is now being sought about "meth mouth," such as the best treatment and what kind of manpower and financial burden it poses for the nation's prison system to treat inmates' dental problems.

PRISON TEETH

In Hawai'i, half of all prison patients with dental problems "are attributed to meth mouth," said Wesley Mun, head of the Department of Public Safety's health care division.

"It is more prevalent now than in the past," Mun said. "It is an issue. We do perform a lot of treatment, sometimes resulting in extractions of the teeth, mostly resulting from meth mouth."

Separate bills in the U.S. Senate and House of Representatives call for a Meth Mouth Prevention and Community Recovery Act that would require research on the public health effects of meth mouth and on prevention and the best methods of treatment.

The condition appears to be caused by a variety of factors related to ice use: The introduction of hydrochloric acid into a user's mouth from the chemicals that make up crystal methamphetamine; a decrease in saliva production that otherwise helps protect teeth and gums; poor oral hygiene; teeth grinding and jaw clenching that are common among ice users; and an increase in consumption of sugary drinks that ice addicts prefer.

"Financially, it's a lot of work and cost to treat meth mouth," said Dr. Brian Kim, a board member of the Hawaii Dental Association.

Just to fix one badly decayed tooth can cost $1,500 for a root canal and crown, Kim said.

"Imagine a meth addict with all of his teeth — 28 to 30 — needing treatment," Kim said. "It's an astronomical cost. Having all this decay in all their teeth is like having a constant open wound. Realistically, a typical meth mouth patient is looking at removing all of their teeth and getting dentures while they're still young."

One 26-year-old former ice addict who lives in Honolulu still suffers pain despite thousands of dollars worth of root canals and repair work.

"I've been punched in the face and had my nose broken and my eye socket broken," said the man, who did not want to be identified because he is trying to rebuild his life and said some family members don't know about his former ice addiction. "But the pain from meth mouth would last for hours with no end. It got to the point where I was pouring Orajel in my mouth and eating Advil like they were Skittles. I would wake up in the middle of the night with a dull, but very powerful throbbing pain. When my heart beated, I would feel 'boom, boom' in my mouth. It was horrible."

The man first started smoking ice at 14 years old. By age 19, his teeth and gums had become overly sensitive to hot and cold liquids.

And then, as his gums turned brown and became infected, pieces of his teeth began chipping away.

"I'd wake up in the middle of the night grinding my teeth and I'd spit out little pieces of my teeth," he said. "I started brushing my teeth five times a day and it wasn't helping at all. The meth was just eating it all away."

"The pain was the worst, but your self-esteem goes down when your teeth are corroded like that," he said. "You don't feel good about yourself. It hurts you physically and it just drains you out when you can't sleep and at night you're full of pain. You become irritable, and I wasn't a nice person for a long time."

He finally kicked his ice addiction at the age of 22. Then three years ago — without dental insurance — he sought help for his pain and for his appearance.

The man's mother had to come up with more than $10,000 for root canals and veneers for just his front six teeth.

"By then, I basically had no teeth," he said. "They were just breaking off. It was pretty bad."

A month ago, the Hawaii Meth Project referred him to Dr. Russell Masunaga, a former president of the Hawaii Dental Association and the director and co-founder of the association's Dental Samaritans, which works with underprivileged patients.

Masunaga performed two more root canals on the former ice addict and repaired two teeth, which Masunaga and the Hawaii Meth Project are paying for.

After Masunaga performed the root canals and fixed "a pretty big cavity, I already feel like a different person," the man said. "I'm one step further away from being an addict. That means I can look in the mirror and not be constantly reminded of the mistakes I made when I was younger."

Masunaga, 46, is the son and nephew of dentists, and one of 10 dentists in his family.

He grew up hearing stories of how his father, Dr. Harold Masunaga of Wahiawa, would sometimes be paid in smoked fish and chicken eggs.

Now Russell Masunaga specializes in helping low- income patients.

"We don't turn people away because of their ability or inability to pay," Masunaga said.

He saw his first case of meth mouth in 1999 in a 17-year-old girl he had been treating since she was 6.

"She had a pretty healthy mouth," Masunaga said. "Then all of a sudden her front teeth were all black and decayed."

SUDDEN ROT

Over the years and without knowing the cause, Masunaga treated dozens of patients who suddenly came in with rotted gums and chipped and blackened teeth.

It wasn't until this year that Masunaga realized that the rest of Hawai'i's 1,000 dentists are probably seeing the same thing — and have their own experiences to share on dealing with ice- addicted patients.

Because of his leadership roles in the Hawaii Dental Association and the Dental Samaritans, "I feel we have the forces we can marshal," Masunaga said. "It never occurred to me to do something before. We need to get more data because not enough people are talking about this."

Dental association board member Kim, 37, calls Masunaga his mentor.

"He's a local boy with a deep desire to help the community," Kim said. "His passion for community service is great. He spearheaded Dental Samaritans into an amazing group of doctors who want to help but didn't know how to get involved."

Masunaga's patient, the 26-year-old recovering ice addict, wishes someone had shown him photos of meth mouth as a teen.

"If they would have shown me a picture of my own mouth and said, 'This is going to be you in 10 years,' I wouldn't have ever smoked ice," he said. "It's embarrassing. It's bad. And it's really painful."