Marijuana and Your Oral Health
This article originally appeared in the Winter-Spring 2020 issue of Word of Mouth. Read the entire issue at massdental.org/Word-of-Mouth.
March 11, 2020 – In 2016, Massachusetts voters legalized the recreational use of cannabis (more commonly known as marijuana), and since late 2018, more than 30 marijuana retail establishments have opened around the state for recreational sales. (Medicinal marijuana was approved in Massachusetts in 2012 for patients seeking to counter the side effects of debilitating medical conditions, such as cancer, glaucoma, and Parkinson’s disease.) Dental patients may be accustomed to sharing their medical and health history with their dentists, including a list of all medications and supplements taken, as these can impact oral health. With the legalization of marijuana in the Bay State, it is important for dentists and their patients to discuss marijuana use in any form (e.g., smoking, edibles, concentrate, etc.), because there are potential oral health impacts and various dental treatment considerations.
Oral Health Impacts
According to the American Dental Association, potential oral health impacts of smoking marijuana include periodontal complications, xerostomia (dry mouth), and leukoplakia, as well as an increased risk of mouth and neck cancers. The long-term oral effects of marijuana use are unknown, due to a lack of controlled studies, though that may be changing soon with more research being conducted given the legalization of marijuana in more states across the country. However, the main health concerns associated with marijuana are related to the act of inhaling smoke from burned plant material and contaminants. Like tobacco smoke, marijuana smoke is associated with increased risk of cancer, lung damage, and oral health diseases—such as oral cancers, dental caries (cavities), and periodontitis, which is advanced gum disease that damages the soft tissue and destroys the bone supporting the teeth. Marijuana users are also prone to oral infections, possibly due to its immunosuppressive effects.
Dental Treatment Considerations
If you consume marijuana, it is important to let your dentist know. A patient under the influence of medicinal or recreational marijuana presents unique implications for dental care:
- Increased anxiety, paranoia, and hyperactivity may heighten the stress of a dental visit.
- Increased heart rate and other cardiorespiratory effects of cannabis make the use of local anesthetics containing epinephrine or products containing alcohol potentially life-threatening.
- Patients who use marijuana before a dental procedure requiring local anesthesia may not get numb in the area.
- Under general anesthesia, the use of cannabis has been shown to increase the likelihood of cardiac arrhythmias and respiratory depression. It is advised that cannabis use be ceased 72 hours prior to the use of general or regional anesthesia.
- Smoking marijuana before or after surgical procedures could result in increased risk of dry socket, implant failure, pain, and infection, along with prolonged healing time.
- Marijuana interacts with many common prescription and over-the-counter medications, herbs, and supplements.
- Marijuana may compromise the user’s judgment, shortterm memory, and attention span, which could impact a patient’s communication with dental practitioners.
- There may be legal implications regarding the validity of informed consent, especially with irreversible procedures such as tooth extractions.
Because of these concerns, dentists may refuse to treat a patient under the influence of marijuana or postpone non-emergency treatment for at least 24 hours.
Patients who use marijuana should be aware of its effects and take steps to protect their oral health, including adopting good oral hygiene and scheduling routine dental visits. They should also alert their dentist to their use of marijuana so that he or she can be aware of and look out for any added oral issues.
What About CBD?
The legalization of marijuana has seen an uptick in the United States, with Politico estimating that more than 40 states will allow some form of legal marijuana by the end of 2020. And in the last couple of years, a marijuana offshoot—cannabidiol (CBD)—has also had a surge in popularity, with CBD and CBD-infused products—in the form of tinctures, edibles, and lotions—marketed as a “miracle cure” for a variety of health issues, including anxiety, chronic pain, and insomnia. Social media is rife with celebrities and “influencers” touting the health and beauty benefits of CBD in everything from capsules and gummies to facial serums and foot creams. CBD is even being marketed for pets, with claims that it can relieve dogs’ and cats’ aches and anxiety. A recent article in the New York Times indicated that the CBD industry is projected to climb to $16 billion by 2025 in the United States alone. With more and more Americans jumping on the CBD bandwagon every day, this prompts the question, are there any health risks associated with CBD?
CBD is a chemical found in marijuana; however, it does not contain the psychoactive properties of tetrahydrocannabinol (THC), the cannabinoid in marijuana that produces a “high” state in marijuana users, according to Harvard Health Publishing. The absence of psychotropic effects has led many consumers to believe that CBD is safe to take. It’s important to note, however, that the Food and Drug Administration (FDA) has only approved one CBD product, Epidiolex, a medication used to treat severe forms of epilepsy. What’s more, the FDA warns that due to the limited data currently available on the safety of CBD, consumers should be aware of its potential risks, which include liver injury, gastrointestinal distress, mood changes (e.g., irritability and agitation), and contraindications with other medications.
Another concern is that CBD products are being marketed with unproven medical claims and produced using unsafe manufacturing practices, according to the FDA. Unapproved CBD products are currently not subject to FDA oversight and therefore are not evaluated for effectiveness; proper dosage; interactions with other medications, supplements, or food; side effects; or other safety concerns. Even more alarming is that the FDA questions the quality of many CBD products. After testing the chemical content of cannabinoid compounds in some CBD products, the agency found that many did not contain the levels of CBD they claimed. There are also reports of CBD products containing unsafe levels of contaminants, such as pesticides.
If you are using CBD, you want to be sure to let your health care providers—including your dentist—know all medications and supplements you are taking, so they can advise you on any possible risks, interactions, or treatment concerns. In the meantime, until comprehensive research is conducted and analyzed, the merits and safety of CBD are still TBD.