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Bruxism after 3,4-methylenedioxymethamphetamine (ecstasy) abuse

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

Abstract

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.
Clinical Toxicology (2010) Early Online, 1–2
Copyright © Informa UK, Ltd.
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
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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
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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
p
ulp in the incisors.
A
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
d
cocaine abuse.
Clinical Toxicology Downloaded from informahealthcare.com by University of California San Francisco on 07/04/10
For personal use only.
... 9 The sympathomimetic effect of ecstasy has been reported to influence oral functions by causing bruxism and xerostomia during use. 11,12,13,14,15,16 The various oral health effects of MDMA have been documented in case reports and case series but were not systematically compared to non-users. The aim of the present study was to compare the oral health parameters of a sample of individuals visiting the Academic Centre of Dentistry Amsterdam (ACTA) who report to use ecstasy on a recreational basis, with a group of age-and sex-matched individuals who report not to use any drugs. ...
... This could also contribute to the higher reported prevalence combination with xerostomia.' polydrug users might be related 35 Ecstasy users also used antiretroviral medication for HIV more frequently, but this seems to have no influence on salivary flow rate or xerostomia 36,37,38,39 Ecstasy use has, in many cases, been associated with bruxism. 11,12,13,15,16,28,29 Bruxism after ecstasy use has been reported to occur for up to 48 hours after use. 11 Since bruxism has a multifactor aetiology, recreational drug-associated bruxism may be induced by a change in dopamine and 5-hydroxytryptamine due to an imbalance of the dopamine mesocortical pathway. ...
... 11,43,44,45,46,47 Ecstasy users try to reduce the effects of these movements by using chewing gum, lollipops and/or pacifiers. 14,15 Several studies have reported an increased tooth wear associated with ecstasy use whereby tooth wear in dentin was mainly present in the premolar and molar regions. 15,27,28 Increase of the progress of tooth wear may be due to bruxism in combination with an acidic oral environment, caused by consumption of energy drinks and/or alcohol, associated with ecstasy use and reduced saliva secretion. ...
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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.
... 9 The sympathomimetic effect of ecstasy has been reported to influence oral functions by causing bruxism and xerostomia during use. 11,12,13,14,15,16 The various oral health effects of MDMA have been documented in case reports and case series but were not systematically compared to non-users. The aim of the present study was to compare the oral health parameters of a sample of individuals visiting the Academic Centre of Dentistry Amsterdam (ACTA) who report to use ecstasy on a recreational basis, with a group of ageand sex-matched individuals who report not to use any drugs. ...
... 35 Ecstasy users also used antiretroviral medication for HIV more frequently, but this seems to have no influence on salivary flow rate or xerostomia 36,37,38,39 Ecstasy use has, in many cases, been associated with bruxism. 11,12,13,15,16,28,29 Bruxism after ecstasy use has been reported to occur for up to 48 hours after use. 11 Since bruxism has a multifactor aetiology, recreational drugassociated bruxism may be induced by a change in dopamine and 5-hydroxytryptamine due to an imbalance of the dopamine mesocortical pathway. ...
... 11,43,44,45,46,47 Ecstasy users try to reduce the effects of these movements by using chewing gum, lollipops and/or pacifiers. 14,15 Several studies have reported an increased tooth wear associated with ecstasy use whereby tooth wear in dentin was mainly present in the premolar and molar regions. 15,27,28 Increase of the progress of tooth wear may be due to bruxism in combination with an acidic oral environment, caused by consumption of energy drinks and/or alcohol, associated with ecstasy use and reduced saliva secretion. ...
Article
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.
... 55 Amphetamine users displayed typical, continuous chewing or tooth grinding movements and bruxism 37,56,57 and a large cohort study confirmed methamphetamine association with bruxism. 37 A case study reported three patients suffering from awake bruxism after chronic MDMA consumption 58 and in a study on the subjective experience/psychological and behaviour sequel of the intake of MDMA, 30% of the patients reported bruxism as an adverse effect. 59 Among cocaine users, severe bruxism symptoms were reported 60 and several reports confirmed the detrimental effects of cocaine misuse on oral health. ...
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Bruxism as a side‐effect of psychotropic medications could result in significant consequences for oral health such as tooth structure destruction and irreversible harm to the temporomandibular joint. The review findings uncovered by these authors can assist in understanding the aetiology of bruxism, establishing an appropriate management plan, while supporting psychiatrists and dentists to detect temporomandibular dysfunctions such as bruxism.
... Cocaine is highly addictive, possessing a relative risk of 5 in a 1-5 scale (Katzung and Trevor 2015), and its use is associated with a variety of health complications, namely midline destruction (Mari et al. 2002;Seyer et al. 2002;Smith et al. 2002), poor dental health (Brewer et al. 2008;Dinis-Oliveira et al. 2010;Maloney 2010), pseudoscleradermatous triad and "crack hands" (Payne-James et al. 2007), necrosis and gangrene of extremities (Dhawan and Wang 2007), reticular purpura (Walsh et al. 2010;Brunt et al. 2017), intracerebral (Bruno et al. 1993;Konzen et al. 1995) and peripheral hemorrhages (Lingamfelter and Knight 2010), angioneurotic edema (Kinsey and Howell 2008), rhabdomyolysis (Ruttenber et al. 1999), infections, and "crack lung" (Kissner et al. 1987). ...
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Cocaine is one of the most widely consumed psychoactive substances and has been recognized as a major public health concern for many years. While several aspects of the toxicology of cocaine have been thoroughly described in the literature, namely its effects on different target organs, other toxicological features should not be disregarded. In this perspective, the in vitro and in vivo genotoxic effects of cocaine, along with the genotoxicity data from human exposure, especially in the context of “crack” smoking, were reviewed. Some concerns regarding (1) the chronic abuse and forms of cocaine, (2) the role of metabolism and (3) the mode of action of cocaine were discussed. The major limitations of the experimental and human studies available were also addressed and some research gaps in this field identified. Overall, although the genotoxicity of cocaine is still a matter of discussion, this psychoactive substance exhibits a genotoxic potential that should be further considered.
... Since severe AB has been reported by patients under the influence of stimulant drugs such as amphetamines 25 , ecstasy 26 , cocaine 27 , and methadone 28 , questions about these drugs should also be included in the history interview. Other oral parafunctions may also induce bruxism-like symptoms, including chewing on the lips, cheeks, fingernails 29 , and writing implements 30 as well as excessive gum chewing. ...
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