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Abstract
Questioning revealed that the patient had initially applied cocaine directly to the nasal mucosa, but was soon unable to do so because the nasal septum became perforated. The findings in both cases support the impression that the observed coronal destruction of the teeth represents an unusual form of dental erosion due to the local effects of the oral or nasal use of cocaine. Cocaine is synthesized by treating the leaves of the evergreen Erythroxylon coca with an organic solvent and then with hydrochloric acid, which extracts the pharmaceutically active, water-soluble salt cocaine hydrochloride.3 In the pure state this material has a pH of 4.5.4 When it is mixed with saliva, either by direct placement on the oral mucosa or through insufflation into the nose and then the mouth, cocaine hydrochloride powder becomes a powerful acid fully capable of dissolving the predominant dental mineral, calcium phosphate hydroxyapatite, from both enamel and dentin.