Extensive tissue necrosis of the tongue in a methamphetamine user: A case report

Abstract

Aims: Methamphetamine (meth) is a powerful, highly addictive stimulant that affects the central nervous system, and its side effects may result in severe selfmutilation. This report describes a case of a meth user with severe oral injury that demonstrates the necessity for prompt treatment when severe tongue biting occurs. Methods and results: A 43-year-old meth-using man with severe tongue biting was left untreated for more than 24 hours, resulting in extensive ischemic changes in the tongue and eventual extensive tissue necrosis. After debridement and deep suture repair in several layers, the wound healed. However, tongue dysfunction and a speech disorder remained because of tongue shortening. Conclusion:Meth may induce or aggravate severe oral self-mutilation. Tongue biting with severe tissue damage may occur as oral self-mutilation in meth users; however, among self-mutilation behaviors, tongue biting is especially difficult to prevent. A withdrawal from meth and a behavioral approach may be necessary for fundamental prevention, but it is often difficult in high dependence users.When severe tongue biting occurs, prompt suture reconstruction must be performed before ischemic change occurs to prevent tissue necrosis. K E Y W O R D Smethamphetamine, self-mutilation, tissue necrosis, tongue biting INTRODUCTIONMethamphetamine (meth) is a widely abused psychostimulant. It is pharmacologically classified as an indirectly acting sympathomimetic 1,2 and may affect excitatory synaptic transmission via activation of the dopamine and serotonin receptor systems in the hippocampus. 3 Meth is considered more neurotoxic than amphetamine, which has a chemical structure similar to meth, due to its cationic lipophilicity allowing transport to the brain across the blood-brain barrier. 4 Meth, in the form of dextro-meth hydrochloride, is also used for medical purposes and has been approved© 2021 Special Care Dentistry Association and Wiley Periodicals LLC for the treatment of attention deficit hyperactivity disorder, extreme obesity, and narcolepsy. 5 Meth, however, is often used recreationally and is most commonly smoked, but also snorted, injected, swallowed, or inserted rectally, 6 with harmful side effects. 7 Acute adverse effects of meth include subjective effects (e.g., anxiety, paranoia, and hallucination) and physiological effects (e.g., hypertension, hyperthermia, tachycardia, tachypnea, and anorexia). 8 Chronic use of meth may result in neurologic and psychiatric symptoms, including amnesia, confusion, depression, psychosis, violence, and suicidal ideation, which are caused by dopamine

Dental health of patients using antidepressants and methamphetamines

“…Вживання метамфетамінів перорально та ін'єкційно асоціювалось із більшою частотою тяжкого періодонтиту порівняно з тими, хто вживав метамфетаміни лише перорально [6]. Описано випадок ішемічного ураження та некрозу язика після його прикушування на фоні вживання метамфетаміну у 43-річного чоловіка [16]. На фоні вживання метамфетамінів також часто виникає бруксизм [8].…”