Ecstasy and Oral Health Effects

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Questions and Answers

What is the primary route of elimination for MDMA?

  • Sweat
  • Fecal excretion
  • Respiratory
  • Urinary excretion (correct)

What enzyme primarily metabolizes MDMA?

  • Monoamine oxidase
  • Catechol-O-methyltransferase
  • Acetylcholinesterase
  • Cytochrome P450 (correct)

Which of these is NOT a commonly used name for MDMA?

  • E
  • Love Drug
  • Speed (correct)
  • XTC

Which of the following is NOT a systemic effect of MDMA use?

<p>Hallucinations (A)</p> Signup and view all the answers

What is the chemical structure of MDMA?

<p>3,4-methylenedioxymethamphetamine (D)</p> Signup and view all the answers

What is MDMA's classification under the 1971 Misuse of Drugs Act?

<p>Class A (D)</p> Signup and view all the answers

What is the primary reason MDMA was first synthesized?

<p>Chemical warfare (C)</p> Signup and view all the answers

What is the most common way to consume MDMA?

<p>Oral (C)</p> Signup and view all the answers

What is the medication being discussed, that is easily obtainable, and potentially fashionable?

<p>Stimulant (A)</p> Signup and view all the answers

What is the name of the effect that resembles a tyramine reaction?

<p>Dependence syndrome (B)</p> Signup and view all the answers

Which of these is NOT a potential cardiovascular complication of this medication?

<p>Slowed Heart Rate (A)</p> Signup and view all the answers

Which of the following is a potential neurological effect of this medication?

<p>Loss of Coordination (B)</p> Signup and view all the answers

Which of these metabolic effects could be caused by this medication?

<p>Low Blood Sugar (A)</p> Signup and view all the answers

Which of the following is NOT a stated potential gastrointestinal effect of this medication?

<p>Constipation (C)</p> Signup and view all the answers

Which of these can be a side effect of this drug?

<p>Hallucinations (C)</p> Signup and view all the answers

Which of the following complications is NOT mentioned as potentially being caused by the medication?

<p>Heart Valve Problems (C)</p> Signup and view all the answers

What was the patient's primary complaint?

<p>Swelling in the mouth (D)</p> Signup and view all the answers

What type of drug was the patient suspected of using?

<p>MDMA (C)</p> Signup and view all the answers

What was the primary finding on the upper anterior occlusal radiograph?

<p>Mild blunting of the roots of the teeth (B)</p> Signup and view all the answers

What was the diagnosis made for the patient?

<p>Local drug-induced necrotising gingivitis (B)</p> Signup and view all the answers

What was the primary treatment for the patient's condition?

<p>Cessation of MDMA use and oral hygiene education (A)</p> Signup and view all the answers

What was the primary reason for the use of fluoride varnish on exposed roots?

<p>To reduce dentin sensitivity (B)</p> Signup and view all the answers

What was the significance of the orthodontic retainer used in this case?

<p>To support the mobile teeth (B)</p> Signup and view all the answers

What was the outcome of the treatment for the patient at the 4-month follow-up?

<p>The patient's condition had improved significantly (C)</p> Signup and view all the answers

What type of dental treatment had the patient recently completed?

<p>Orthodontic treatment (B)</p> Signup and view all the answers

What recreational drug did the patient disclose using?

<p>Ecstasy (A)</p> Signup and view all the answers

What is the primary mechanism by which SSRIs may worsen the effects of Ecstasy?

<p>SSRIs inhibit the breakdown of MDMA, prolonging its effects and potential for harm. (C)</p> Signup and view all the answers

What was the patient's oral hygiene status described as?

<p>Good (B)</p> Signup and view all the answers

What is a common acute oral manifestation of MDMA use?

<p>Jaw clenching (C)</p> Signup and view all the answers

What was a possible contributing factor to the patient's lip swelling?

<p>Prolonged contact with the drug in the labial vestibule (D)</p> Signup and view all the answers

What periodontitis was found in the patient's oral examination?

<p>Localized periodontitis (D)</p> Signup and view all the answers

Which of the following factors contributes to tooth surface loss (TSL) in MDMA users?

<p>Prolonged tooth clenching (B)</p> Signup and view all the answers

What aspect of the patient's case highlights the need for suspicion of drug abuse?

<p>The patient's reported drug use (B)</p> Signup and view all the answers

What is the primary reason behind the elevation of AST and GGT levels in the case study described?

<p>Possible liver damage associated with MDMA use (D)</p> Signup and view all the answers

Why is MDMA described as potentially dangerous despite being widely accepted?

<p>It can have serious side effects that are not related to dose or frequency of use. (A)</p> Signup and view all the answers

What is the likely reason for the increased white blood cell count (WCC), particularly eosinophils, in the case study?

<p>Infection associated with dental abscess (A)</p> Signup and view all the answers

Why might drug abusers require higher doses of local anesthetics for dental treatment?

<p>Tolerance developed from long-term use of substances (D)</p> Signup and view all the answers

Which of the following oral manifestations of MDMA use can lead to tooth decay?

<p>Thirst and consumption of sugary drinks (D)</p> Signup and view all the answers

What is the enzyme involved in the metabolism of MDMA that is inhibited by SSRIs?

<p>CYP2D6 (B)</p> Signup and view all the answers

What is a common oral manifestation associated with MDMA use?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary reason for the gingival damage associated with MDMA use?

<p>Excessive toothbrushing during intoxication (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as a possible explanation for the gingival lesions observed in the patient described in the text?

<p>Local drug reaction due to application of MDMA (B)</p> Signup and view all the answers

What is the primary reason MDMA is typically ingested orally?

<p>It is the most convenient method of administration (D)</p> Signup and view all the answers

Which of the following drugs, when used in a similar way as MDMA, has been linked to oral lesions?

<p>Cocaine (A)</p> Signup and view all the answers

How does the text describe the presentation of necrotizing gingivitis in the patient?

<p>With erythema and ulceration of the gingiva (A)</p> Signup and view all the answers

What is the primary reason for the patient's gingival lesions being initially attributed to MDMA?

<p>The patient's self-reported application of MDMA to the gums (D)</p> Signup and view all the answers

Which of the following is NOT a possible reason why the patient's lesions were not initially attributed to cocaine use?

<p>Cocaine is not known to cause necrotizing gingivitis (C)</p> Signup and view all the answers

Flashcards

MDMA

Methylenedioxymethamphetamine, also known as Ecstasy, a recreational drug.

Systemic effects of MDMA

Various health impacts affecting the entire body, potentially including death.

Tooth clenching

Involuntary grinding or clenching of teeth often due to MDMA use.

Periodontitis

Inflammation and infection of the periodontal tissues often linked to drug use.

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Oral implications of MDMA

Effects of MDMA on the mouth including tooth loss and ulcers.

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Psychoactive properties

Effects on mood, perception, and cognitive functions from MDMA.

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MDMA metabolism

The breakdown of MDMA in the body primarily in the liver, often through cytochrome P450.

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Long-term effects of MDMA

Potential chronic health issues resulting from repeated use, such as addiction.

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Sympathomimetic

A substance that mimics the effects of the sympathetic nervous system, often leading to increased alertness and euphoria.

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Effects of Sympathomimetics

Agitation, delirium, panic disorders, hallucinations, and even suicidal ideation can occur with sympathomimetics.

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Neurological Sequelae

Physical effects on the nervous system, such as seizures and tremors, caused by drug use.

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Cardiovascular Risks

Potential heart-related issues including tachyarrhythmias and myocardial ischaemia due to drug intake.

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Respiratory Complications

Breathing-related issues such as pulmonary hypertension and edema linked to stimulant use.

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Hepatorenal Effects

Kidney and liver complications including renal failure and jaundice, induced by substance use.

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Metabolic Issues

Alterations in body chemistry leading to acidosis, hypo/hyperglycemia as a result of stimulants.

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Gastrointestinal Reactions

Digestive side effects including nausea, vomiting, and ischaemic colitis from drug usage.

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SSRI

Selective serotonin reuptake inhibitor, a class of antidepressants.

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CYP2D6

An enzyme that metabolizes various drugs, including MDMA.

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Bruxism

Involuntary teeth grinding or jaw clenching, commonly seen with MDMA use.

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Dry Mouth

A common oral effect of MDMA use, leading to discomfort.

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Tooth Surface Loss (TSL)

Loss of tooth structure, often caused by acid consumption and bruxism.

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Acute Dentoalveolar Abscess

A painful dental condition resulting from infection, possibly worsened by MDMA.

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Eosinophils

A type of white blood cell that may increase during allergic reactions or infections.

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Elevated Liver Enzymes

Increased levels of liver enzymes indicating potential liver stress or damage, often checked in drug use.

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Ischaemic vasoconstriction

Vasoconstriction caused by reduced blood flow due to an ischemic event, often linked to drug use.

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Cervical abrasions

Wearing away of the tooth enamel at the neck of the tooth, often due to excessive brushing or drug interactions.

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Necrotising gingivitis

Severe gum disease characterized by ulceration, swelling, and the death of gum tissue, potentially induced by drug use.

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Gingival ulceration

Formation of ulcers in the gum tissue, often associated with irritants like drugs.

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Oral mucosa reaction

Local effects occurring in the mouth, especially after drug application or irritation.

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Local drug reaction

A reaction that occurs in a specific area of the body due to the application of drugs, rather than systemic effects.

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Cocaine-related injuries

Damage to oral tissues potentially resulting from the use of cocaine, such as lacerations or abrasions.

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MDMA and oral health

The effects of MDMA on dental and oral health, including possible tissue damage and dental erosion.

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General Malaise

A state of general discomfort or unease, often indicative of an underlying condition.

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Pyrexia

An elevated body temperature or fever, often a sign of illness.

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MDMA (Ecstasy)

A recreational drug known for its stimulating and empathogenic effects, potentially leading to adverse side effects.

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periodontal pockets

Spaces that form between the teeth and gums due to gum disease, indicating periodontal destruction.

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Salivary flow

The production and secretion of saliva in the mouth, crucial for oral health.

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Localised defect in alveolar gingiva

A specific area of loss or damage in the gum tissue or bone supporting the teeth.

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Recreational drug use

The consumption of substances for pleasure rather than for medical reasons.

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Symptoms of drug use

Signs that may include malaise, fever, or unusual changes in health due to substance abuse.

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Viridans Streptococci

A group of streptococci bacteria commonly found in the oral cavity.

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TMJ Arthromyalgia

Pain in the temporomandibular joint and surrounding muscles.

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Dental Attrition

Wearing away of tooth enamel due to grinding or clenching.

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Xerostomia

Dry mouth condition often leading to discomfort and oral issues.

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Mucosal Ulceration

Sores that develop on the mucous membranes of the mouth.

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Cessation of MDMA Use

Stopping the intake of MDMA, which may lead to recovery from complications.

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Sub-gingival Debridement

Cleaning below the gum line to remove plaque and tartar.

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Fluoride Application

Topical treatment to prevent dental sensitivity and decay.

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Study Notes

  • Methylenedioxymethamphetamine (MDMA), commonly known as ecstasy, is a recreational drug with oral and systemic effects.

  • MDMA use has been linked to a previously unreported oral manifestation: periodontitis.

  • Systemic effects of MDMA use include:

    • Psychiatric: agitation, delirium, panic, paranoia, depression, psychosis, suicidal thoughts.
    • Neurological: ataxia, seizures, tremor, tics, nystagmus, cerebral hemorrhage.
    • Cardiovascular: tachycardia, hypertension, myocardial ischemia/infarction, ventricular ectopy.
    • Respiratory: pulmonary hypertension and edema.
    • Hepatorenal: renal failure, urinary retention, myoglobinuria, jaundice, hepatitis, hepatic failure.
    • Metabolic: metabolic acidosis, hyponatremia, hypoglycemia, rhabdomyolysis, hyperthermia.
    • Gastrointestinal: nausea, vomiting, anorexia, diarrhea, ischemic colitis.
    • Other: disseminated intravascular coagulation (DIC), vasculitis, sexual dysfunction, serotonin syndrome, aplastic anemia, death.
  • Oral effects of MDMA include

    • Bruxism and tooth clenching
    • Temporomandibular joint (TMJ) arthromyalgia
    • Dental attrition
    • Xerostomia (dry mouth)
    • Mucosal ulceration
    • Periodontitis
  • A 15-year-old boy presented with upper lip swelling, malaise, and fever.

    • He had just finished orthodontic treatment and had good oral hygiene.
    • He reported using MDMA recreationally the day prior.
    • MDMA was found in the labial vestibule adjacent to periodontal destruction.
  • A mucosal fenestration defect was found on the upper lip, with exposed alveolar bone and roots.

  • Mild root blunting and no significant bone loss were observed on radiographs.

  • White blood cell count was elevated with an increase in eosinophils.

  • Erythrocyte sedimentation rate (ESR) and liver enzymes were elevated.

  • The culture of the fluid from the abscess showed normal oral flora.

  • Topical application of MDMA was suspected as the cause.

  • Treatment included:

    • Oral antibiotics (Penicillin V and Metronidazole)
    • Oral hygiene instruction, scaling, and polishing
    • Scaling and sub-gingival debridement
    • Fluoride application to exposed roots
    • Orthodontic retainer for mobile teeth
  • The mucosal ulcer healed in one week, and the patient was discharged for routine periodontal care after 4 months.

  • MDMA is frequently used, though it can be dangerous.

  • Dentists should be aware of potential complications of MDMA use.

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