The use of cannabis, particularly marijuana smoking, has been associated with poor quality of oral health,but etiology has been complicated by number of factors including xerostomia (dry mouth), which can contribute to a number of oral health conditions.Further, the main psychotropic agent, THC, is an appetite stimulant, which often leads users to consume cariogenic snack foods (foods that contain more sugar which will then increase the incidence of caries). Regular cannabis users are known to have significantly higher numbers of caries than nonusers.
Leukoedema (a white or whitish-gray edematous lesion of the cheek or lip region) is more common among cannabis users than non-users but it is unclear whether associated irritants, such as orally inhaled smoke, rather than cannabis itself, may be contributing causes.Smoking marijuana is associated with gingival (gum) enlargement,and chronic inflammation of the oral mucosa that can develop into malignant lesions. It has been reported that a synergistic effect between tobacco and cannabis smoke may increase oral and neck cancer risk for people who smoke both.The risk and aggressiveness of cancers associated with cannabis appear to be higher in younger (i.e.,
The immunosuppressive effects of cannabis may contribute to a higher prevalence of oral candidiasis (yeast infection) compared to non-users.It has also been hypothesized that hydrocarbons present in cannabis provide an energy source for Candida albicans, resulting in increased presence and density of colonies leading to more oral health issues.
A number of studies have suggested a direct relationship between cannabis use and periodontal disease.Recent studies have tested the relationship between periodontitis and frequent cannabis use and found significantly higher rates of periodontitis were observed among the frequent users compared to non-users, with significantly higher numbers of sites with high pocket depths (≥4mm) and attachment/bone loss.Further, periodontitis may occur at an earlier age in marijuana users than the general population with chronic periodontitis. A study of adolescents in Chile, however, found no association between regular use of cannabis and periodontal disease,but it may be expected that long-term use would result in periodontal disease later in life.In a histometric experiment, laboratory rats exposed to marijuana smoke had a significant increase in alveolar bone loss due to periodontitis,23 despite research that has indicated that specific cannabinoids, such as the non-psychotropic cannabidiol, may prevent bone loss.
When dental health-care providers suspect cannabis use, it is recommended to:
- Complete a comprehensive oral examination and include questions about cannabis use in a thorough dental and medical history.
- Emphasize the importance of regular dental visits and oral care.
- Encourage healthy, nutritious snacks over sweet, cariogenic snacks.
- Consider employing preventive measures, such as topical fluorides.
- Consider treatment for xerostomia, while avoiding alcohol-containing products.
- Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J 2005;50(2):70-4.
- Rawal SY, Tatakis DN, Tipton D. Periodontal and oral manifestations of marijuana use. Journal of the Tennessee Dental Association 2012;92(2):26.
- Rechthand MM, Bashirelahi N. What every dentist needs to know about cannabis. Gen Dent 2016;64(1):40-3.
- McCarthy J. One in Eight US Adults Say They Smoke Marijuana. Gallup Social Series: Gallup; 2016.
- National Academies of Sciences E, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press; 2017.
- McGill N. As marijuana decriminalization spreads, public health prepares: Health effects, regulations examined. The Nation’s Health 2014;44(7):1,14.
- Joshi S, Ashley M. Cannabis: A joint problem for patients and the dental profession. Br Dent J 2016;220(11):597-601.
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