Robert Trinneer opens his mouth and exposes his teeth. He knows they'll make people flinch.

He's got one bad case of "meth mouth," and he hopes if people take a good hard look, they might make better decisions than he did.

He gets respect for submitting to a close-up, wide-angled photograph of his teeth - what's left of them.

He's got bare gums where 13 teeth should be. The teeth he does have are either affixed to an upper plate, or scored with black pockets of decay.

Before leaning in for a photograph, the photographer worries that a picture of Trinneer's teeth won't pass the morning breakfast test down at the newspaper copy editor's desk.

Trinneer, who's got three years left to serve at the State Penitentiary, figures seeing his mouth might do people good, even if it makes them gag on their granola.

He used methamphetamine, an "upper," for 11 years and says smoking it was harder on his teeth than when he injected it intravenously.

The chemical-laden smoke directly contacted his teeth on the way to his lungs and the rest of his system.

Trinneer knows he's got an exceptionally bad case of meth mouth.

"I'd go days without remembering to take a drink of water, much less brush my teeth," he said.

Every meth user he knows has damaged teeth.

A lot of them end up in prison, wards of the state of North Dakota, which antes up for dental and medical care.

More meth users mean more dental costs.

The State Penitentiary spent almost $150,000 for dental time and supplies last year compared to $56,000 in 2000.

Prison warden Tim Schuetzle said he remembers asking the Legislature for a substantial dental budget increase as early as 1997.

"The increase in the medical budget has been phenomenal," Schuetzle said.

Part of the increase is a more expensive dentist contract. Part is in the numbers. The number of days the dentist is in house increased from 50 a year to 78 between 2000 and 2003, tracking an increase in inmates.

Lynn Odne sees as many as 30 of the 750 inmates each day he's at the prison.

In some cases, his practice puts a whole new meaning to the concept of "sedation" dentistry.

Maximum security prisoners are handcuffed to the dental chair and two guards are posted at the doorway.

Odne said when he looks into a mouth like Trinneer's, he knows he's looking at meth mouth.

"There's not much to work with," Odne said of Trinneer's case.

Trinneer said his infected and loose teeth are painful. So is his embarrassment when people see his teeth.

Kathy Bachmeier, who directs prison medical care, said meth mouth is just one health problem meth users bring to prison, and it's increasing.

"We're seeing a lot more bad mouth disasters than we used to," she said.

While Trinneer was up front about his name and agreed to embarrassing photographs in hopes of deterring others, a female inmate at the Dakota Women's Correction and Rehabilitation Center in New England felt differently.

Darlene, not her real name, is serving four and a half years for possession of meth. By remaining anonymous, she's hoping to prevent more shame upon her parents.

She's got meth mouth, too, but not as bad as it gets. She's still got all her teeth.

She does have 14 cavities and could actually feel her teeth starting to break away at the gum line.

Darlene believes lithium - a chemical from car batteries used to make some meth - accelerated the decay.

She'd reach to smoke and other users would tell her, "This is really good lithium dope."

Even if she hadn't been told, she knew.

"I could taste the metal on my teeth, and I'd brush five, six times a day," she said.

Some meth users had such bad mouths, even other meth users were shocked.

"If we'd see somebody we hadn't seen in a year, we'd be like 'Whoa, did you see their teeth?'" she said.

In times when her job provided dental benefits, she took care of her teeth, overcoming an extreme fear of the procedure.

She said she thinks the chemicals in meth accelerated her problems.

Dentists like Odne and Lonnie Neuberger, of Dickinson, say theories abound about the malady, but there's no corroborating research.

Odne believes a lot of meth users and drug users generally drink inordinate amounts of high-sugar pops like Mountain Dew and Mello Yello.

He said he doesn't ask every patient-inmate, but when he does, they tell him their teeth are worse since they started using meth.

And face it, when meth users are geaking out days on end, activities like flossing and brushing don't come into focus, say prison medical staff. Money that could go toward dental care goes up in smoke or into their veins.

Neuberger, who sees juvenile prisoners at Dickinson, along with the female prisoners from New England, pulls up X-rays of one female prisoner.

The decay and missing teeth in every quadrant of her mouth are obvious even to the inexperienced.

"It's almost like looking into an old person's mouth," he said.

Trinneer is only 31; Darlene is 33.

They are not old, but their mouths are.

Neuberger thinks there's a relationship between the chemicals in meth and tooth decay, but there's nothing in the scientific literature to support his thinking.

Something eats the enamel away and causes decay, infection and root exposure. Often, the only thing left to do is to grab a dental pliers and pull.

Charlene Falcon, a prisoner at New England, thinks meth ripped the calcium out of her body.

She's got beautiful long brown hair, but a smile that's going nowhere fast.

Falcon just had a tooth pulled, a molar, and has 19 cavities. She's 36.

"I don't want to look like this. It's embarrassing," she said, moving her hand to cover her mouth.

Neuberger said malfunctioning salivary glands are another factor that causes tooth decay among meth users.

The glands normally secrete saliva, which neutralizes acids present in the mouth and around teeth.

In meth users - partly because of the dehydration that's so common because they forget to drink fluids - the salivary glands right in front of the ears quit and swell shut.

The same thing often happens to the elderly because of inadequate hydration and a side effect of medication.

Neuberger said he was expecting he'd see a lot of female prisoners.

"I told them (at the prison) if they're using meth, they'll be seeing me quite a bit," he said.

The New England prison opened in November and dental costs through February totaled $1,890, said administrator Norbert Sickler.

Prisoners don't leave the system with a Hollywood smile, which increasingly fewer come in with anyway because of meth mouth.

Bachmeier said federal guidelines stipulate the prison can't ignore serious medical needs.

When it comes to dental care, the standard is like a Volkswagen as opposed to a Cadillac.

Bachmeier said her job is to make sure prisoners don't have pain or infections and have teeth necessary for eating.

Those front teeth? Prisoners are best off asking Santa.

They're considered cosmetic and if they go, they're gone.

Trinneer, for example, bought and paid for his front upper partial on his own dime - $900 worth.

Tara Bieber, medical director at the Dakota Women's Correction and Rehabilitation Center in New England, said the same standard applies.

"Do I pay if all their ugly teeth are removed and they need dentures so they can have a pretty smile? No," she said.

Bieber said women in for marijuana don't exhibit the same degree of dental problems. Women in for theft and forgery had money for a dentist.

Female prisoners get good medical care, but Bieber said she's a "tough nut to crack" in terms of giving women what they think they need.

Falcon said she had dental visits scheduled and then was busted again and incarcerated for violating her parole.

She said if taxpayers are going to lock her up, they'd "best fix my teeth. What am I going to do, I had my appointments."

Darlene takes a more prosaic perspective.

She wants her teeth fixed now. If they aren't, they'll have rotted away by the time she leaves prison.

But she doesn't think the state should have to pay the cost.

"I think the state should fix them and bill me," she said. "I'm more than happy to pay when I get out."

Ruined teeth are just one of many regrets prisoners have, when, straight, sober and with plenty of time to think about it, they look at their lives.

Trinneer said when he looks in a mirror, he sees his meth mouth and hates it.

When he looks past the lost teeth, he sees his lost family, kids, job and self-respect.

What, he wonders, are teeth compared to that?

(Reach reporter Lauren Donovan at 888-303-5511 or lauren@westriv.com.)