Lower Lip Erosion and Temporomandibuar Joint Pain Due to the Pure MDMA Intake

3,4-Methylenedioxymethamphetamine (MDMA) is a serotonergic neurotoxin which has widespread use in drug abusers due to its effect of increased energy level, heightened sense of “closeness” with other people and overall mood enhancement [1]. MDMA known as ecstasy or molly is a synthetic psychoactive drug with both stimulant and hallucinogenic properties [2]. It produces an energizing effect, distortions in time and perception, and enhanced enjoyment from sensory experiences. It has also been described as an entactogen-a drug that can increase self-awareness and empathy [3,4]. MDMA affects dopaminecontaining neurons that use chemical serotonin to communicate with other neurons. Subsequently, a decrease in serotonin transporters have been shown in the brain of MDMA users by use of positron emission tomography [2]. MDMA is usually taken by mouth but it can be also snorted and injected. The effect starts after 20-60 minutes and lasts for 3-6 hours. Physical symptoms of MDMA users are muscle tension, nausea, blurred vision, rapid eye movement, faintness, chills or sweating, raised heart rate and blood pressure and rarely ataxia and seizures while psychological problems manifest in depression anxiety, sleep disturbances, confusion, agitation and even paranoia [2]. Patients attending dental office who intake MDMA usually present with poor oral hygiene, xerostomia, rampant caries i.e. “meth-mouth” and excessive tooth wear [5]. Furthermore, it has been reported that MDMA abusers are prone to bruxism, TMJ dysfunction, mucosal burns and ulcerations and periodontitis [2].