MDMA and mouth ulcers

Sir, 3,4-methylenedioxymethamphetamine (MDMA), otherwise known as ecstasy, is an illicit drug which is consumed for recreational use. In addition to systemic complications, it can also present with a variety of oral side effects. Patients may first present to their primary care practitioners before being referred acutely onwards to an oral and maxillofacial surgery or oral medicine department for further investigations and management, which has been our experience here in a secondary care setting. I would like to raise awareness about these oral manifestations and the management options that can be provided.

Xerostomia can occur which should subside after approximately 48 hours. Patients should be advised to stay hydrated until normal salivary flow returns. Erosion also occurs due to increased consumption of soft drinks and vomiting during the recreational use of MDMA. A fluoride mouthwash and sugar-free chewing gum is recommended to maintain salivary flow and buffering capacity. Sugar-free chewing gum is also recommended for alleviating the symptoms of bruxism which occurs due to partial inhibition of the jaw opening reflex.

Perhaps one of the most common manifestations for concern is severe, widespread oral ulceration. With these cases, reassurance and a soft diet is advised as these ulcers tend to resolve after 14 days. Management options may include the use of benzydamine, chlorhexidine or corticosteroid mouthwash for symptomatic relief. If there are any concerns for infection, a course of antibiotics could be prescribed.