Abuse of which of the following illicit drugs is MOST likely to be associated with accelerated dental caries and tooth decay?
- (A) Lysergic acid (LSD)
- (B) Methamphetamine
- (C) Phencyclidine (PCP)
Methamphetamine (also known by the street names meth, speed, ice, tweak, yaba, chalk, crystal, and crank) is a highly addictive amphetamine analogue that has undergone a surge in abuse and illegal manufacturing in the United States. Methamphetamine is a neurotoxin and a dangerous central nervous system stimulant. It causes the acute release of epinephrine, norepinephrine, and dopamine and blocks the reuptake of these neurotransmitters, which can lead to hyperthermia, hypertension, seizure, stroke, cardiac arrhythmias, and even death. Prolonged methamphetamine use leads to depletion of these neurotransmitters.
Methamphetamine is prepared in illegal laboratories and is of highly variable purity. It can be crushed and snorted, mixed with water for injection, or smoked in crystal form. The use of methamphetamine is associated with rapid acceleration of dental caries with distinct characteristics that are often referred to as “meth mouth” (Figure). The etiology of the dental effects of methamphetamine use is likely multifactorial. One of the adverse effects of methamphetamine is xerostomia (dry mouth). Without the protective effect of saliva, development of dental caries becomes accelerated. In addition, the acidic substances used in the manufacturing process for methamphetamine have been implicated in the rapid development of tooth decay. Drug-induced hyperactivity is also associated with bruxism (teeth grinding), which further accelerates decay and tooth loss. In addition, patients taking crystal methamphetamine typically have a poor diet, which may also worsen tooth decay. Overall, this combination of causes leads to very rapid tooth decay and a distinct appearance that is often easily recognizable. These dental changes can impact anesthesia care by increasing the risk of dislodged teeth during endotracheal intubation.
In addition to the important effect on dentition and the circulatory system, methamphetamine use can impact the minimum alveolar concentration (MAC) for volatile anesthetics. Acute methamphetamine intoxication causes the MAC to be higher, while chronic methamphetamine use lowers the MAC.
Pseudoephedrine is an active ingredient in some over-the-counter cold medications and is a key ingredient in the production of illicit methamphetamine. As the problem has increased in severity, most states have restricted sales of these over-the-counter drugs.
Lysergic acid diethylamide (LSD, or acid) is a powerful hallucinogenic with mild sympathomimetic effects. It is derived from naturally occurring ergot alkaloids. Phencyclidine (PCP, or angel dust) is an illicit N-methyl-D-aspartate (NMDA) receptor antagonist and dopamine receptor agonist that produces psychotomimetic effects similar to those experienced by individuals with schizophrenia. The abuse of LSD and PCP has not been associated with dental caries.
Answer: B
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