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Clinical director at Franklin Park Family Dental in Dorchester and Tremont Family Dentistry in Boston, Charan Teja Bobba, discusses his article “Treating methamphetamine-associated dental disease in safety-net clinics.” Charan reflects on the profound human reality behind treating patients with severe addiction, noting that a ruined smile often represents a lifetime of being let down by the health care system. He explains the physical devastation of meth mouth, where acidity, dry mouth, and teeth grinding create a perfect storm of enamel erosion and decay. The conversation emphasizes why safety-net practices are vital for restoring not just oral health, but a person’s identity and self-esteem. By prioritizing patience and trust over rushed clinical work, dentists can help vulnerable populations feel human again. Discover how providing full dental care to those in recovery is a fundamental step toward restoring true medical equity and wholeness.

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Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Charan Tej Bobba. He is a dentist and a clinical director at Franklin Park Family Dental in Dorchester, Massachusetts. His KevinMD article is “Treating methamphetamine-associated dental disease in safety-net clinics.” Charan, welcome to the show.

Charan Tej Bobba: All right, thank you, Dr. Pho. Thank you for the warm introduction.

Kevin Pho: I don’t have very many dentists come on the show, but I found your article fascinating. Why did you decide to write it and share it on KevinMD?

Charan Tej Bobba: The pleasure is all mine because KevinMD is known to reach a massive audience of mostly physicians and clinicians. These are the ones who treat patients with methamphetamine-associated diseases and things like that. So I thought of reaching out to you personally because this is a case I have done recently. That is why I reached out to you.

Kevin Pho: All right. For those who didn’t get a chance to read your article, tell us what it is about.

Charan Tej Bobba: This is a case related to a patient who came into my clinic because he had been addicted to methamphetamine for the last seven years or so. He came in with rampant decay in all his teeth. There was a thick calculus that was structurally built and hard to remove. When I saw his teeth, the last thing he expected from me was to judge him. I assured him that I was going to bring his smile back. After that, he felt so happy. He came here because he had been failed by the systems before. After treating that patient and giving his smile back, the way he saw it and the way he looked at me showed that he can never bring back what happened to him, but we can always give him a new smile. I believe a smile is the front line for every person. So I thought of sharing it with a lot of clinicians and physicians who are willing to treat these kinds of people.

Kevin Pho: Tell us about some of the symptoms associated with methamphetamine that can affect the mouth and the teeth.

Charan Tej Bobba: With severe methamphetamine usage, it can rot your teeth. I have seen far worse cases where I couldn’t even save them because the teeth were so far gone. When you see them, you either make it or break it, but this patient was at the final stage of breaking it. So he came to me at the right time. When you see the teeth, they are all decayed with a brownish color. For most of those teeth, I treated them with root canals and then put crowns on them. The back gums are swollen and bleeding on contact. We need to do a lot of tissue management and a lot of root canals and crowns to save these patients’ teeth.

Kevin Pho: Is that because of the drug itself that causes that decay?

Charan Tej Bobba: Yes. With the use of methamphetamine, the main issue is dry mouth. I believe saliva is the key factor in our mouth that prevents 90 percent of cavities. With dry mouth, there is no saliva, creating a playground for bacteria where they can wear down and attack any teeth, doing as much damage as possible.

Kevin Pho: When you told that patient that despite years of addiction and failure from our health care system—he clearly fell through the cracks—that you were going to bring his smile back, tell us the impact those words had on that particular patient.

Charan Tej Bobba: I think those are the golden words that he had heard in a long time. Wherever you go with rotten teeth, when you need to smile and find yourself hiding your face under a mask, that brings a kind of shame. But when I told him those golden words, he felt so happy. He thought that I had actually helped him. He went out, spoke to his family, and showed his smile to everyone after the treatment was done. Giving assurance to the patient before we start the treatment is a kind of positive attitude where you build trust with the patient as well.

Kevin Pho: What percentage of methamphetamine-addicted patients can have their teeth saved? You said that there is a proportion where you can’t do anything. Can the majority be saved if they come to a dentist soon enough, or is there a period of time where nothing can be done?

Charan Tej Bobba: Don’t take me wrong, but most of the methamphetamine patients are usually people who are in underserved areas. The problem with this U.S. dental system is it is structurally designed in a way not to serve these underserved areas. In schools, no one is going to teach you to go treat the underserved areas and help these patients. They don’t have health care access or dental access. If we don’t recognize them at the earliest stages, we can’t actually save them. I would say connecting schools to camps in rural areas of the United States can prevent most of this, or at least identify the people who are associated with these kinds of diseases and prevent the future possible harm that can happen to their teeth.

Kevin Pho: Now you practice at a safety-net clinic among some of the other things that you do. Tell us about some of the variety of dental and mouth conditions that you see in patients from safety-net clinics.

Charan Tej Bobba: Safety-net clinics are mainly facilities that take most of the Medicaid patients. Medicaid patients may not be able to access health care as much as normal people. I have seen a lot of patients not only with methamphetamine issues but also with other chronic drug addictions and a lot of HIV-positive individuals. I am not saying this is something we should not treat, but I am saying safety-net clinics are the first place where we can help the majority of the people who actually need treatment. Rather than doing cosmetics and implants, we also need to consider taking care of these patients in the safety-net clinics now.

Kevin Pho: A lot of times when patients come to a dental clinic, especially a safety-net clinic, it is obviously a situation where their disease has reached such a severe point that they have no choice but to go to a dentist. Are you saying that these Medicaid patients have very little coverage for routine preventative dental care?

Charan Tej Bobba: I am not saying they have very little coverage. But if I am a clinician and I am hoping to treat safety-net people with Medicaid, I spent hundreds of thousands of dollars going to dental school and getting my degree. Treating these patients is a service to the nation and the people of the country. On the other hand, I need to survive, as do other clinicians. I am talking about the Medicare reimbursement rates, which are very, very low. That is why a lot of dentists and clinicians are not getting credentialed with Medicaid insurance, so they are not able to treat these patients. The problem with these Medicaid patients is they are not aware of the need to visit a dentist every six months to get their teeth cleaned and examined. Since they are not aware of all these problems, there are lots and lots of cases where the possibility of damage has already happened.

Kevin Pho: In the Boston area where you practice, how difficult is it for Medicaid patients to even find a dentist to take Medicaid?

Charan Tej Bobba: Exclusively in Massachusetts, only about 30 percent of dentists right now are treating Medicaid patients. If you compare the population of underserved people who are on Medicaid, 30 percent is very low. It is like having one clinician for every 500 to 1,000 people, which means a lot of Medicaid people are underserved in that dental care, I believe.

Kevin Pho: In dental training, do you have a lot of experience or exposure to patients specifically like this with methamphetamine addictions? Do you get that type of training?

Charan Tej Bobba: There is one thing I need to talk about. In dental school, they are going to talk about a lot of things, but there is no particular case where they show you a meth-related patient or some other disease-related patient. It is all something you need to learn from experience.

Kevin Pho: So how did you learn? Did you literally learn outside of dental school and after you graduated, and just learned on the fly?

Charan Tej Bobba: Yes, I did learn outside of dental school. I learned it actually from the chairside, doing a lot of research, looking for articles on how to treat these patients, and coming up with a good treatment plan that meets the needs of both the patient and us. I learned everything from the chairside.

Kevin Pho: Now, what was going through your mind when you realized you were talking to this patient and it was really the first time that patient had felt seen and heard? When you had that realization, tell us what was going through your mind.

Charan Tej Bobba: The first thing that happened was a surprise, wondering what had happened to his teeth. When I spoke to the patient and when he got comfortable, like I said, first we need to build trust with the patient. That is how he can open up and say things that no one wants to hear. When I got to know he was a patient and he told his story, and when I looked at his mouth, I felt pity. But I also thought of all the possible treatments that I could give him to bring his smile back. With a lot of discussion with the patient, deciding the treatment plan, doing the treatment, and giving his smile back, that is when you realize your hard work has paid off and the patient is happy.

Kevin Pho: For those patients who may be listening to you on this podcast and maybe struggling with addiction, tell us about the symptoms and signs they need to look out for and realize they need to see a dentist sooner rather than later.

Charan Tej Bobba: First things first, I would say irrespective of the symptoms, everyone should visit the dentist. Everyone should visit the dentist every six months. That is how we catch a lot of problems hiding behind the scenes that we don’t even notice if there is no pain. Most patients think that nothing is happening, but that is not true. A lot of symptoms are dormant in the mouth and only show up suddenly, leading to a rush to the ER where there will be no dentist available to diagnose or treat them. So I would say irrespective of the symptoms, you should get examined by a dentist every six months no matter what.

Kevin Pho: From a policy standpoint, is there anything our policymakers can do to improve dental access for Medicaid patients?

Charan Tej Bobba: I would say for underserved patients, yes. Regarding policy, there are a lot of foreign-trained dentists who are actually an untapped source. In my journey, I came here, went to dental school, and got my degree here. There are a lot of internationally trained dentists who can go to underserved areas. By this means, I think we can manage patients who are on Medicaid and living in rural communities so they get the accessible care they wish for.

Kevin Pho: We are talking with Charan Tej Bobba. He is a dentist, and today’s KevinMD article is “Treating methamphetamine-associated dental disease in safety-net clinics.” Charan, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Charan Tej Bobba: First, before you treat the patient, you have to meet the patient. You have to get comfortable with them, and they need to trust us. The second thing is for clinicians outside of dentistry to look for oral cavity symptoms in their patients’ teeth. As dentists, we always look at the entire body, but I notice a lot of clinicians skip the mouth and only check the rest of the body. So people who are outside of dentistry should start looking at the teeth and identifying symptoms. Also, a smile is not a luxury. It is a front line for everyone. If you see anyone suffering from hiding their smile, just go give them the confidence and treat them as much as you can.

Kevin Pho: Charan, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Charan Tej Bobba: All right, thank you, Dr. Pho.