The Better to Bite/Chew With?

February 2, 2012 3:22 PM

My 21-year-old niece has a new compulsion to bite and chew things that might be due to her new epilepsy medication (Keppra). Anyone have experience with this?

She's been on the new meds for a few weeks, but the compulsion is more recent. She has already chipped a tooth from biting water bottles, and has even tried chewing her own body. Her family doctor has recommended a teething ring in the short term, and she has an appointment with her neurologist in a couple of weeks, so hopefully her meds can be adjusted.

I ordered her a teething pendant to wear, though I don't know how long it will withstand her grown-up biting. She doesn't think that gum will satisfy her urge to bite.

Any suggestions on how to help her deal with this?

posted by Knappster to health & fitness (23 answers total)

not 100% clear - does she have the power to choose what to bite/chew, or does she feel the random impulse to bite something she sees? me, i would suggest she gets a nice mouthguard for people who grind their teeth. an expensive one, not a crappy one.
posted by facetious at 3:26 PM on February 2, 2012

Not a random impulse. She's just looking for something to chew that will satisfy the urge, but won't damage her teeth. We are looking into getting a mouthguard.
posted by Knappster at 3:28 PM on February 2, 2012

Mouthguard? They sell them at the drug store for people who grind their teeth in their sleep, you can form-fit them to your own teeth. She'll chew through it but it may hold up better than other things while still being relatively gentle on her teeth?
posted by LobsterMitten at 3:36 PM on February 2, 2012

Apologies, didn't see your last sentence. What about something like very tough dried fruit or meat?
posted by LobsterMitten at 3:37 PM on February 2, 2012

She actually loves beef jerky, but not the idea of eating it every day. Dried fruit is a good idea.
posted by Knappster at 3:40 PM on February 2, 2012

Would celery be chewy enough? It's healthier than gobs of jerky all day, at least.
posted by elizardbits at 3:43 PM on February 2, 2012

For fruit jerky, I suggest going to a natural foods store (or the bulk organic section if your supermarket has one). A lot of unsulphured dried fruits are chewier - try unsulphured dry mango, which comes in big slices in my mega supermarket, very satisfying to chew.
posted by LobsterMitten at 3:47 PM on February 2, 2012

I second the dried fruit. She might also want to try different kinds of nuts.

This might sound weird but she might like chewing on frozen fabric. I used to put a wet washcloth in the freezer for my teething babies and because I'm insatiably curious I tried chomping down on it too. It has an oddly satisfying mouth feel. She could experiment with different kinds of fabric and different levels of water/juice saturation. It should be pretty easy on her teeth. The only thing is that it doesn't last to long, so she'd have to have a bunch ready to go in the freezer.

I would also wrap an ice cube in a wash cloth and put a rubber band around it. That could work too.
posted by TooFewShoes at 3:50 PM on February 2, 2012

Bar straws are VERY satisfying to chew. I used to be on medication that would give me terrible jaw tension, and these were the best things I found to chew on. They are fairly unobtrusive since the more you chew the more they crinkle like an accordion (meaning more ends up in your mouth than out), they don't get too slobbery, they keep their composition (unlike toothpicks, say), and they aren't damaging to teeth. One straw usually lasted me about half an hour.
posted by stellaluna at 3:56 PM on February 2, 2012

I had a long answer about Keppra and the Crazy Meds website and the possible causes of the compulsion and then I realized the question might just be "what can my niece gnaw on?". If that's not the (entire) question and you want some non-medical-advice thoughts on Keppra from someone who is not a doctor but just a fellow epileptic whose been on a bunch of different meds, please feel free to MeMail me so I don't clutter the thread.
posted by The Bellman at 4:00 PM on February 2, 2012 [1 favorite]

I don't have epilepsy but I have taken Keppra and never had this compulsion.

This definitely needs to be checked out to rule out Tardive dyskenesia.
posted by St. Alia of the Bunnies at 4:29 PM on February 2, 2012 [1 favorite]

Seconding straws. My friend chews on these when she has anxiety. Cheap, durable, and easy to find.
posted by whalebreath at 4:33 PM on February 2, 2012

Thanks for the heads-up. She'll be talking to her neurologist tomorrow, and seeing him later this month.
posted by Knappster at 4:34 PM on February 2, 2012

She does suffer from anxiety, which may be a contributing factor.
posted by Knappster at 4:34 PM on February 2, 2012

I had the urge to bite and chew when I started on Zoloft. I chewed on rubberized spatulas. The urge went away eventually.
posted by christinetheslp at 5:07 PM on February 2, 2012

Thanks to all for your help! I've shared your suggestions with her, and she feels much better now about her condition and less like (to use her word) a "freak."
posted by Knappster at 7:11 PM on February 2, 2012

Sugarfree altoid smalls or similar strong-flavored candy (either mints or super-sour or something). She can try resisting the impulse to bite by sucking really hard on them (with the candy up near her pursed lips, but inside the vestibule--i.e., not sticking out and slurping or making noise). I'd encourage her to redirect/substitute and practice other options for the times she can't be chewing on something.

Hot beverages. Herbal tea, whatever. I'm drinking super-hot chamomile mint tea right now. I get dry mouth exacerbated by two different drugs, both of which have clenching/grinding as side-effects as well, so I can't tease out if the Keppra has been helping or hindering the compulsion to clench/chew/sensation-seeking. I do find that if I flood the area with stimulus of some sort, I don't have to chew. I have unbearable hot sauce that wipes out all the substance P in my mouth, and that about does it for my clenching/chewing. But...it's pretty vicious hot sauce. Hot tea is less painful, but it doesn't last as long.

She should also go to the dentist in case it's activated some latent infection, and the irritation is triggering the need to chew/bite (which overrides the 'irritating' sensation). In some people Keppra can be associated with an increase in oral infections and upper respiratory infections.

As to tardive dyskinesia...I am not a neurologist. Anything is possible, not all of levetiracetam's actions are well-understood, and brains are weird. But...I would be surprised. TD seems to be specific to a few classes of pharmaceuticals, none of which are related to Keppra, except that all of these drugs act on the central nervous system.

Levetiracetam (generic Keppra) is occasionally used as an anti-manic treatment for people with bipolar disorder. It can be very effective in that role. However, its mechanism is not the same as other treatments for bipolar disorder, even the other anticonvulsants used as mood stabilizers. Other medications used to treat bipolar disorder are associated with tardive dyskinesia. IIRC, levetiracetam is in limited trials for treating tardive dyskinesia. I mean, they put all the CNS agents through their paces nowadays, but if TD were a known risk, I don't see those trials getting approved.
posted by Uniformitarianism Now! at 8:22 PM on February 2, 2012 [1 favorite]

How about some sort of chewing stick? I've had these tea-tree ones before and they were actually quite pleasant, or if those are a little too lightweight to be of use there's also actual licorice root sticks ...
posted by DingoMutt at 9:04 PM on February 2, 2012

How about raw sugar cane?
posted by zia at 9:31 PM on February 2, 2012

actual licorice root sticks

She's had these before, and loves the idea.
posted by Knappster at 9:54 PM on February 2, 2012

if she decides to go the licorice route she needs to monitor her intake very carefully as it can have significant side effects, even in doses that don't seem that large.
posted by The Elusive Architeuthis at 9:57 AM on February 3, 2012

I hear from some of the other moms in my playgroup that straight up infants' teething biscuits are actually pretty tasty. I haven't tried them myself - mostly because my infant son prefers to chew on fabric rather than food.
posted by sonika at 10:39 AM on February 3, 2012

Frozen waffles.
posted by kamikazegopher at 7:27 PM on February 3, 2012