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Bruxism after 3,4-methylenedioxymethamphetamine (ecstasy) abuse

October 2010
Clinical Toxicology 48(8):863-4

DOI:10.3109/15563650.2010.489903

Source
PubMed

Authors:

Ricardo Dinis-Oliveira

TOXRUN - Toxicology Research Unit - University Institute of Health Sciences - CESPU / Faculty of Medicine, University of Porto / UCIBIO-REQUIMTE

Ines Caldas

University of Porto

Félix Carvalho

University of Porto

Teresa Magalhães

University of Porto

Bruxism is a recognized side effect of several licit and illicit drugs. In this report, we illustrate this phenomenon in three patients suffering from 3,4-methylenedioxymethamphetamine (ecstasy) abuse.

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Clinical Toxicology (2010) Early Online, 1–2

ISSN: 1556-3650 print / 1556-9519 online

DOI: 10.3109/15563650.2010.489903

LCLT

IMAGES

Bruxism after 3,4-methylenedioxymethamphetamine

(ecstasy) abuse

Bruxism and ecstasy

RICARDO JORGE DINIS-OLIVEIRA1,2,3, INÊS CALDAS4, FÉLIX CARVALHO3, and TERESA MAGALHÃES1,5,6

1Faculty of Medicine, Institute of Legal Medicine, University of Porto, Porto, Portugal

2Department of Clinical Analysis and Public Health, Center of Research in Health Technologies (CITS)-IPSN-CESPU, CRL,

Vila Nova de Famalicão, Portugal

3REQUIMTE, Department of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal

4Faculty of Dentistry, University of Porto, Porto, Portugal

5Biomedical Sciences Institute Abel Salazar, University of Porto, Porto, Portugal

6National Institute of Legal Medicine I.P., Center of Research in Forensic Sciences, Porto, Portugal

Bruxism is a recognized side effect of several licit and illicit drugs. In this report, we illustrate this phenomenon in three patients suffering

from 3,4-methylenedioxymethamphetamine (ecstasy) abuse.

Keywords Bruxism; Ecstasy; Teeth clenching and grinding; Enamel destruction

In medicine, bruxism refers to the habit of clenching and/or

grinding the teeth and is a recognized side effect of several

licit and illicit drugs.1,2 Particularly for 3,4-methylene-

dioxymethamphetamine (ecstasy, MDMA), bruxism is an

almost universal symptom, which explains the propensity of

many MDMA users to seek for this effect as a rough “qual-

ity control” for the taken pill, and justifies the generalized

use of chewing gum, lollipops, or even (baby) pacifiers to

prevent bruxism-related deleterious effects in teeth. The

mechanism of MDMA-induced bruxism is hitherto not fully

understood. The interaction between dopaminergic and

serotoninergic neurons is probably implicated in this effect.

Dopamine is involved in the balance of the motor output of

the prefrontal cortex by maintaining an inhibitory tone.1

Moreover, the dopaminergic activity of the prefrontal cor-

tex can be modulated by inhibitory serotoninergic neurons

that synapse with both the mesocortical tract and the ventral

tegmental area, where the corresponding dopaminergic

neurons are originated. Thus, MDMA-induced release of

serotonin, at the mesocortical tract and ventral tegmental

area, may result in lower dopaminergic activity at the pre-

frontal cortex, contributing to the development of bruxism.

In addition, the trigeminal motor neurons, which control

jaw position and movements, and the masseteric reflex,

which controls jaw closing force, are overstimulated by

MDMA-released serotonin and norepinephrine, this being

another possible way by which MDMA contributes to

clenching and/or grinding of the teeth.3 The deleterious

effects of bruxism can be aggravated by other symptoms expe-

rienced by MDMA users, namely xerostomia (dry mouth), dia-

phoresis (profuse sweating), hyperthermia, and thirst.4,5 To

relieve these symptoms and related dehydration, MDMA

abuse is frequently associated with an excessive consumption

of water, alcohol, or soft drinks. Thus, bruxism-related teeth

damage may result from clenching and/or grinding the teeth in

the acidic environment caused by carbonated (fizzy) drinks,

further enhanced by the reduced saliva secretion.4,5

Despite the previously reported data concerning MDMA-

induced bruxism, images of related tooth damage do not

exist in the scientific literature. In this report, we illustrate

this phenomenon in the accompanying photographs. The

subjects were three men of ages 29 (Fig. 1A), 37 (Fig. 1B),

and 40 (Fig. 2), who were observed in routine medical

consultations at our Forensic Dental Department. These

patients reported long-term use of ecstasy (patients 1 and 2)

and ecstasy plus cocaine (patient 3) and the habit of clenching

and/or grinding the teeth after using these drugs. Bruxism is

an almost universal effect mediated by MDMA. Its detection,

associated with abnormal behavior and/or MDMA-related

paraphernalia is suggestive of ecstasy abuse and therefore

should be considered to help further rapid toxicological

analysis and therapeutic measures.

Received 15 April 2010; accepted 26 April 2010.

Address correspondence to Ricardo Jorge Dinis-Oliveira, Faculty of

Medicine, Institute of Legal Medicine, University of Porto, Jardim Car-

rilho Videira, Porto 4050-167, Portugal. E-mail: ricardinis@sapo.pt;

ricardinis@med.up.pt

Clinical Toxicology Downloaded from informahealthcare.com by University of California San Francisco on 07/04/10

For personal use only.

2R.J. Dinis-Oliveira et al.

Acknowledgment

Ricardo Dinis-Oliveira acknowledges FCT for his post-

doc grant (SFRH/BPD/36865/2007).

Declaration of interest

The authors report no conflicts of interest. The authors alone

are responsible for the content and writing of this paper.

References

1. Chen WH, Lu YC, Lui CC, Liu JS. A proposed mechanism for diurnal/

nocturnal bruxism: hypersensitivity of presynaptic dopamine receptors in

the frontal lobe. J Clin Neurosci 2005; 12:161–163.

2. Winocur E, Gavish A, Voikovitch M, Emodi-Perlman A, Eli I. Drugs

and bruxism: a critical review. J Orofac Pain 2003; 17:99–111.

3. Arrue A, Gomez FM, Giralt MT. Effects of 3,4-methylenedioxymetham-

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adrenoceptors which regulate this reflex in the anesthetized rat. Eur J Oral

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4. Hamamoto DT, Rhodus NL. Methamphetamine abuse and dentistry.

Oral Dis 2009; 15:27–37.

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wear in users of ecstasy (3,4-methylenedioxymethamphetamine). Com-

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Fig. 1. (A) Bruxism-related microtrauma of the crowns of the

mandibular incisors with 41 and 31 necrosis and mentonian abscess

as consequence of 3,4-methylenedioxymethamphetamine abuse.

(B) Complete enamel destruction and visualization of the dental

ulp in the incisors.

BFig. 2. Severe caries and bruxism-related microtrauma of the

crowns of the mandibular incisors, canines, premolars, and molars

as a consequence of 3,4-methylenedioxymethamphetamine an

cocaine abuse.

Clinical Toxicology Downloaded from informahealthcare.com by University of California San Francisco on 07/04/10

For personal use only.

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Are periodontitis, dental caries and xerostomia more frequently present in recreational ecstasy users?

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Objectives The aim of this retrospective study was to determine whether there is a difference in oral health between recreational ecstasy users and non-recreational drug users.Study design In a cross-sectional study, dental records of 149 individuals visiting an academic dental clinic in Amsterdam who reported recreational ecstasy use, defined as no more than twice a week, were systematically analysed and compared to a group of age- and sex-matched non-drug users randomly selected from this institute. The parameters retrieved from the dental records were decayed, missed and filled teeth index (DMFT), number of endodontically treated teeth, presence of active caries lesions, periodontitis, tooth wear, xerostomia and self-reported use of oral hygiene devices.Results Periodontitis, active caries lesions and xerostomia were statistically significantly more present in ecstasy users. Ecstasy users brush their teeth significant less frequently per day than non-recreational drug users. There were no significant differences in DMFT and in the devices used for brushing/interdental cleaning and frequency of use of these interdental devices between both groups.Conclusion Periodontitis, active caries lesions and xerostomia are more frequently present in recreational ecstasy users compared to age- and sex-matched non-users.

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Ecstasy users have reported that dry mouth, jaw tension and tooth grinding were common side effects of its use although the influence of these effects upon toothwear have not been previously investigated. This study aimed to compare incisal and occlusal toothwear in Ecstasy users and a group of non-users of Ecstasy but users of other drugs. Groups were established by a snowball peer information network from visitors to the "drop-in" Maryland Centre in Liverpool. Volunteers completed a questionnaire about social life, drug use and diet. Clinical examination for wear on the incisal edges and on canine tips was conducted with a mirror and probe, whereas occlusal wear was recorded in impressions and subsequently scored from stone replica casts. The degree of toothwear was scored according to the criteria of the Tooth Wear Index (Smith & Knight, Br Dent J 1984;157:16). Ecstasy users (n = 30) were compared with non-users (n = 28). Toothwear through the enamel into the underlying dentine occurred in 18 (60%) Ecstasy users but in only three (11%) non-users. The overall mean toothwear score in Ecstasy users was 0.63 compared with 0.16 in non-users (t = 4.34, P < 0.001). Dry mouth was reported by 93% of Ecstasy users whilst 89% stated that they clenched or ground their teeth after taking the drug. Tooth grinding commonly continued into the following morning. Carbonated (acidic) beverages were consumed by 93% of the users with a mean of three cans per "trip". The severity of toothwear and the number of teeth affected were greater in Ecstasy users than in a group of non-users. The occlusal surfaces were more commonly affected than the incisal, which may indicate jaw clenching rather than grinding as a feature of Ecstasy-induced muscle hyperactivity.

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Methamphetamine is a highly addictive powerful stimulant that increases wakefulness and physical activity and produces other effects including cardiac dysrhythmias, hypertension, hallucinations, and violent behavior. The prevalence of methamphetamine use is estimated at 35 million people worldwide and 10.4 million people in the United States. In the United States, the prevalence of methamphetamine use is beginning to decline but methamphetamine trafficking and use are still significant problems. Dental patients who abuse methamphetamine can present with poor oral hygiene, xerostomia, rampant caries ('Meth mouth'), and excessive tooth wear. Dental management of methamphetamine users requires obtaining a thorough medical history and performing a careful oral examination. The most important factor in treating the oral effects of methamphetamine is for the patient to stop using the drug. Continued abuse will make it difficult to increase salivary flow and hinder the patient's ability to improve nutrition and oral hygiene. Local anesthetics with vasoconstrictors should be used with care in patients taking methamphetamine because they may result in cardiac dysrhythmias, myocardial infarction, and cerebrovascular accidents. Thus, dental management of patients who use methamphetamine can be challenging. Dentists need to be aware of the clinical presentation and medical risks presented by these patients.

Effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') on the jaw-opening reflex and on the α2-adrenoceptors which regulate this reflex in the anesthetized rat

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May 2004

Bruxism, principally jaw clenching, is frequently observed in users of the recreational drug 3,4-methylenedioxymethamphetamine (MDMA). It has been suggested that during bruxism a reduction of the activity of oral protective reflexes occurs. In this study we investigated the effects of intravenously administered MDMA on the digastric electromyographic responses elicited by orofacial electrical stimulation in the rat. We also assessed the effects of either the administration of a single dose (20 mg kg(-1), s.c.) or repeated doses of MDMA (same dose, twice a day, for 4 d) on the jaw-opening reflex (JOR) and on the sensitivity of the alpha(2)-adrenoceptors which, in an inhibitory way, regulate it. Increasing doses of MDMA (1-29440 micro g kg(-1)) induced an incomplete inhibition of JOR and 50% inhibition (ED(50)) at 2550 micro g kg(-1); maximal inhibition was 88%. The repeated treatment with MDMA led to an enhancement of the inhibition of JOR induced by the alpha(2)-agonist, clonidine (ED(50) was reduced by 77%), indicating an increased sensitivity of the alpha(2)-adrenoceptors. This study shows that the intravenous administration of MDMA reduces the JOR while repeated doses of the drug enhance the inhibitory noradrenergic mechanisms which regulate the reflex. The results also allow speculation that a reduction of JOR may underlie the occurrence of episodes of bruxism in MDMA users.

A proposed mechanism for diurnal/nocturnal bruxism: Hypersensitivity of presynaptic dopamine receptors in the frontal lobe

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Mar 2005
J CLIN NEUROSCI

There are many reports in the literature concerning nocturnal bruxism, however, diurnal (non-sleep)/nocturnal bruxism is rarely mentioned. We report three patients with diurnal/nocturnal bruxism. They differed from the usual features of nocturnal bruxism in hypoperfusion of the left frontal lobe, a poor response to l-dopa or bromocriptine therapy and a favourable response to metoclopramide. Hypersensitive presynaptic dopamine receptors may be the underlying pathology responsible for this type of bruxism. Regional differences in dopamine receptor pharmacology may explain the perplexing relationship of bruxism to both hyper- and hypo-dopaminergic states.

Bruxism after 3,4-methylenedioxymethamphetamine (ecstasy) abuse

Abstract

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